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

• 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
• 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

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）发生的迁移率的逐渐下降归因于两个因素：神经系统产生足够的肌肉激活信号的能力降低，并降低了由于久坐不变的生活方式而导致的身体状况水平降低。锻炼计划可以通过降低调节水平，但仅适用于残疾水平较低的人来提供一些缓解。对于中度残疾的MS患者而言，步行性能局限性的人没有有效的对策。为了解决这一知识差距，我们将研究一种干预措施的有效性，该干预措施以一种新型的神经肌肉电刺激（NMES）唤起腿部肌肉中的非自愿收缩。常规NME主要使用狭窄（0.2-0.5 ms）刺激脉冲激活运动轴突，但不能改善MS人的步行性能。作为另一种方法，我们将使用宽（1毫秒）的刺激脉冲来激活运动轴突和感觉轴突，从而调节脊柱和皮质神经元的兴奋性，以促进神经系统中运动功能的恢复。主要结果将是行走耐力，该耐力将在6分钟内行走时进行量化。参与者（n = 30，18 - 55年）将是被诊断出患有临床定义中等残疾水平的MS的个体。研究设计包括6周（18次），随机评估者对步行性能的狭窄和宽脉冲NME治疗的比较，然后在6个月的随访中保留步行耐力的收益。基于宽脉冲NME在健康志愿者中所证明的急性效应，干预措施将用30列刺激（20 s on，20 s off）单独刺激每条腿，并具有良好的电流，从而引发了次宏（最大值）。我们将评估两个假设：H1：对宽脉冲NME的中度残疾MS患者的治疗比使用狭窄的脉冲NME的治疗更能改善步行耐力。 H2：步行耐力的改善将与治疗后将保持更长的习惯性体育锻炼水平相关 与狭窄的脉冲NMES组相比，宽脉冲NMES组的末端。我们预计，宽脉冲NME会比狭窄的脉冲NME产生更大的步行耐力，并且收益与：（1）步行过程中腿部肌肉的持续肌电图（EMG）活性； （2）步行经济改善； （3）步幅长度增加。如果广泛的NME可以为中度残疾患者提供临床上的移动和生活质量改善，那么临床医生将能够为这一服务不足的MS患者开出有意义的策略。此外，干预可能会延迟受疾病影响较小的个体的残疾发展。这种可行性的结果 研究将为随后的R01项目提出指示。