Locomotor capacity of spinal cord in paraplegic patients

Dietz, V.

doi:10.1016/s0013-4694(97)88001-0

Cited by 71 publications

(118 citation statements)

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“…Since we stimulated patients with spinal lesions, these effects might be better explained by spinal fiber systems than by influences on motor cortical systems. Examples for a crossing fiber system are the central pattern generator [16][17][18][19] or the fibers of the flexor reflex afferents. 18,20 Enhanced reactivity is often seen in patients with spinal cord lesions and spasticity.…”

Section: Discussionmentioning

confidence: 99%

“…They can be considered an attempt to regenerate spinal motor systems, suggesting the large potential for neuroplastic changes within injured spinal motor systems. 23 These motor systems are influenced for short periods, that is, during physiotherapy 3 or with treadmill training 16 that leads to reduced spastic tone or automatic step cycling. We hypothesize that the repetitive magnetic stimulation can influence these injured spinal motor systems by reducing spastic tone.…”

Section: Discussionmentioning

confidence: 99%

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Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs

Krause¹,

Edrich²,

Straube³

2004

Spinal Cord

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Study Design: Comparison of spinal lesion subjects and normal subjects. Objective: To investigate the effects of a paravertebral repetitive magnetic stimulation on spastic tone increase of the lower limbs. Setting: Munich, Germany. Methods: We compared the effects in 15 patients with different spinal lesions and in 16 healthy subjects. The spastic tone increase was evaluated clinically with the Ashworth scale and apparatively with the pendulum test, both at fixed times before and after stimulation. Unilateral stimulation was applied to the lumbar nerve roots L3 and L4 of the clinically more spastic leg. Results: The spastic tone decreased significantly in the interval between 4 and 24 h after stimulation. This effect was slightly more pronounced in the contralateral extremity. Furthermore, the stimulation motor threshold of the patients was significantly raised. Conclusion: Repetitive magnetic unilateral stimulation has a positive effect on spastic tone increase due to spinal lesions, causing a decrease that lasts for about 1 day not only on the ipsilateral but also on the contralateral side.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs

Krause¹,

Edrich²,

Straube³

2004

Spinal Cord

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“…Secondarily occurring non-neuronal changes, that is, alteration in muscle mechanic, rather than a neuronal hyperactivity, are assumed to be responsible to increased muscle tone at the subacute stage after the SCI. [30][31][32] In addition, the difference in the level of muscle activity between active (movement) and passive (clinical) conditions is lesser in spastic limbs than in unaffected limbs. 33 Both spinal and supraspinal lesions lead to both loss of supraspinal drive and defective use of afferent input.…”

Section: Neuronal Dysfunction After Scimentioning

confidence: 99%

Neuronal dysfunction in chronic spinal cord injury

2010

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This review describes the changes of spinal neuronal function that occur after a motor complete spinal cord injury (cSCI) in humans. In healthy subjects, polysynaptic spinal reflex (SR) evoked by non-noxious tibial nerve stimulation consists of an early SR component and rarely a late SR component. Soon after a cSCI, SR and locomotor activity are absent. After spinal shock; however, an early SR component re-appears associated with the recovery of locomotor activity in response to appropriate peripheral afferent input. Clinical signs of spasticity take place in the following months, largely as a result of nonneuronal changes. After around 1 year, the locomotor and SR activity undergo fundamental changes, that is, the electromyographic amplitude in the leg muscles during assisted locomotion exhaust rapidly, accompanied by a shift from early to dominant late SR components. The exhaustion of locomotor activity is also observed in non-ambulatory patients with an incomplete spinal cord injury (SCI). At about 1 year after injury, in most cSCI subjects the neuronal dysfunction is fully established and remains more or less stable in the following years. It is assumed that in chronic SCI, the patient's immobility resulting in a reduced input from supraspinal and peripheral sources leads to a predominance of inhibitory drive within spinal neuronal circuitries underlying locomotor pattern and SR generation. Training of spinal interneuronal circuits including the enhancement of an appropriate afferent input might serve as an intervention to prevent neuronal dysfunction after an SCI.

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“…In recent years it has been shown that speci®c locomotor training could enhance locomotor activity and thereby improve mobility. 44,45 Antispastic drug therapy is the second tool. It reduces muscle tone and spasms by the induction of a paresis which may interfere with the performance of functional movements.…”

Section: Therapeutic Consequencesmentioning

confidence: 99%

Spastic movement disorder

Dietz¹

2000

Spinal Cord

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This review deals with the neuronal mechanisms underlying spastic movement disorder, assessed by electrophysiological means with the aim of ®rst, a better understanding of the underlying pathophysiology and second, the selection of an adequate treatment. For the patient usually one of the ®rst symptoms of a lesion within the central motor system represents the movement disorder, which is most characteristic during locomotion in patients with spasticity. The clinical examination reveals exaggerated tendon tap re¯exes and increased muscle tone typical of the spastic movement disorder. However, today we know that there exists only a weak relationship between the physical signs obtained during the clinical examination in a passive motor condition and the impaired neuronal mechanisms being in operation during an active movement. By the recording and analysis of electrophysiological and biomechanical parameters during a functional movement such as locomotion, the signi®cance of, for example, impaired re¯ex behaviour or pathophysiology of muscle tone and its contribution to the movement disorder can reliably be assessed. Consequently, an adequate treatment should not be restricted to the cosmetic therapy and correction of an isolated clinical parameter but should be based on the pathophysiology and signi®cance of the mechanisms underlying the disorder of functional movement which impairs the patient. Spinal Cord (2000) 38, 389 ± 393

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Locomotor capacity of spinal cord in paraplegic patients

Cited by 71 publications

References 0 publications

Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs

Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs

Neuronal dysfunction in chronic spinal cord injury

Spastic movement disorder

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