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

　　步態和姿勢

　　皮層和脊髓低信號對雙腿直立行走的貢獻

　　FutoshiMORI

　　日本，縣立廣島大學, 醫學中心，職業治療部

　　盡管看似簡單，人類雙足行走是高度協調的運動行為。為了闡明人類中樞神經系統對雙足行走的調控機制，SPECT和NIRS已應用于研究健康人與患者在靜止平面和移動的跑步機上行走時的中樞神經系統的神經活動。這些研究結果表明多個大腦皮層區域如感覺運動區的神經活動興奮性增高。然而，由于人類研究個體的限制，有關中樞神經系統神經調控機制的進一步分析仍未完成。為此，我們開發了雙足行走的猴子模型及雙足行走的大鼠模型。猴子模型的PET研究表明，同一只猴子在雙足行走時，其大腦皮層運動區（初級皮質運動區，輔助運動區和運動前區）的神經活動水平明顯高于其在靜止期的大腦皮層運動區的神經活動水平。由于錐體和錐體外的下行運動神經束源于運動相關的大腦皮層，所以可能存在多個下行運動神經束發揮并行和優化激活與行走相關的脊髓機制的作用。我們還發現雙足行走的大鼠與對照組的大鼠相比，其脊髓運動神經元激活水平是受抑制的。當選擇性切斷皮層脊髓束，運動神經元激活水平恢復到對照組水平。所有這些結果表明，對于高度協調的雙足行走，選擇性的多個皮層和皮層下激活，以及與行走相關的脊髓同步協調激活機制是必須的。

　　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

　　步態和姿勢

　　MAL DE DEBARQUEMENT綜合征對旋轉刺激的感覺和反射高敏感性

　　Richard Charles FITZPATRICK1,ShaunWATSON1

　　1澳大利亞，新威爾士大學，神經科學科

　　MaldeDebarquement (MdD)是一種失平衡綜合癥，特征表現為航海后持續性異常的非眩暈性運動感覺。除了該病的前庭功能檢查正常，可能不是一個原發性的前庭疾病外，該病的發病機制尚無其他共識。本研究旨在探討MdD病人是否對旋轉前庭信號高反應，并假設他們表現出感知高敏感性而不是反射高敏感性。

　　對患者和配對的對照組進行了研究，所有受試者頭脈沖試驗和溫度試驗VOR功能均正常。通過心理生理學測試，判斷前庭直流電刺激（GVS）誘發對全身轉動（yaw）和側向搖擺刺激的感知敏感性，包括真實和虛幻運動感。平板姿勢圖評估站立時的平衡功能，而GVS誘發的中潛伏期反射評估前庭脊髓反射。在姿勢檢測方面MdD患者與對照組沒有差異。MdD患者表現出真實和虛擬（GVS誘發）的身體轉動時夸大的自身運動感。但是，MdD患者對小的、左右旋轉刺激的感受閾值增加。MdD患者表現出真實和虛擬（GVS誘發）身體轉動時夸大的自身運動感。與我們的假設相反，MdD患者表現出顯著增加和延遲的站立時中潛伏期GVS反應。我們得出結論MdD以運動感知高敏感性和前庭脊髓高反射性為特征，但是VOR反應正常。結果表明前庭傳入的感知、平衡和眼動處理的分離。如正常個體一樣，MdD可能表現出前庭敏感性自我調節，或與本體和視覺傳入整合異常。

　　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

　　步態和姿勢

　　自定步速跑步機速度控制界面的建立以增強步態康復效果

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

　　1 韓國，大田，韓國高級科學技術研究所，機械工程系

　　2 韓國，大田，DaeguGyeongbu科學技術研究所，機器人工程系

　　3 韓國，Jinju，Gyeong-Sang國立大學，機械工程系

　　4 美國，國立衛生院，康復醫學科

　　由于機器人外骨骼和體重支持的跑步機訓練(BWSTT)可以提供安全、方便的康復環境，因此被廣泛用于腦損傷后的步態康復。然而，基于跑步機的訓練模式與傳統的地面訓練相比并沒有顯示出優越性。一種可能的解釋是恒定速度的行走很少需要使用者的認知參與，而后者被推測是運動學習成功的關鍵因素。為增強跑步機步態訓練的有效性，本研究旨在建立自我步伐跑步機速度控制界面，這可根據使用者的意愿調節跑步帶的速度，后者可以通過深度感受器（depth sensors）檢測。自定步速度的速度控制算法是基于骨盆位置和擺動腳速度測量。該臨床研究通過設計和比較在恒定跑步機速度行走和控制跑步速度下行走中大腦的活動來評估新的跑步機訓練界面的有效性。相對于傳統的恒速跑步機，腦電圖（EEG）數據顯示，用戶在控制（自定步速）行走時可顯著減少光譜功率，即前扣帶回、感覺運動皮質和大腦后頂葉皮層的去同步化。這些結果表明該用戶控制的跑步機更能充分利用運動皮層，因此可以比傳統的跑步機得到更好的訓練效果。

　　(于棟禎譯，上海交通大學附屬第六人民醫院耳鼻咽喉頭頸外科)

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