Respiratory motor control and blood pressure regulation after spinal cord injury

脊髓损伤后的呼吸运动控制和血压调节

基本信息

批准号：
8688329
负责人：
Alexander Vladimirovich Ovechkin
金额：
$ 29.4万
依托单位：
UNIVERSITY OF LOUISVILLE
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-06-07 至 2016-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8688329
关键词：
Activities of Daily Living Affect Area Autonomic nervous system Baroreflex Blood Blood Pressure Breathing Cardiac Output Cardiovascular Physiology Cardiovascular system Catecholamines Cause of Death Chronic Clinic Control Groups Data Diagnosis Diastolic blood pressure Educational Intervention Effectiveness Electromyography Exercise Face Frequencies Functional disorder Goals Health Heart Heart Rate Hypotension Individual Injury Laboratories Location Lung Measurement Measures Motor Muscle Muscle Weakness Neurologic Orthostatic Hypotension Outcome Outcome Measure Paralysed Paresis Participant Performance Persons Physiological Play Population Posture Procedures Pulmonary Function Test/Forced Expiratory Volume 1 Quality of life Recovery Recruitment Activity Regulation Rehabilitation therapy Research Resistance Respiration Respiratory Insufficiency Respiratory Muscles Respiratory Paralysis Respiratory physiology Response Latencies Rest Role Secondary to Severities Skin Spinal Cord Lesions Spinal cord injury Spirometry Stress Stress Tests Surface Techniques Testing Therapeutic Intervention Time Training Training Technics Venous Vital capacity base blood pressure regulation cardiopulmonary system clinically relevant cost density experience follow-up functional outcomes improved motor control motor function improvement muscle strength novel novel therapeutic intervention pressure programs pulmonary function rehabilitation strategy respiratory response

项目摘要

DESCRIPTION (provided by applicant): Many individuals with chronic spinal cord injury (SCI) face the challenge of managing their unstable blood pressure which frequently results in persistent hypotension due to decreased cardiac output and autonomic nervous system dysfunction. In addition, blood pooling in the lower body during upright posture leads to a further decrease in blood pressure known as orthostatic hypotension. These conditions severely impact the overall health of SCI individuals, delay their participation in rehabilitative treatment, limit the effectiveness of such treatment, and significantly interfere with activities of daily living. In our clinic that utilizes activity-based therapy programs, we have observed that one of the most common impediments to full participation in these programs was orthostatic hypotension. Further, orthostatic intolerance increases the cost and decreases the efficacy of rehabilitative treatment. Another common impediment to rehabilitation after SCI is respiratory insufficiency due to paresis and paralysis of respiratory muscles. Physiologically, these respiratory and cardiovascular dysfunctions are closely related. Data from our laboratory show that resting blood pressure correlates positively with pulmonary function outcomes and the location and severity of spinal cord lesion. These relationships could be due to better venous return to the heart as a result of higher negative intrapleural pressure and/or higher sympathetic tone due to better baroreflex response in individuals with better inspiratory and expiratory motor control. Our preliminary data showed that respiratory motor function after SCI can be improved by respiratory muscle training (RMT), a rehabilitative technique based on the breathing with resistance exercise. We observed that resting blood pressure and orthostatic tolerance were also improved after RMT in individuals with SCI. Therefore, for the current proposal, we hypothesize that RMT will improve blood pressure regulation in individuals with chronic SCI. We will examine the response of physiological regulatory mechanisms to RMT. Based on statistical power analysis, forty five individuals who have chronic SCI will be recruited for this study over a four-year period. All subjects will have been diagnosed as having respiratory function deficits and orthostatic hypotension. We will evaluate pulmonary and cardiovascular function using spirometry, respiratory muscle strength, sympathetic skin response tests, and surface electromyography of respiratory muscles. In addition, we will use continuous beat-to-beat recording of systemic arterial blood pressure, heart rate, cardiac output, and the measurements of blood catecholamines level during orthostatic stress test. Autonomic regulation outcomes will be calculated from beat-to-beat blood pressure and heart rate frequency composition analysis. We will also evaluate Spinal Cord Injury Independence (SCIM-III) and quality of life (CHART) measures. These outcomes will be obtained before a total of 20 RMT sessions lasting 45 minutes each / 5 days per week, immediately after RMT, and during 6-month follow-up period in 35 research participants forming the experimental group. Another 10 individuals, serving as a control group, will undergo the same procedures, except the RMT intervention, during the same time course. This technique as a therapeutic intervention in order to improve the blood pressure regulation and investigate its mechanisms in individuals with SCI has never been tested before. The results of this study will have direct effect on the SCI population by improving our understanding of the mechanisms of pulmonary function and blood pressure regulation and offering a pathophysiologically based rehabilitation strategy.

描述（由申请人提供）：许多患有慢性脊髓损伤（SCI）的人面临着管理不稳定血压的挑战，这常常导致由于心输出量减少和自主神经系统功能障碍而导致持续性低血压。此外，直立姿势时下半身的血液淤积会导致血压进一步下降，称为直立性低血压。这些情况严重影响 SCI 个体的整体健康，延迟他们参与康复治疗，限制此类治疗的有效性，并严重干扰日常生活活动。在我们采用基于活动的治疗计划的诊所中，我们观察到充分参与这些计划的最常见障碍之一是直立性低血压。此外，直立不耐受会增加康复治疗的成本并降低其功效。 SCI 后康复的另一个常见障碍是呼吸肌轻瘫和麻痹导致的呼吸功能不全。从生理上讲，这些呼吸和心血管功能障碍密切相关。我们实验室的数据显示，静息血压与肺功能结果以及脊髓病变的位置和严重程度呈正相关。这些关系可能是由于较高的胸膜内负压导致静脉回流更好，和/或由于吸气和呼气运动控制更好的个体有更好的压力反射反应而导致交感神经张力更高。我们的初步数据表明，脊髓损伤后的呼吸运动功能可以通过呼吸肌训练（RMT）得到改善，这是一种基于呼吸阻力运动的康复技术。我们观察到 SCI 患者在 RMT 后静息血压和体位耐受力也得到改善。因此，对于目前的提议，我们假设 RMT 将改善慢性 SCI 患者的血压调节。我们将研究生理调节机制对 RMT 的反应。根据统计效力分析，将招募 45 名患有慢性 SCI 的人参与这项为期四年的研究。所有受试者均被诊断为患有呼吸功能缺陷和直立性低血压。我们将使用肺活量测定、呼吸肌力量、交感皮肤反应测试和呼吸肌表面肌电图来评估肺和心血管功能。此外，我们将使用连续逐次记录全身动脉血压、心率、心输出量，以及在直立性压力测试期间测量血液儿茶酚胺水平。自主调节结果将通过逐次血压和心率频率成分分析来计算。我们还将评估脊髓损伤独立性 (SCIM-III) 和生活质量 (CHART) 指标。这些结果将在每周 5 天、每次 45 分钟的 20 次 RMT 课程之前、RMT 后立即以及组成实验组的 35 名研究参与者的 6 个月随访期间获得。另外 10 个人作为对照组，将在同一时间过程中接受相同的程序，但 RMT 干预除外。这项技术作为一种治疗干预措施，旨在改善 SCI 患者的血压调节并研究其机制，此前从未进行过测试。这项研究的结果将提高我们对肺功能和血压调节机制的理解，并提供基于病理生理学的康复策略，从而对 SCI 人群产生直接影响。

项目成果

期刊论文数量（13）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Response to Letter to the Editor regarding "Effects of respiratory training on heart rate variability and baroreflex sensitivity in individuals with chronic spinal cord injury".

回复关于“呼吸训练对慢性脊髓损伤个体心率变异性和压力反射敏感性的影响”的致编辑信。

DOI：
10.1016/j.apmr.2018.01.001
发表时间：
2018
期刊：
Archives of physical medicine and rehabilitation
影响因子：
4.3
作者：
LeggDitterline,BonnieE;Asian,SevdaC;Randall,DavidC;Harkema,SusanJ;Castillo,Camilo;Ovechkin,AlexanderV
通讯作者：
Ovechkin,AlexanderV

Respiratory functional and motor control deficits in children with spinal cord injury.