Targeted intraspinal stimulation for restoration of limb movement following spina

有针对性的脊柱内刺激以恢复脊柱后的肢体运动

• 批准号: 8803824
• 负责人: Luis Lujan
• 金额: $ 19.88万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8803824
• 关键词: Address; Affect; Animal Model; Animals; Cannulas; Cell Nucleus; Clinical; Development; Disease; Electric Stimulation; Electrodes; Emerging Technologies; Engineering; Ensure; Family suidae; Fatigue; Flexor; Freedom; Goals; Hand functions; Health; Hip Joint; Hip region structure; Horns; Human; Implant; Individual; Injury; Intramuscular; Knee; Knee joint; Limb structure; Location; Lumbar spinal cord structure; Magnetic Resonance Imaging; Manuals; Maps; Mediating; Methods; Microelectrodes; Modeling; Motor; Motor Neurons; Movement; Muscle; Muscle Contraction; Muscle Fatigue; Navigation System; Nerve; Neuroanatomy; Neurologic; Neurons; Neurostimulation procedures of spinal cord tissue; Operative Surgical Procedures; Outcome; Paralysed; Peripheral Nerves; Population; Positioning Attribute; Quality of life; Resistance; Resolution; Sensory; Skeletal Muscle; Spinal; Spinal Cord; Spinal Injuries; Spinal cord grey matter structure; Spinal cord injury; Structure; Surgeon; System; Techniques; Technology; Therapeutic; Translating; Translations; Work; base; clinical efficacy; design; experience; functional restoration; image guided; improved; instrument; intraspinal microstimulation; joint mobilization; limb movement; meetings; microstimulation; millimeter; nonhuman primate; prevent; response; restoration; retinal rods; sample fixation; skills; success; targeted delivery

DESCRIPTION (provided by applicant): Restoration of limb movement following spinal cord injury (SCI) has been achieved using electrical stimulation of peripheral nerves and skeletal muscles. However, these stimulation techniques are limited by a rapid onset of muscle fatigue and by limited degrees of freedom that can be independently controlled using existing technology. Intraspinal microstimulation (ISMS) is an emerging technology that has shown significant potential for overcoming some of the limitations associated with electrical stimulation techniques. Specifically, intraspinal stimulation has been successful in evoking controlled limb movements in previously paralyzed limbs by directly activating motor neurons within the ventral gray matter of the spinal cord. State-of-the-art intraspinal microstimulation techniques rely on manual targeting of neuron populations and manual insertion of stimulating microelectrodes into the spinal cord. However, variance in neuroanatomy combined with differences in surgical strategy and skill can compromise clinical outcomes and prevent cross-study analysis. The goals of this proposal are to develop a targeting strategy for identifying motor neuron populations associated with specific target movements in a large animal model and demonstrate that targeted intraspinal stimulation can evoke controlled, reproducible, and sustained muscle contractions. In addition to evoking limb movements, the targeting and stimulation strategies proposed herein will allow characterization of spinal networks responsible for mediating motor function in a large animal. This in turn will allow optimization of stimulation paradigms for selective and coordinated recruitment of fatigue-resistant motor units. Moreover, it will allow ths technology to move closer to a clinical therapeutic system for human use.

描述（由申请人提供）：使用周围神经和骨骼肌的电刺激实现了脊髓损伤后肢体运动（SCI）的恢复。 但是，这些刺激技术受到肌肉疲劳的迅速发作和有限的自由度的限制，可以使用现有技术独立控制。 脊柱内微刺激（ISMS）是一种新兴技术，它显示出克服与电刺激相关的某些局限性的显着潜力 技术。 具体而言，通过直接在脊髓的腹侧灰质内直接激活运动神经元，脊柱内刺激已成功地唤起了先前瘫痪的肢体的受控肢体运动。 最先进的脊柱内微刺激技术依赖于神经元种群的手动靶向以及将刺激的微电极插入到脊髓中的手动插入。 但是，神经解剖学的差异与手术策略和技能的差异相结合可以损害临床结果并防止跨研究分析。 该提案的目标是制定针对性策略，以识别大型动物模型中与特定目标运动相关的运动神经元种群，并证明靶向的载体刺激可以唤起受控，可重现和持续的肌肉收缩。 除了唤起肢体运动外，此处提出的靶向和刺激策略还将允许表征负责介导大动物中运动功能的脊柱网络。 反过来，这将允许优化刺激范例，以选择性和协调抗疲劳的运动单元。 此外，这将使THS技术更靠近人类使用的临床治疗系统。