SP08-1

　　Gait & Posture

　　CORTICAL AND SPINAL DESCENDING SIGNAL CONTRIBUTION TO BIPEDAL LOCOMOTION

　　Futoshi MORI

　　Department of Occupational Therapy, University Medical Center, Prefectural University of Hiroshima, Japan

　　Despite its apparent simplicity, human bipedal (Bp) walking is a highly tuned motor behavior. To elucidate CNS control mechanisms of human Bp walking, SPECT and NIRS studies have been performed in the healthy and morbid human subjects, walking on the still surface and the moving treadmill surface. Results of these studies have already demonstrated that neural activity of multiple cerebral cortical areas, including sensorimotor areas, was highly enhanced. However, because of limitation in the human subjects, further analytical studies of CNS neuronal mechanisms have not been done. For this reason, we have developed Bp walking monkey model, and even Bp walking rat model. PET monkey study showed that during its Bp walking, neural activation level was much higher in the motor areas (primary motor cortex, supplementary motor area and premotor area) than that at the rest period in the same monkey. Since pyramidal and extrapyramidal descending tracts originate from the motor-related cerebral cortex, it is possible that multiple descending tracts exert parallel and tuned activation of walking-related spinal cord mechanisms. We have also found that spinal motoneuronal activation level of Bp-walking rats are depressed than that in the control rats, and that after selective severance of the corticospinal tract, activation level of motor neuron returns to that in the control. All these results suggest that, for the elaboration of seamless Bp walking, selective yet multiple cortical and subcortical activations, and resultant simultaneous tuned activation of walking-related spinal cord mechanisms are necessary.

　　SP08-1

　　步态和姿势

　　皮层和脊髓低信号对双腿直立行走的贡献

　　FutoshiMORI

　　日本，县立广岛大学, 医学中心，职业治疗部

　　尽管看似简单，人类双足行走是高度协调的运动行为。为了阐明人类中枢神经系统对双足行走的调控机制，SPECT和NIRS已应用于研究健康人与患者在静止平面和移动的跑步机上行走时的中枢神经系统的神经活动。这些研究结果表明多个大脑皮层区域如感觉运动区的神经活动兴奋性增高。然而，由于人类研究个体的限制，有关中枢神经系统神经调控机制的进一步分析仍未完成。为此，我们开发了双足行走的猴子模型及双足行走的大鼠模型。猴子模型的PET研究表明，同一只猴子在双足行走时，其大脑皮层运动区（初级皮质运动区，辅助运动区和运动前区）的神经活动水平明显高于其在静止期的大脑皮层运动区的神经活动水平。由于锥体和锥体外的下行运动神经束源于运动相关的大脑皮层，所以可能存在多个下行运动神经束发挥并行和优化激活与行走相关的脊髓机制的作用。我们还发现双足行走的大鼠与对照组的大鼠相比，其脊髓运动神经元激活水平是受抑制的。当选择性切断皮层脊髓束，运动神经元激活水平恢复到对照组水平。所有这些结果表明，对于高度协调的双足行走，选择性的多个皮层和皮层下激活，以及与行走相关的脊髓同步协调激活机制是必须的。

　　SP08-2

　　Gait & Posture

　　SENSORY AND REFLEXIVE HYPERSENSITIVITY TO ROTATIONAL STIMULI IN MAL DE

　　DEBARQUEMENT SYNDROME

　　Richard Charles FITZPATRICK1, ShaunWATSON1

　　1Department of Neuroscience, University of New South Wales, Australia

　　Mal de Debarquement (MdD) is an imbalance syndrome presenting classically as persistent abnormal nonvertiginous motion sensations after a sea voyage. There is no consensus on pathogenesis other than it is probably not a primary vestibular disorder as clinical vestibular function tests are normal and it is unresponsive to vestibular treatments. This study aimed to determine if MdD patients are hypersensitive to vestibular signals of rotation with the hypothesis that they would show perceptual but not reflex hypersensitivity.

　　Patients and matched controls were studied. All had normal head impulse and caloric tests of VOR function. Perceptual sensitivity to whole-body yaw and lateral rocking stimulation, both real and illusory motion evoked by galvanic vestibular stimulation (GVS) were determined by psychophysical tests. Balance during standing was assessed by forceplate posturography while vestibulospinal reflexes were assessed by GVS-evoked medium-latency reflexes. Posturographic measures fromMdD patients were not different to control. MdD patients showed exaggerated senses of self-motion during real and virtual (GVS evoked) yaw.However,MdD thresholds for detecting small imposed yaw rotations were increased. MdD patients showed exaggerated senses of self-motion during real and virtual. Against our hypothesis, MdD showed markedly increased and delayed medium-latency GVS responses during standing. We conclude that MdD is characterised by perceptual motion hypersensitivity and vestibulospinal hyper-reflexia, but normal VOR responses. The results indicate separation of perceptual, balance and ocular processing of vestibular afference. MdD could reflect disordered autoregulation of vestibular sensitivity or integration with somatosensory and visual afference as occurs in normal subjects.

　　SP08-2

　　步态和姿势

　　MAL DE DEBARQUEMENT综合征对旋转刺激的感觉和反射高敏感性

　　Richard Charles FITZPATRICK1,ShaunWATSON1

　　1澳大利亚，新威尔士大学，神经科学科

　　MaldeDebarquement (MdD)是一种失平衡综合症，特征表现为航海后持续性异常的非眩晕性运动感觉。除了该病的前庭功能检查正常，可能不是一个原发性的前庭疾病外，该病的发病机制尚无其他共识。本研究旨在探讨MdD病人是否对旋转前庭信号高反应，并假设他们表现出感知高敏感性而不是反射高敏感性。

　　对患者和配对的对照组进行了研究，所有受试者头脉冲试验和温度试验VOR功能均正常。通过心理生理学测试，判断前庭直流电刺激（GVS）诱发对全身转动（yaw）和侧向摇摆刺激的感知敏感性，包括真实和虚幻运动感。平板姿势图评估站立时的平衡功能，而GVS诱发的中潜伏期反射评估前庭脊髓反射。在姿势检测方面MdD患者与对照组没有差异。MdD患者表现出真实和虚拟（GVS诱发）的身体转动时夸大的自身运动感。但是，MdD患者对小的、左右旋转刺激的感受阈值增加。MdD患者表现出真实和虚拟（GVS诱发）身体转动时夸大的自身运动感。与我们的假设相反，MdD患者表现出显著增加和延迟的站立时中潜伏期GVS反应。我们得出结论MdD以运动感知高敏感性和前庭脊髓高反射性为特征，但是VOR反应正常。结果表明前庭传入的感知、平衡和眼动处理的分离。如正常个体一样，MdD可能表现出前庭敏感性自我调节，或与本体和视觉传入整合异常。

　　SP08-3

　　Gait & Posture

　　DEVELOPMENT OF A SELF-PACED TREADMILL TRAINING INTERFACE FOR ENHANCING

　　EFFECTIVENESS OF GAIT REHABILITATION

　　Hyung-Soon PARK1, Jonghyun KIM2, JungWon YOON3, Thomas C. BULEA4

　　1Mechanical Engineering Department, Korea Advanced Institute of Science and Technology, Daejeon, Korea

　　2Robotics Engineering Department, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea

　　3Mechanical Engineering Department, Gyeong-Sang National University, Jinju, Korea

　　4Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA

　　Robotic exoskeletons and body-weight supported treadmill training (BWSTT) are widely used for gait rehabilitation after brain injury since they provide safe and convenient rehabilitation environment; however, treadmill based training paradigms have not been shown to create superior results when compared with traditional physical therapy methods such as overground training. One explanation for this may be that walking at a constant, fixed speed requires little cognitive engagement from the user, which has been postulated as a key factor in the success of motor learning. To enhance the effectiveness of treadmill-based gait training, this study aims to develop a self-paced treadmill speed control interface that adjusts belt speed according to the user’s intention to change walking speed that was detected by using depth sensors. A self-paced speed control algorithm was developed based on the pelvis position and swing foot speed measurement. To evaluate the effectiveness of new treadmill training interface, a clinical study was designed and conducted to compare brain activities during two different walking conditions – walking under constant treadmill speed and walking under user-driven treadmill speed. The EEG (electroencephalogram) data revealed that relative to the traditional constant speed treadmill, the user-driven (self-paced) walking resulted in statistically significant decreases in spectral power, i.e. desynchronization, in the anterior cingulate, sensorimotor cortices, and posterior parietal lobe of the cortex. These results indicate that user-driven treadmillsmore fully engage the motor cortex and therefore could facilitate better training outcomes than a traditional treadmill.

　　SP08-3

　　步态和姿势

　　自定步速跑步机速度控制界面的建立以增强步态康复效果

　　Hyung-Soon PARK1, JonghyunKIM2, JungWon YOON3, Thomas C. BULEA4

　　1 韩国，大田，韩国高级科学技术研究所，机械工程系

　　2 韩国，大田，DaeguGyeongbu科学技术研究所，机器人工程系

　　3 韩国，Jinju，Gyeong-Sang国立大学，机械工程系

　　4 美国，国立卫生院，康复医学科

　　由于机器人外骨骼和体重支持的跑步机训练(BWSTT)可以提供安全、方便的康复环境，因此被广泛用于脑损伤后的步态康复。然而，基于跑步机的训练模式与传统的地面训练相比并没有显示出优越性。一种可能的解释是恒定速度的行走很少需要使用者的认知参与，而后者被推测是运动学习成功的关键因素。为增强跑步机步态训练的有效性，本研究旨在建立自我步伐跑步机速度控制界面，这可根据使用者的意愿调节跑步带的速度，后者可以通过深度感受器（depth sensors）检测。自定步速度的速度控制算法是基于骨盆位置和摆动脚速度测量。该临床研究通过设计和比较在恒定跑步机速度行走和控制跑步速度下行走中大脑的活动来评估新的跑步机训练界面的有效性。相对于传统的恒速跑步机，脑电图（EEG）数据显示，用户在控制（自定步速）行走时可显著减少光谱功率，即前扣带回、感觉运动皮质和大脑后顶叶皮层的去同步化。这些结果表明该用户控制的跑步机更能充分利用运动皮层，因此可以比传统的跑步机得到更好的训练效果。

　　(于栋祯译，上海交通大学附属第六人民医院耳鼻咽喉头颈外科)

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