Spinal Cord Stimulation for Functional Recovery in Humans with Tetraplegia

脊髓刺激促进四肢瘫痪患者功能恢复

• 批准号: 10542337
• 负责人: Monica A Perez
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542337
• 关键词: Acoustics; Amyotrophic Lateral Sclerosis; Behavioral; Brain; Caregivers; Caring; Cells; Cervical; Cervical spinal cord injury; Cervical spinal cord structure; Chronic; Community Participation; Crossover Design; Cutaneous; Data; Diameter; Effectiveness; Employment; Future; General Population; Goals; Hand; Hand functions; Human; Impairment; Individual; Injury; Intervention; Investigation; Knowledge; Lesion; Life; Limb structure; Loudness; Measures; Methodology; Methods; Motor; Motor Cortex; Motor Neurons; Movement; Multiple Sclerosis; Muscle; Neuronal Plasticity; Neurons; Neurostimulation procedures of spinal cord tissue; Participant; Pathway interactions; Persons; Phase; Physiologic pulse; Physiological; Process; Protocols documentation; Quadriplegia; Quality of life; Reaction Time; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Research; Reticular Formation; Signal Transduction; Spinal; Spinal Cord; Spinal cord injury; Stimulus; Structure; Testing; Time; Training; Training Activity; Transcranial magnetic stimulation; Travel; Upper Extremity; Vertebral column; Veterans; Work; arm; arm function; arm movement; clinical practice; cooking; exercise training; experience; experimental study; follow-up; grasp; hand rehabilitation; improved; kinematics; motor disorder; motor impairment; neuromechanism; novel; novel strategies; post stroke; randomized controlled design; recruit; rehabilitation strategy; response; spine bone structure; success; transmission process; virtual reality

Abstract/summary Arm and hand movements are essential for daily-life functions and are largely impaired in veterans with cervical spinal cord injury (SCI). Promising results have been reported on the effects of transcutaneous electrical spinal stimulation (TESS) on arm and hand functional recovery, however, the effects remain limited and this method has not yet entered clinical practice. Our specific goals are to: 1) examine physiological effects of TESS on upper-limb muscles after cervical SCI, and 2) maximize the recovery of arm and hand function by using tailored TESS in a task-specific manner combined with motor training. We focus on reaching and grasping movements because of their importance in daily life activities. Thus, our results may have a direct impact on the quality of life of veterans and their caregivers by enhancing their independence and level of care. [In Aim 1, we will investigate the effects of TESS on cortical and subcortical neuronal pathways including the reticulospinal pathway, intracortical inhibition in the primary motor cortex, and in their interaction. Transcranial magnetic stimulation (TMS) will be used to examine transmission in intracortical pathways within the primary motor cortex and a loud acoustic stimuli will be used to engage reticulospinal inputs. In Aim 2, we propose to maximize the effects of TESS on recovery of arm and hand function by applying TESS in a task-specific manner during the reaching or the grasping phases of movements followed up by massed practice training. TESS will be applied using a novel closed-loop paradigm that relies on ongoing kinematic signals to trigger stimulation in a task-dependent manner in Veterans with chronic cervical SCI.] Training activities will focus on intrinsic and extrinsic muscles of the hand and arm movements using the virtual reality RAPAEL Smart Glove. These unique approaches aiming at promoting neuroplasticity during functionally relevant movements using targeted task- specific TESS have not been used before. The proposed experiments will provide new knowledge on the control of upper-limb functions, which will be used to guide functionally-relevant plasticity-inducing protocols to enhance recovery of hand and arm function. The absence of well-accepted treatments for upper-limb motor impairments for veterans with cervical SCI and the limited behavioral gains of present interventions underline the importance of these investigations.

摘要/总结 手臂和手部的运动对于日常生活功能至关重要，但患有颈椎病的退伍军人的手臂和手部运动严重受损 脊髓损伤（SCI）。据报道，经皮脊髓电疗法的效果有希望的结果 刺激（TESS）对手臂和手的功能恢复，但效果仍然有限，这种方法 尚未进入临床实践。我们的具体目标是：1）检查 TESS 对 颈椎 SCI 后的上肢肌肉，以及 2) 通过使用量身定制的方法最大限度地恢复手臂和手的功能 TESS 以特定任务的方式与运动训练相结合。我们专注于伸手和抓握动作 因为它们在日常生活活动中的重要性。因此，我们的结果可能会直接影响到我们的质量。 通过提高退伍军人及其护理人员的独立性和护理水平来改善他们的生活。 [在目标 1 中，我们将研究 TESS 对皮质和皮质下神经元通路的影响，包括 网状脊髓通路、初级运动皮层的皮质内抑制及其相互作用。经颅 磁刺激（TMS）将用于检查初级皮质内通路的传输 运动皮层和响亮的声音刺激将用于参与网状脊髓输入。在目标 2 中，我们建议 通过以特定任务的方式应用 TESS，最大限度地发挥 TESS 对手臂和手部功能恢复的影响 在运动的到达或抓握阶段，随后进行集中练习训练。苔丝将 使用一种新颖的闭环范例来应用，该范例依赖于持续的运动信号来触发刺激 ] 训练活动将侧重于内在和 使用虚拟现实 RAPAEL 智能手套进行手部外在肌肉和手臂运动。这些独特的 旨在使用目标任务在功能相关运动期间促进神经可塑性的方法 之前没有使用过特定的TESS。 所提出的实验将提供有关上肢功能控制的新知识，这些知识将用于 指导功能相关的可塑性诱导方案，以促进手和手臂功能的恢复。这 对于患有颈椎 SCI 的退伍军人来说，缺乏公认的上肢运动障碍治疗方法， 目前干预措施的行为收益有限，凸显了这些调查的重要性。