Elsevier

Gait & Posture

Volume 7, Issue 3, 1 May 1998, Pages 251-263
Gait & Posture

Neural control of locomotion: sensory control of the central pattern generator and its relation to treadmill training

https://doi.org/10.1016/S0966-6362(98)00010-1Get rights and content

Abstract

Many studies have shown that a special treadmill training is effective in restoring locomotor function in cats with a complete spinal lesion. In the last few years it has become possible to regain some locomotor activity in patients suffering from a spinal cord injury through an intense training on a treadmill, as in cats. The ideas behind this approach owe much to insights derived from studies on spinalized animals. The neural system responsible for the locomotor restoration in both cats and humans is thought to be located at spinal level and is referred to as the central pattern generator. The evidence for such a spinal central pattern generator is reviewed in part 1. An important element in the treadmill training for both spinal injured cats and humans is the provision of adequate locomotor related sensory input, which can possibly activate and/or regulate the spinal locomotor circuitry. This part of the review deals with the afferent control of the central pattern generator. Furthermore, the results of treadmill training for both cats and humans and their relation to sensory input are treated. These insights can possibly contribute to the design of a better treadmill training program for the rehabilitation of gait in spinal cord injured patients.

Introduction

A common approach to investigate the neural basis of animal locomotion, is to make use of surgically reduced animal preparations. In this way the role of separate parts of the central nervous system (CNS) in rhythm generation can be determined. Studying such preparations makes it possible to answer important questions such as ‘is it possible to express stereotypic and locomotor related patterns in these isolated preparations i.e. in the absence of the eliminated neural structures?’ and ‘what is the relation of these patterns to those observed in the intact animal?’. First, the different types of reduced preparations, as used in this review, will be dealt with shortly.

Within the ‘decerebrated’ preparations, several classes can be distinguished. The classes used in this review are the ‘pre-mammillary or thalamic’ and ‘post-mammillary or mesencephalic’ preparation. The pre-mammillary and post-mammillary preparations are transected above and between the colliculi and the subthalamic nuclei in the brainstem, respectively. The pre-mammillary preparation exhibits spontaneous periods of locomotion in response to a moving treadmill. The post-mammillary preparation does not walk spontaneously. Stepping movements can be elicited by electrical stimulation of the mesencephalic region (MLR) of the brainstem 1, 2. Both types of the decerebrate preparations can be used to study the locomotor output in the absence of movement related feedback. During this so-called ‘fictive’ locomotion, feedback is completely eliminated through blocking of the movement. This can be achieved by either injection of neuromuscular relaxants [3]or transection of the efferent nerves at the ventral root or at muscle nerve level. In these preparations, locomotor output can be evoked only by electrical stimulation of the MLR region [4]or pharmacologically with substances mimicking the action of descending pathways (noradrenergic agonists and/or precursors: l-DOPA+nialamide or clonidine; [5]). In spinalized cats the connections between the neural networks at supraspinal and spinal level are interrupted by transection of the spinal cord. The level of transection can differ but it is mostly at thoracic level. Spinalized cats can restore locomotor function of the hind-limbs when trained on a treadmill. This stepping can be evoked or enhanced with the use of drugs. This will be treated in the later part of this review more extensively.

Before evaluating results of experiments on the various preparations one has to bear in mind some limits when these results are used to understand the neural system of the intact animal.

When recovery is allowed, the reduced preparation has the capability to reorganize. Let us consider first the spinalized animal. Even if the structures above and below the lesion are still in a functional preserved state, the capabilities of the system to function as one total system have changed drastically [6]. Hence, it is far too simple to consider the spinal cord below the lesion as being the same as in the intact animal, except for the absence of interaction with supraspinal levels. Basically this view does not take into account the potential of the spinal cord to reorganize (see also [7]on this point). Therefore, it is fair to argue that the locomotor output of a chronic spinal cat (i.e. spinalized cat which was trained regularly on a treadmill and recovers locomotor ability) may not be based on exactly the same circuitry as the locomotor output of the intact animal. It is, indeed, conceivable that some of the patterns observed in chronic spinal cats reflect the capacity of the nervous system to cope with an injured system.

Furthermore, the sensory related input to the CNS of walking spinal cats can differ considerably from normal. Although the basic locomotor pattern can be present in fictive locomotion (i.e. in complete absence of afferent input), it will be shown that the role of afferents is very important in shaping the rhythmic pattern, to control phase-transitions and to reinforce the ongoing activity [8]. Therefore, a rhythm generating structure without its normal afferent input can be very artificial and possibly therefore cannot entirely reproduce the motor output as seen in the intact cat.

Despite these restrictions it will be shown that the locomotor output of chronic spinal cats is nevertheless strikingly similar to the one seen in intact cats. According to Edgerton et al. 9, 10, there are two main features that are different in the locomotion of chronic adult spinal cats as compared to normal. First there is a delay in the initiation of the swing phase resulting in the paw dragging over the treadmill. Second, the force and the EMG of the fast extensor muscles decline prematurely at the end of the stance phase. Interestingly, enhanced loading of the hind-limb muscles (for example by pulling the tail downwards) can compensate for both deficits. Hence, this suggests that the main differences are related to changes in afferent input rather than to spinal ‘rewiring’.

Recently, it has become possible to regain some locomotor activity in patients suffering from a spinal cord injury (SCI) through an intense training on a treadmill. These improvements are thought to be a consequence of a (re)activation of neural circuits located at spinal level. These neural networks are collectively termed central pattern generators (CPGs). CPGs are thought to be responsible for the generation of the basic rhythmic muscle activity as seen during locomotion. The evidence for such a spinal CPG in both cats and humans is reviewed in part 1.

Since afferent input is important in refining the locomotor output, it is conceivable that the provision of adequate sensory input during such treadmill training is of the utmost importance to achieve a more optimal locomotor output of the spinal locomotor circuitry. Hence, it is essential to learn more about how such CPGs are controlled by sensory input produced during gait.

The next section will deal with the influence of afferents on the cats’ CPG. Next, the results of treadmill training for spinalized cats, monkeys and humans are treated. Finally, the treadmill training results and their relation to sensory inputs are discussed.

Section snippets

The influence of afferents on the cat CPG

In cats, it has long been known that the spinal CPG can be activated by a variety of input sources. Grillner and Zangger [11]showed that electrical stimulation of dorsal roots could effectively trigger the initiation of locomotion in spinal cats (similar experiments in mesencephalic cats were reported earlier by Budakova [12]). Furthermore, many authors have confirmed that spinal locomotion can be either induced or facilitated through ‘a-specific’ sensory stimulation (which usually consists of

Chronic spinalized cats

After transection of the spinal cord of adult cats and dogs at a thoracic level (typically Th 12) or at upper lumbar level and after recovery from spinal shock, the so-called ‘low spinal’ cats and dogs are able to generate rhythmic alternating movements of the hind-limbs. In the earliest experiments, this stepping was very limited because these animals could not fully support themselves 44, 45. However, Ten Cate 46, 47, 48provided additional support for these animals. The spinalized cat was

Afferent influence on human CPG during treadmill training

When BWS treadmill training was started in humans, it was suggested that locomotor related afferent input could be of importance for the enhancement of locomotor activity. Several studies mentioned, only at a qualitative level, the relationship between the locomotor related load and kinematic input and the observed locomotor output. In subjects with one completely paralyzed lower limb, a flexor-like stepping movement could be elicited in the paralyzed leg when the SCI person shifted the body

Alternative explanations for locomotor recovery on the treadmill

Although it is tempting to conclude that the results following treadmill training, as described above, can be ascribed to activation of CPGs, one first has to consider some alternative explanations.

Conclusions

As in cats, improvement of locomotor function is seen in both complete and incomplete SCI persons when intensively trained on a treadmill by using BWS. This suggests that spinal locomotor centres can be activated in paraplegic patients in a manner similar to that in the chronic spinal cat after training on a treadmill. The most important features are a better modulation pattern of EMG activity in muscles of the lower extremities and the increased ability to support body weight. The question

Acknowledgements

We want to thank B. Bussel for providing us with some very valuable references and for general guidance, D.A. Winter and V. Dietz for helpful discussions and comments. B. Van Wezel and S. Donker for reading this paper and for providing critical remarks. This work was supported by a grant from STW and Sint Maartenskliniek to HC and from Nato (twinning grant 910574) to JD.

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