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Neurociência

导航经颅磁刺激踝关节脊椎通路的双边评价

Published: February 19, 2019
doi:
10.3791/58944
, , , ,
1Department of Neurology,New York University School of Medicine, 2Department of Health Sciences and Research,Medical University of South Carolina, 3Department of Physical Therapy,University of Nevada Las Vegas, 4Department of Health Professions,Medical University of South Carolina, 5Ralph H. Johnson VA Medical Center, 6Department of Psychiatry,Medical University of South Carolina, 7Division of Physical Therapy,Medical University of South Carolina

Summary

本协议描述了使用单脉冲经颅磁刺激和神经导航在休息和补体自愿激活过程中对胫骨前部和单索的皮质细胞反应的同时双边评估系统。

Abstract

远端腿部肌肉通过皮质脊髓道接收来自运动皮质区域的神经输入, 皮质脊髓道是人类运动下降的主要途径之一, 可以使用经颅磁刺激 (tms) 进行评估。考虑到远端腿部肌肉在直立姿势和动态任务 (如行走) 中的作用, 在过去十年中, 人们对相对于这些肌肉的功能的皮质边缘区域的评估和调节产生了越来越大的研究兴趣。然而, 以往工作中使用的方法参数因研究而异, 因此对横断面和纵向研究结果的解释不那么有力。因此, 使用专门用于评估腿部肌肉皮质反应 (cmr) 的标准化 tms 协议, 将可以直接比较不同研究和队列的结果。本文的目的是提出一个协议, 提供了一个灵活的同时评估双侧 cmr 的两个主要踝关节拮抗肌肉, 胫骨前肌和单索, 使用单脉冲 tms 与神经导航系统。本协议适用于被检查的肌肉完全放松或等距收缩在最大等距自愿收缩的规定百分比。使用每个对象的结构 mri 与神经导航系统, 确保准确和准确地定位线圈在腿皮质表示在评估过程中。鉴于 cmr 衍生度量值的不一致, 该协议还描述了使用自动算法对这些度量值进行标准化计算的方法。虽然这种协议不是在直立的姿势或动态任务中进行的, 但它可以用来双边评估任何一对腿部肌肉, 无论是对抗的还是协同的, 在神经完整和受损的对象。

Introduction

胫骨前部 (ta) 和单侧肌 (sol) 分别位于小腿前、后室。两种肌肉均为单关节, 而 ta 和 sol 的主要功能分别是背侧和扁平关节, 分别为1。此外, ta 是更有效的长肌肉出游和不太重要的力量生产, 而 sol 是一个反重力肌肉设计产生高力与肌肉2的小偏移.在直立的姿势和动态任务 (如步行)3, 4 时, 两种肌肉尤其重要。关于神经控制, 两个肌肉的摩托车池通过运动下降路径5, 6,以及不同程度的感觉驱动从大脑接受神经驱动。

主要运动下降途径是皮质脊髓道, 它起源于原发、前运动和辅助运动区域, 并在脊髓运动神经元池7,8终止。在人类中, 可以利用经颅磁刺激 (tms) (一种非侵入性脑刺激工具 9,10) 来评估这一通道的功能状态。自 tms 引入以来, 并考虑到其在直立姿势任务和行走过程中的功能意义, 对 ta 和 sol 的 cmr 进行了不同队列和任务11、12、13、14的评估. ,15,16,17,18,19,20,21, 22,23 , 24、25、26、27、28、29、30、31、32.

与上肢肌肉33中 cmr的评估不同, 目前还没有建立通用的 tms 协议来评估下肢肌肉中的 cmr。由于缺乏既定的协议和以前研究的方法差异很大 (例如,线圈的类型、神经导航的使用、补体激活水平、测试方面和肌肉、cmr 措施的使用和计算等)。), 对研究和队列中结果的解释可能是繁琐、复杂和不准确的。由于这些措施在功能上与各种运动任务相关, 针对下肢 cmr 评估的既定 tms 协议将使运动神经科学家和康复科学家能够系统地评估这些肌肉中的 cmr。会议和各种队列。

因此, 本协议的目的是描述使用单脉冲 tms 和神经导航系统对 ta 和 sol cmr 的双边评估。与以往的工作不同, 该协议旨在最大限度地提高实验程序、数据采集和数据分析的严谨性, 方法要素优化实验的有效性和持续时间, 并使 cmr 标准化评估这两个下肢肌肉。鉴于肌肉的 cmr 取决于肌肉是否完全放松或部分激活, 该协议描述了如何在休息和补体自愿激活 (tonic) 期间评估 ta 和 sol cmr。以下各节将全面介绍本议定书。最后, 将介绍和讨论具有代表性的数据。这里所描述的议定书来自 charalambous等人的议定书, 2018年32.

Protocol

本议定书中提出的所有试验程序都已得到地方机构审查委员会的批准, 并符合《赫尔辛基宣言》。 1. 同意流程和安全问卷 在任何实验之前, 向每个科目解释研究的目的、主要实验程序以及与参与研究有关的任何潜在风险因素。在回答主体可能有的任何问题或关切后, 要求主体承认同意程序, 并签署知情同意书。 管理 mri34和 tms35份</…

Representative Results

图 2-4显示了一位具有代表性的神经完整的31岁男性的数据, 身高和体重分别为178厘米和83公斤。 图 2显示了每个踝关节肌肉的双侧热点和 rmt。利用位于每个半球腿部区域中心的位置 (参见图 1 b 中的正方形), 45% mso 的强度被双边用于热点狩猎。每个肌肉的热点位置在半球之间不同, 但不出所料, 这四个热点都位于腿部运动皮质区域。这一发现…

Discussion

鉴于人们对运动皮层如何在不同队列的动态任务中对腿部肌肉的运动控制产生了兴趣, 因此需要一个标准化的 tms 协议来描述对这些肌肉的彻底评估。因此, 本协议首次提供了标准化的方法程序, 用于在两个肌肉状态 (休息和 tva) 中使用带有神经导航的单脉冲 tms 对两个踝关节对抗肌肉 (sol 和 ta) 进行双边评估。

代表性成果部分所述的调查结果指出了应考虑的几个关键步骤。首先…

Declarações

The authors have nothing to disclose.

Acknowledgements

作者感谢 jesse c. dean 博士帮助方法的发展, 并提供了对手稿草稿的反馈。这项工作得到了 va 职业发展奖-2 rr & d n077-w (mgb) 的支持, 该奖项是国家卫生研究院国家普通医学研究所的机构发展奖, 赠款号为 p20-gm1090 (sak) 和 P2CHD086844 (sak)。内容并不代表退伍军人事务部或美国政府的意见。

Materials

2 Magstim stimulators (Bistim module) The Magstim Company Limited; Whitland, UK Used to elicit bilateral motor evoked potentials in tibialis anterior and soleus muscles.
Adaptive parameter estimation by sequential testing (PEST) for TMS http://www.clinicalresearcher.org/software.htm Used to determine motor thresholds.
Amplifier Motion Lab Systems; Baton Rouge, LN, USA MA-300 Used to amplify EMG data.
Data Aqcuisition Unit Motion Lab Systems; Baton Rouge, LN, USA Micro 1401 Used to aqcuire EMG data.
Double cone coil The Magstim Company Limited; Whitland, UK PN: 9902AP Used to elicit bilateral motor evoked potentials in tibialis anterior and soleus muscles.
Polaris Northen Digital Inc.; Waterloo, Ontario, Canada Used to track the reflectiive markers located on subject tracker and coil tracker.
Signal Cambridge Electronics Design Limited; Cambridge, UK version 6 Used to collect motor evoked potentials during rest and TVA.
Single double differential surface EMG electrodes Motion Lab Systems; Baton Rouge, LN, USA MA-411 Used to record EMG signals.
TMS Frameless Stereotaxy Neuronavigation Sytem Brainsight 3, Rouge Research,
Montreal, Canada		 Used to navigate coil position during TMS assessment.
Walker boot Mountainside Medical Equipment, Marcy, NY Used to stabilize ankle joint.
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Keyword Extraction: Navigated Transcranial Magnetic StimulationCorticospinal PathwaysAnkle MusclesBilateral AssessmentMotor-evoked PotentialsLower ExtremityTibialis AnteriorStrokeMotor ControlGaitNeuronavigationMRIMontreal Neurological Institute AtlasSkin ModelLeg Motor AreaMotor MappingElectrodesTibialis AnteriorLateral Soleus
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Charalambous, C. C., Liang, J. N., Kautz, S. A., George, M. S., Bowden, M. G. Bilateral Assessment of the Corticospinal Pathways of the Ankle Muscles Using Navigated Transcranial Magnetic Stimulation. J. Vis. Exp. (144), e58944, doi:10.3791/58944 (2019).
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