Neuromuscular Electrical Stimulation and Mobility in Multiple Sclerosis

多发性硬化症的神经肌肉电刺激和活动能力

基本信息

批准号：
8677061
负责人：
ROGER M. ENOKA
金额：
$ 7.97万
依托单位：
UNIVERSITY OF COLORADO
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-05-01 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8677061
关键词：
Action Potentials Acute Address Affect Aftercare Axon Blinded Classification Development Diagnosis Disabled Persons Disease Effectiveness Effectiveness of Interventions Electric Stimulation Esthesia Exercise Exhibits Feasibility Studies Future Goals Health Health Professional Impairment Individual Inflammation International Intervention Knowledge Leg Length Life Style Measures Motor Multiple Sclerosis Muscle Muscle Contraction Nerve Nerve Degeneration Nervous system structure Neuraxis Neurons Outcome Participant Patients Performance Persons Physical activity Physical therapy exercises Physiologic pulse Protocols documentation Quality of life Randomized Recovery of Function Research Design Sensory Signal Transduction Spinal Stimulus Therapeutic Uses Training Walking Work base burden of illness clinical Diagnosis clinically significant conditioning disability femoral nerve follow-up functional restoration gray matter healthy volunteer improved innovation motor function recovery neuromuscular neuromusculoskeletal novel physical conditioning primary outcome programs public health relevance secondary outcome sedentary spinal pathway white matter

项目摘要

DESCRIPTION (provided by applicant): The progressive decline in mobility that occurs with multiple sclerosis (MS) is attributable to two factors: a reduction in the ability of the nervous system to generate adequate muscle activation signals and a decrease in the level of physical conditioning that results from the development of a more sedentary lifestyle. Exercise programs can provide some relief by reducing the level of deconditioning, but only for individuals with low levels of disability. There are no effective countermeasures for persons with MS who are moderately disabled with limitations in walking performance. To address this knowledge gap, we will examine the effectiveness of an intervention that evokes involuntary contractions in leg muscles with a novel form of neuromuscular electrical stimulation (NMES). Conventional NMES mainly activates motor axons using narrow (0.2-0.5 ms) stimulus pulses, but does not improve the walking performance of persons with MS. As an alternative approach, we will use wide (1 ms) stimulus pulses to activate both motor and sensory axons and thereby modulate the excitability of spinal and cortical neurons to promote the recovery of motor function in the nervous system. The primary outcome will be walking endurance, which will be quantified as the distance walked in 6 min. The participants (n = 30, 18-55 yrs) will be individuals diagnosed with MS who exhibit a clinically defined moderate level of disability. The research design comprises a 6 week (18 sessions), randomized, evaluator-blinded comparison of narrow- and wide-pulse NMES treatment on walking performance and then retention of the gains in walking endurance during 6 months of follow-up. Based on the demonstrated acute effects of wide-pulse NMES in healthy volunteers, the intervention will comprise stimulation of each leg individually with 30 trains of stimulation (20 s on, 20 s off) with a well-tolerated current that elicits a submaximal force (~20% maximum). We will evaluate two hypotheses: H1: Treatment of moderately disabled MS patients with wide-pulse NMES will improve walking endurance more than treatment with narrow-pulse NMES. H2: Improvements in walking endurance will be associated with elevated levels of habitual physical activity that will be retained longer after the treatment ends for the wide-pulse NMES group compared with the narrow-pulse NMES group. We expect wide-pulse NMES to produce greater improvement in walking endurance than narrow-pulse NMES and the gains to be associated with: (1) sustained electromyographic (EMG) activity in leg muscles during walking; (2) improved walking economy; and (3) increases in stride length. If wide-pulse NMES can elicit clinically significant improvements in mobility and quality of life for persons with moderate disability, clinicians will be able to prescribe a meaningful strategy for this underserved group of MS patients. Moreover, the intervention may delay the development of disability in individuals who are less affected by the disease. The outcomes of this feasibility study will suggest directions for subsequent R01 projects.

描述（由申请人提供）：多发性硬化症 (MS) 导致的活动能力逐渐下降可归因于两个因素：神经系统产生足够肌肉激活信号的能力下降以及身体调节水平下降这是由于久坐的生活方式的发展造成的。锻炼计划可以通过降低身体状况不佳的程度来提供一定的缓解，但仅限于残疾程度较低的个人。对于行走能力有限的中度残疾的多发性硬化症患者，没有有效的对策。为了解决这一知识差距，我们将检查通过新型神经肌肉电刺激 (NMES) 引起腿部肌肉不自主收缩的干预措施的有效性。传统的 NMES 主要使用窄（0.2-0.5 ms）刺激脉冲激活运动轴突，但不能改善 MS 患者的步行表现。作为替代方法，我们将使用宽（1 ms）刺激脉冲来激活运动轴突和感觉轴突，从而调节脊髓和皮质神经元的兴奋性，以促进神经系统运动功能的恢复。主要结果是步行耐力，量化为 6 分钟内步行的距离。参与者（n = 30，18-55 岁）将是被诊断患有多发性硬化症且表现出临床定义的中度残疾的个体。研究设计包括对窄脉冲和宽脉冲 NMES 治疗对步行表现的影响进行为期 6 周（18 个疗程）的随机、评估者盲法比较，然后在 6 个月的随访期间保留步行耐力的增益。基于宽脉冲 NMES 对健康志愿者的急性影响，干预措施将包括用耐受性良好的电流单独刺激每条腿，进行 30 组刺激（20 秒开启，20 秒关闭），产生次最大力（最大~20%）。我们将评估两个假设： H1：用宽脉冲 NMES 治疗中度残疾 MS 患者比用窄脉冲 NMES 治疗更能改善步行耐力。 H2：步行耐力的改善与习惯性身体活动水平的提高有关，这种水平在治疗后将保持更长时间宽脉冲 NMES 组与窄脉冲 NMES 组相比。我们预计宽脉冲 NMES 比窄脉冲 NMES 能在步行耐力方面产生更大的改善，并且收益与以下因素相关：（1）步行期间腿部肌肉的持续肌电图（EMG）活动； (2)改善步行经济性； (3) 增加步幅。如果宽脉冲 NMES 能够在临床上显着改善中度残疾患者的活动能力和生活质量，那么临床医生将能够为这一服务不足的 MS 患者群体制定有意义的策略。此外，干预措施可能会延缓受疾病影响较小的个体残疾的发展。本次可行性研究的成果研究将为后续 R01 项目提出方向。