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/摘要 手臂和手部动作对于日常生活的功能至关重要，并且在具有宫颈的退伍军人中受到了很大的损害 脊髓损伤（SCI）。已经报道了经皮脊柱的影响的有希望的结果 但是，刺激（苔丝）对手臂和手部功能恢复，但是效果仍然有限，此方法 尚未进入临床实践。我们的具体目标是：1）检查苔丝的生理影响 宫颈SCI后的上limb肌肉，以及2）使用量身定制的手臂和手部功能的恢复 苔丝以特定于任务的方式与运动训练相结合。我们专注于达到和抓住动作 因为它们在日常生活活动中的重要性。因此，我们的结果可能直接影响 退伍军人及其照顾者的生活通过增强他们的独立性和护理水平。 [在AIM 1中，我们将研究苔丝对皮质和皮质下神经元途径的影响 网状脊髓途径，一级运动皮层的皮质内抑制以及它们的相互作用。经颅 磁性刺激（TMS）将用于检查主要内物质途径的传播 运动皮层和大声的声学刺激将用于参与网状脊髓输入。在AIM 2中，我们建议 通过以特定于任务的方式应用苔丝，最大化苔丝对臂和手部功能的恢复的影响 在到达期间或运动的抓握阶段，随后进行了大规模的练习训练。苔丝会 使用依赖持续的运动学信号触发刺激的新型闭环范式应用 具有慢性宫颈科学的退伍军人的任务依赖性方式。]培训活动将集中于内在的和 使用虚拟现实Rapael Smart Glove的手和手臂运动的外部肌肉。这些独特 旨在使用有针对性的任务在功能相关运动过程中促进神经可塑性的方法 特定的苔丝以前从未使用过。 拟议的实验将提供有关上限函数控制的新知识，将使用该知识 指导与功能相关的可塑性诱导方案，以增强手臂功能的恢复。这 缺乏对具有宫颈SCI的退伍军人的上LIMB运动障碍的良好治疗方法 目前干预措施的行为收益有限，这突显了这些调查的重要性。