Evaluating Upper Limb Motor Control after Tendon Transfer and Task-Based Therapy

评估肌腱转移和基于任务的治疗后的上肢运动控制

• 批准号: 8990394
• 负责人: Mary Elise Johanson
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8990394
• 关键词: Acute; Address; Bladder; Caring; Cervical spinal cord injury; Chronic; Clinical; Conventional Surgery; Data; Education; Effectiveness; Elbow; Evaluation; Exhibits; Flexor; Floor; Future; Goals; Healed; Healthcare Systems; Home environment; Individual; Intervention; Intestines; Intramuscular; Investigation; Isometric Exercise; Lateral; Lead; Learning; Literature; Location; Measurable; Measurement; Measures; Medical; Methods; Mission; Motor; Muscle; Occupational; Operative Surgical Procedures; Outcome; Outcome Measure; Paralysed; Participant; Patients; Pattern; Performance; Pilot Projects; Postoperative Period; Posture; Procedures; Protocols documentation; Quadriplegia; Quality of life; Recovery; Rehabilitation therapy; Research Design; Role; Services; Sex Functioning; Signal Transduction; Societies; Spinal cord injury; Stroke; Task Performances; Techniques; Tendon Transfer; Tendon structure; Thumb structure; Time; Training; Training Programs; Translating; United States; Upper Extremity; Upper limb movement; Veterans; Work; base; clinically significant; conventional therapy; cost; evidence base; follow-up; functional outcomes; functional restoration; healing; improved; motor control; motor learning; neuroimaging; neuromuscular system; novel; patient population; programs; prospective; public health relevance; relating to nervous system; response; restoration

DESCRIPTION (provided by applicant): The proposed pilot project is a critical step towards the broader objective to improve functional outcomes of tendon transfer procedures in tetraplegia. Tendon transfers are surgical procedures in which the tendon of a muscle under voluntary control (donor muscle) is released from its insertion and is surgically attached to the tendon of a paralyzed muscle in order to restore function lost to paralysis. Individuals who undergo these procedures must learn to voluntarily activate the transferred muscle in its new anatomical location and more importantly to coordinate with new synergists during functional task performance. However, after surgery and conventional care, individuals do not fully activate the transferred muscle to perform its new function. Thus there is potential to advance rehabilitation programs that will improve surgical outcomes by improving postoperative performance with a muscle re-education and training program. Understanding how motor planning and control strategies determine postoperative upper limb function is essential for objective evaluation of current and prospective intervention protocols. The goal of this pilot project is to evaluate the effectiveness of a task-based home therapy program that follows tendon transfer to restore lateral pinch strength and conventional therapy. It is expected that a task-based program will address motor learning after transfer and result in improved voluntary activation of the transferred muscle as part of coordinated upper limb movements, important for producing pinch force in functional postures. Currently, patients must be discharged prior to receiving a focused re-training program. It is proposed that measurable increases in transferred muscle activation in functional postures will translate to improved upper limb performance. The specific objectives are to: 1. Evaluate the effectiveness of the proposed task-based home therapy program using clinical outcome measures to compare isometric pinch force magnitude, the ability to perform selected pinch tasks, and self- perceived performance before and after participation. 2. Assess training-related changes in the motor control of the transferred Br. Intramuscular EMG will be recorded to compare the activation of the transferred Br and the other elbow flexors during elbow flexion and pinch in various functional upper limb postures. The EMG will be quantified in terms of its magnitude and by using EMG decomposition to extract the recruitment and firing patterns of the active motor units. 3. Assess the effects of a task-based therapy for participants with different surgica outcomes to determine which individuals will benefit from task-based therapy and identify the mechanisms responsible for changes in motor performance. The ultimate goal of this work is to provide evidence that a task-based program should become part of the standard post-operative rehabilitation for individuals who receive tendon-transfer surgery. A more effective post-surgical rehabilitation program will lead to improved long-term functional outcomes following tendon- transfer and is intended to be effective in patients with both acute and chronic spinal cord injuries. These data will be used towards a broader study design for a prospective investigation of the effects of a focused rehabilitation intervention. The proposed time period for this pilot study is two years. Information gained from the proposed pilot study will be used to develop hypotheses and statistical power to guide a full-scale study to evaluate the capacity for improving tendon transfer surgical outcomes through task-based training. PUBLIC HEALTH RELEVANCE: The mission of the VA Palo Alto Health Care System, Spinal Cord Injury Service is "to provide comprehensive treatment to maximize functional independence, enhance quality of life, and assist the individual regain and maintain his or her role in society." Of the over 100,000 individuals in the United States who have spinal cord injuries resulting in tetraplegia, 22% are veterans. Recovery of upper limb function has been ranked higher than bladder, bowel, and sexual function in this patient population and is an important goal in rehabilitation that will reslt in decreased medical costs and improved quality of life. The proposed pilot study addresses the need to examine traditional approaches to restoring upper limb function by evaluating the effectiveness of a novel task-based therapy program after tendon transfer and conventional therapy. This study will contribute to understanding the motor learning strategies that determine upper limb function and may lead to evidence- based rehabilitation protocols for improving upper limb performance in tetraplegia.

描述（由申请人提供）： 拟议的试点项目是朝着改善四肢瘫痪肌腱转移手术的功能结果这一更广泛目标迈出的关键一步。肌腱转移是一种外科手术，其中将自愿控制的肌肉（供体肌肉）的肌腱从其插入处释放出来，并通过手术将其附着到瘫痪肌肉的肌腱上，以恢复因瘫痪而丧失的功能。接受这些手术的个人必须学会在新的解剖位置自愿激活转移的肌肉，更重要的是在功能任务执行过程中与新的协同剂协调。然而，在手术和常规护理之后，个体并没有完全激活转移的肌肉来执行其新功能。因此，有可能推进康复计划，通过肌肉再教育和训练计划改善术后表现，从而改善手术结果。了解运动规划和控制策略如何决定术后上肢功能对于客观评估当前和未来的干预方案至关重要。 该试点项目的目标是评估基于任务的家庭治疗计划的有效性，该计划在肌腱转移后恢复侧捏强度和常规治疗。预计基于任务的计划将解决转移后的运动学习问题，并导致转移肌肉的自愿激活得到改善，作为协调上肢运动的一部分，这对于在功能姿势中产生捏力很重要。目前，患者必须在接受集中再培训计划之前出院。有人提出，功能性姿势中转移肌肉激活的可测量增加将转化为改善上肢性能。 具体目标是： 1. 使用临床结果测量来比较等长捏力大小、执行选定捏捏任务的能力以及参与前后的自我感知表现，评估所提出的基于任务的家庭治疗计划的有效性。 2. 评估转移后的 Br 运动控制中与训练相关的变化。将记录肌内肌电图，以比较在各种功能性上肢姿势下肘部屈曲和捏捏期间转移的 Br 和其他肘部屈肌的激活情况。肌电图将根据其大小进行量化，并通过使用肌电图分解来提取活跃运动单位的募集和放电模式。 3. 评估基于任务的治疗对具有不同手术结果的参与者的效果，以确定哪些个体将从基于任务的治疗中受益，并确定导致运动表现变化的机制。 这项工作的最终目标是提供证据，证明基于任务的计划应该成为接受肌腱转移手术的患者标准术后康复的一部分。更有效的术后康复计划将改善肌腱移植后的长期功能结果，并且旨在对急性和慢性脊髓损伤患者有效。这些数据将用于更广泛的研究设计，以对重点康复干预的效果进行前瞻性调查。建议的时间段为 这项试点研究为期两年。从拟议的试点研究中获得的信息将用于制定假设和统计能力，以指导全面研究，以评估通过基于任务的培训改善肌腱转移手术结果的能力。 公共卫生相关性： VA 帕洛阿尔托医疗保健系统脊髓损伤服务中心的使命是“提供综合治疗，以最大限度地提高功能独立性，提高生活质量，并帮助个人重新获得并维持其在社会中的角色。”美国有超过 10 万名脊髓损伤导致四肢瘫痪的人，其中 22% 是退伍军人。在该患者群体中，上肢功能的恢复排名高于膀胱、肠道和性功能，是康复的一个重要目标，将导致医疗费用的降低和生活质量的提高。拟议的试点研究通过评估肌腱转移和常规治疗后基于任务的新型治疗计划的有效性，解决了检查恢复上肢功能的传统方法的需要。这项研究将有助于理解决定上肢功能的运动学习策略，并可能导致基于证据的康复方案，以改善四肢瘫痪的上肢表现。