Targeted Transcutaneous Stimulation to Restore Autonomic Cardiovascular Health in Veterans with Spinal Cord Injury

有针对性的经皮刺激可恢复脊髓损伤退伍军人的自主心血管健康

• 批准号: 10418182
• 负责人: Caitlyn G. Peters
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10418182
• 关键词: Activities of Daily Living; Adverse effects; Aldosterone; Applications Grants; Autonomic Dysreflexia; Autonomic nervous system; Biological Assay; Blood Flow Velocity; Blood Pressure; Blood Vessels; Cardiac; Cardiovascular Diseases; Cardiovascular Physiology; Cardiovascular system; Cerebrovascular Circulation; Cerebrovascular Disorders; Cervical spinal cord injury; Chest; Chronic; Clinical; Clinical Research; Data; Decentralization; Dependence; Electrodes; Electromyography; Equipment; Foundations; Frequencies; Functional disorder; Future; General Population; Goals; Gold; Grant; Growth; Head; Healthcare Systems; Home; Hormones; Hyperactivity; Hypotension; Hypotensives; Immobilization; Impaired cognition; Individual; Intervention; Investigation; Laboratories; Lesion; Link; Literature; Maintenance; Maps; Medical center; Mentors; Mentorship; Methodology; Methods; Morbidity - disease rate; Motor; Neighborhood Health Center; Neurostimulation procedures of spinal cord tissue; Norepinephrine; Orthostatic Hypotension; Personal Satisfaction; Physical therapy; Physiologic pulse; Physiological; Plant Roots; Plasma; Population; Process; Quality of life; Ramp; Rehabilitation therapy; Renin; Renin-Angiotensin-Aldosterone System; Reporting; Research; Research Personnel; Severities; Signal Transduction; Spinal; Spinal Cord; Spinal cord injury; Standardization; Supination; Symptoms; Testing; Training; Veterans; Width; Writing; arterial stiffness; associated symptom; base; biophysical tools; blood pressure control; blood treatment; cardiovascular disorder risk; cardiovascular effects; cardiovascular health; cerebrovascular health; cognitive function; disorder risk; effective intervention; experience; falls; improved; injured; knowledge base; mortality; neuroregulation; response; restoration; skills training; spine bone structure; statistics; transcutaneous stimulation

PROJECT SUMMARY/ABSTRACT Dr. Caitlyn Katzelnick has been working with investigators in the National Center for Spinal Cord Injury (SCI) and Immobilizing Conditions at the VA Medical Center, Bronx, NY for eight years as a senior research coordinator. Along with her Primary Mentor, Dr. Wecht, Caitlyn has been studying the effects of cardiovascular, cerebrovascular and cognitive dysfunction post SCI, and the results of her Doctoral dissertation suggest that increased arterial stiffness in individuals with SCI may relate to the degree of decentralized sympathetic cardiovascular control and increased reliance on the renin-angiotensin-aldosterone system (RAAS) for maintenance of orthostatic blood pressure (BP). Recent evidence indicates that increased arterial stiffness is an independent predictor of cardiovascular disease risk, which may contribute to the heightened cardiovascular morbidity and mortality in the SCI, compared to the general population. Increased reliance on the RAAS is believed to mitigate orthostatic falls in BP and reduce the severity of symptoms reporting; however, findings in the general population link the RAAS with vascular restructuring and remodeling. Therefore, clinical intervention to stabilize and normalize BP should be a priority in hypotensive individuals with SCI. Advances in methods of neuromodulation of the spinal processes offer a non-pharmacologic approach to restore endogenous autonomic cardiovascular control and improve orthostatic BP control. Based on our present understanding of the somatovisceral integration within the spinal cord, it is plausible that transcutaneous spinal cord stimulation (TSCS) can be targeted to excite and modulate appropriate spinal autonomic circuitry to rapidly normalize orthostatic BP; however, electrode placement and stimulation parameter mapping is needed to optimize orthostatic BP control. Therefore, our primary aim is to identify an individualized map using noninvasive TSCS of the spinal autonomic circuitry that results in an increase of seated BP. Our secondary aim is to compare BP, plasma concentrations of norepinephrine, renin and aldosterone during a head-up tilt with and without optimal TSCS. This investigation will be completed at the brand- new Center of Spinal Stimulation, located at the Kessler Foundation, which is home to our VA satellite center. Dr. Katzelnick will have access to all the necessary facilities and equipment including: TSCS, electromyography (EMG) and cardiovascular. The CDA-1 will provide Dr. Katzelnick with the advanced skill training, clinical research experience, and mentorship to facilitate her growth into an independent VA investigator. Training objectives include: 1) administering and mapping TSCS; 2) gaining an understanding of EMG recordings and analysis; and 3) assaying the RAAS hormones. Dr. Katzelnick will take academic courses to advance her knowledge base in grant writing, cardiovascular physiology, statistics, biophysics and EMG. Her mentors encompass various relevant scientific backgrounds, which converge with a similar understanding of secondary consequences after a SCI. It is anticipated that these data will begin to establish a standard methodology for TSCS mapping of spinal autonomic circuits to promote restoration of cardiovascular health, and overall well-being in Veterans with immobilizing conditions. Standardized TSCS methodology will be used in future grant applications, including a CDA-2 application, to promote improved vitality and quality of life in Veterans with SCI.

项目概要/摘要 Caitlyn Katzelnick 博士一直与国家脊柱中心的研究人员合作 纽约州布朗克斯 VA 医疗中心的 8 名患者出现脊髓损伤 (SCI) 和无法活动的情况 担任高级研究协调员多年。凯特琳与她的主要导师韦克特博士一起， 一直在研究 SCI 后心血管、脑血管和认知功能障碍的影响， 她的博士论文结果表明，动脉僵硬度增加 脊髓损伤患者可能与交感神经心血管的分散程度有关 控制和增加对肾素-血管紧张素-醛固酮系统（RAAS）的依赖 维持直立血压（BP）。最近的证据表明增加 动脉僵硬度是心血管疾病风险的独立预测因子，可能 与 SCI 患者相比，导致 SCI 患者心血管发病率和死亡率升高 一般人群。增加对 RAAS 的依赖被认为可以减轻直立性跌倒的情况 血压并降低症状报告的严重程度；然而，在一般人群中的发现 将 RAAS 与血管重组和重塑联系起来。因此，临床干预 对于患有 SCI 的低血压患者，应优先考虑使血压稳定并正常化。进展 脊柱过程的神经调节方法提供了一种非药物方法 恢复内源性自主心血管控制并改善直立血压控制。 根据我们目前对脊髓内躯体内脏整合的理解， 经皮脊髓刺激（TSCS）可以有针对性地激发和 调节适当的脊柱自主神经回路，以快速使直立血压正常化；然而， 需要电极放置和刺激参数映射来优化直立血压 控制。因此，我们的主要目标是使用非侵入性方法识别个性化地图 脊髓自主神经回路的 TSCS 导致坐位血压升高。我们的中学 目的是比较血压、去甲肾上腺素、肾素和醛固酮的血浆浓度 具有和不具有最佳 TSCS 的平视倾斜。这项调查将在品牌完成—— 新的脊髓刺激中心，位于凯斯勒基金会，也是我们 VA 的所在地 卫星中心。卡泽尼克博士将可以使用所有必要的设施和设备 包括：TSCS、肌电图 (EMG) 和心血管。 CDA-1 将提供博士。 Katzelnick 拥有先进的技能培训、临床研究经验和指导 促进她成长为一名独立的退伍军人事务部调查员。培训目标包括：1) 管理和映射 TSCS； 2）了解肌电图记录和 分析; 3) 测定 RAAS 激素。卡泽尼克博士将参加学术课程 提高她在资助写作、心血管生理学、统计学、生物物理学方面的知识基础 和肌电图。她的导师涵盖各种相关的科学背景，这些背景与 对 SCI 后继发后果的类似理解。预计这些数据 将开始建立脊髓自主神经回路 TSCS 映射的标准方法 促进退伍军人心血管健康和整体福祉的恢复 固定条件。未来的拨款将使用标准化 TSCS 方法 应用程序，包括 CDA-2 应用程序，以促进改善活力和生活质量 患有 SCI 的退伍军人。