Evidence for a Spinal Central Pattern Generator in Humans<sup>a</sup>

Dimitrijevič, Milan R.; Gerasimenko, Yu. P.; Pinter, Michaela M.

doi:10.1111/j.1749-6632.1998.tb09062.x

Cited by 694 publications

(534 citation statements)

References 27 publications

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“…Tonically stimulating the dorsal surface of the lumbosacral spinal cord via electrodes placed on top of the dura can induce locomotor-like movements in vivo in complete spinal rats (Ichiyama, 2005) and cats Gerasimenko et al, 2003) and in humans that are classified as clinically complete (Dimitrijevic et al, 1998). The intensity, frequency, and site of simulation are important parameters to control in defining the nature of the locomotor movements that are generated.…”

Section: Epidural Stimulationmentioning

confidence: 99%

“…In other words, it is technically feasible, at least from an engineering perspective, to administer some "pharmacological cocktail" directly to the spinal cord at a dosage that is needed at any given time point. It also is technically feasible to apply electrical stimulation to the dorsum of the spinal cord at specific segmental levels in a manner that can induce step-like patterns (Dimitrijevic et al, 1998).…”

Section: Are the Variations In The Pathways Activated From Step To Stmentioning

confidence: 99%

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Training locomotor networks

Edgerton

Courtine

Gerasimenko

et al. 2008

Brain Research Reviews

274

205

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For a complete adult spinal rat to regain some weight-bearing stepping capability, it appears that a sequence of specific proprioceptive inputs that are similar, but not identical, from step to step must be generated over repetitive step cycles. Furthermore, these cycles must include the activation of specific neural circuits that are intrinsic to the lumbosacral spinal cord segments. For these sensorimotor pathways to be effective in generating stepping, the spinal circuitry must be modulated to an appropriate excitability level. This level of modulation is sustained from supraspinal input in intact, but not spinal, rats. In a series of experiments with complete spinal rats, we have shown that an appropriate level of excitability of the spinal circuitry can be achieved using widely different means. For example, this modulation level can be acquired pharmacologically, via epidural electrical stimulation over specific lumbosacral spinal cord segments, and/or by use-dependent mechanisms such as step or stand training. Evidence as to how each of these treatments can "tune" the spinal circuitry to a "physiological state" that enables it to respond appropriately to proprioceptive input will be presented. We have found that each of these interventions can enable the proprioceptive input to actually control extensive details that define the dynamics of stepping over a range of speeds, loads, and directions. A series of experiments will be described that illustrate sensory control of stepping and standing after a spinal cord injury and the necessity for the "physiological state" of the spinal circuitry to be modulated within a critical window of excitability for this control to be manifested. The present findings have important consequences not only for our understanding of how the motor pattern for stepping is formed, but also for the design of rehabilitation intervention to restore lumbosacral circuit function in humans following a spinal cord injury.

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Section: Epidural Stimulationmentioning

confidence: 99%

Section: Are the Variations In The Pathways Activated From Step To Stmentioning

confidence: 99%

Training locomotor networks

Edgerton

Courtine

Gerasimenko

et al. 2008

Brain Research Reviews

274

205

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“…Treadmill training activates central pattern generators (CPGs) in the spinal cord at the lumbar level 28 . CPGs are neural activations capable of forming motor patterns, leading to rhythmic, automatic strides, allowing the training of biomechanical components involved in the different phases of gait, postural control and balance 14,29 .…”

Section: Control N=7mentioning

confidence: 99%

Effect of treadmill gait training on static and functional balance in children with cerebral palsy: a randomized controlled trial

Grecco

Tomita

Christovão

et al. 2013

Braz. J. Phys. Ther.

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| Background: Treadmill gait training as a therapeutic resource in the rehabilitation of children with cerebral palsy has recently been the focus of many studies; however, little is still known regarding its effect on static and functional balance in children. Objective: The aim of the present study was to compare the effects of treadmill training and over ground gait training in children with cerebral palsy. Method: A randomized controlled trial with blinded evaluator was conducted with children with cerebral palsy between three and 12 years of age categorized in Levels I to III of the Gross Motor Function Classification System. Assessments were performed before and after the intervention and involved the Berg balance scale as well as the determination of oscillations from the center of pressure in the anteroposterior and mediolateral directions with eyes open and closed. The experimental group was submitted to treadmill training and the control group performed gait training over the ground. The intervention consisted of two 30-minute sessions per week for seven weeks. Results: Both groups exhibited better functional balance after the protocol. The experimental group had higher Berg balance scale scores and exhibited lesser mediolateral oscillation with eyes open in comparison to the control group. Conclusions: Treadmill training had a greater effect on functional balance and mediolateral oscillation in comparison to over ground gait training in children with cerebral palsy. Trial registration: RBR-5v3kg9 (Brazilian Registry of Clinical Trials).Keywords: cerebral palsy; physical therapy; postural balance. HOW TO CITE THIS ARTICLEGrecco LAC, Tomita SM, Christovão TCL, Pasini H, Sampaio LMM, Oliveira CS. Effect of treadmill gait training on static and functional balance in children with cerebral palsy: a randomized controlled trial. Braz J Phys Ther.

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“…This has been demonstrated via experiments in which FL is recorded in response to trains of square electrical pulses applied in vitro either to a DR (Marchetti et al 2001) or to the cauda equina (Etlin et al 2010) of the isolated spinal cord. These studies have typically replicated the in vivo stimulation paradigms with intramuscular electrodes in cats (Guevremont et al 2007) or with different parameters of peripheral (Selionov et al 2009) or epidural electrical stimuli (Dimitrijevic et al 1998) or transmagnetic stimulation in humans (Gerasimenko et al 2010). In all these cases, however, stimulation was only effective in generating a few oscillatory cycles despite continuous stimulation.…”

mentioning

confidence: 99%

The locomotor central pattern generator of the rat spinal cord in vitro is optimally activated by noisy dorsal root waveforms

Taccola

2011

Journal of Neurophysiology

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The spinal cord contains an intrinsic locomotor program driven by a central pattern generator that rhythmically activates flexor and extensor limb motor pools. Although long-lasting locomotor activity can be generated pharmacologically, trains of afferent stimuli trigger only few locomotor cycles. The present study investigated whether a new electrical stimulation protocol (termed FL istim) could elicit long-lasting fictive locomotion (FL) in the rat spinal cord in vitro. Thus, after first inducing FL by bath application of N-methyl-d-aspartate and serotonin, the recorded waveform obtained from a lumbar ventral root was digitized and then applied to either a lumbar dorsal root or the cauda equina following washout of pharmacological agents. Two FL istim cycles were the threshold input to evoke an episode of FL from ventral roots. Longer cycles (up to 1 min) induced sustained FL (up to 1 min) with stereotyped periodicity (2.2 ± 0.5 s), despite changing frequency (2–4 s) or cycle amplitude of FL istim. Gradual filtering out of the noise from FL istim trace concomitantly decreased the efficiency of FL so that stimulation with equivalent pure sinusoids produced asynchronous, irregular discharges only that could not be converted to FL by adding spontaneous basal activity. This study is the first demonstration that epochs of rhythmic locomotor-like oscillations applied to a dorsal root represent an efficient stimulus to evoke FL as long as they contain the electrophysiological noise produced within FL cycles. These observations suggest novel strategies to improve the efficiency of electrical stimulation delivered by clinical devices for neurorehabilitation after spinal injury.

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Evidence for a Spinal Central Pattern Generator in Humans^a

Cited by 694 publications

References 27 publications

Training locomotor networks

Training locomotor networks

Effect of treadmill gait training on static and functional balance in children with cerebral palsy: a randomized controlled trial

The locomotor central pattern generator of the rat spinal cord in vitro is optimally activated by noisy dorsal root waveforms

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Evidence for a Spinal Central Pattern Generator in Humansa

Cited by 694 publications

References 27 publications

Training locomotor networks

Training locomotor networks

Effect of treadmill gait training on static and functional balance in children with cerebral palsy: a randomized controlled trial

The locomotor central pattern generator of the rat spinal cord in vitro is optimally activated by noisy dorsal root waveforms

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Evidence for a Spinal Central Pattern Generator in Humans^a