High-density Surface EMG Assessment of Motor Unit Alterations of the External Anal Sphincter Associated with Aging

高密度表面肌电图评估与衰老相关的肛门外括约肌运动单位改变

• 批准号: 9566428
• 负责人: Yingchun Zhang
• 金额: $ 20.54万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9566428
• 关键词: Affect; Aging; Anatomy; Biofeedback; Communities; Defecation; Defect; Elderly; Electric Stimulation; Electromyography; Esthesia; Estimation Techniques; External anal sphincter structure; Functional disorder; Future; Goals; Image; Imaging Techniques; Individual; Injury; Intramuscular; Magnetic Resonance Imaging; Manometry; Measures; Motor; Muscle; Myopathy; Nature; Nerve; Neural Conduction; Neuropathy; Normal Range; Operative Surgical Procedures; Pattern; Phenotype; Physiological; Population; Recruitment Activity; Rectum; Reflex action; Reproducibility; Research; Rest; Spatial Distribution; Sphincter; Surface; Techniques; Testing; Therapeutic; Time; Ultrasonography; Woman; age effect; aged; clinically significant; density; imaging study; minimally invasive; nerve supply; neuromuscular; neuromuscular function; novel; predictive tools; pressure; relating to nervous system; signal processing; sphincter ani muscle structure; Affect; Aging; Anatomy; Biofeedback; Communities; Defecation; Defect; Elderly; Electric Stimulation; Electromyography; Esthesia; Estimation Techniques; External anal sphincter structure; Functional disorder; Future; Goals; Image; Imaging Techniques; Individual; Injury; Intramuscular; Magnetic Resonance Imaging; Manometry; Measures; Motor; Muscle; Myopathy; Nature; Nerve; Neural Conduction; Neuropathy; Normal Range; Operative Surgical Procedures; Pattern; Phenotype; Physiological; Population; Recruitment Activity; Rectum; Reflex action; Reproducibility; Research; Rest; Spatial Distribution; Sphincter; Surface; Techniques; Testing; Therapeutic; Time; Ultrasonography; Woman; age effect; aged; clinically significant; density; imaging study; minimally invasive; nerve supply; neuromuscular; neuromuscular function; novel; predictive tools; pressure; relating to nervous system; signal processing; sphincter ani muscle structure

Abstract The external anal sphincter (EAS) is essential for maintaining fecal continence, which affects 6% to 19% of elderly individuals aged 65 years and older living in the community. Aging significantly affects anorectal function both neurogenically and myogenically. However, there is an unmet need of advanced and less- invasive approaches to quantitatively and objectively evaluate the neuromuscular function of the EAS. Anorectal imaging techniques with ultrasound or magnetic resonance imaging provide useful information in detecting anatomical defects in the EAS, but they are not capable of detecting neurogenic injuries. Intramuscular electromyography (EMG) is the only technique available for documenting neurogenic sphincter injury, but its application is limited by its highly invasive nature, poor repeatability and inability to describe global innervation. Pudendal nerve terminal motor latency has several limitations including the fact that a normal latency time does not exclude neuropathy and its clinical significance remains controversial. Anorectal manometry measures pressures of the anal sphincter muscles, sensation in the rectum, and neural reflexes that are necessary for normal bowel movements. However, normal ranges of various parameters measured are highly variable and poorly reproducible. The goal of this project is to develop a minimally invasive EAS innervation pattern characterization technique using the most recent advances in high-density (HD) surface EMG recording and signal processing techniques, to quantitatively and objectively assess the neuromuscular function of the EAS, 1) at rest when only tonic activities are present, 2) during voluntary contraction when motor units are selectively recruited, and 3) under supramaximal pudendal stimulation when all motor units are simultaneously activated, as well as to investigate specific alterations of the EAS innervation associated with aging. This research represents the first effort to quantitatively and objectively characterize the innervation patterns of the EAS under three different physiological conditions. The innervation patterns of the EAS characterized at rest, during voluntary contraction and under supramaximal pudendal nerve stimulation provide specific EAS function information associated with the resting tone, voluntary activation and global innervation of the EAS respectively. Aging effects on specific changes of the EAS innervation under these three conditions will be investigated. The proposed EAS innervation pattern characterization technique will serve as a novel phenotyping and predictive tool for anorectal dysfunctions caused by neurogenic weaknesses of the EAS. The results will advance our understanding of the pathophysiology of anorectal neuromuscular dysfunctions associated with aging, will also have clinical significance with regard to future therapeutic “choice” of biofeedback or surgical intervention.

抽象的 外部肛门括约肌（EAS）对于维持粪便持续性至关重要，这影响了6％至19％ 在社区中居住的65岁及65岁以上的老体中。衰老显着影响厌食症 在神经源和肌遗传上既有功能。但是，没有满足的高级和更少的需求 侵入性的方法，用于定量和客观地评估EAS的神经肌肉功能。 具有超声或磁共振成像的厌食直肠成像技术可提供有用的信息 检测EA中的解剖缺陷，但它们无法检测神经源性损伤。 肌内肌电图（EMG）是记录神经源性括约肌的唯一技术 受伤，但其应用受到高度侵入性的限制，可重复性差和无法描述 全球神经。 Pudendal神经末端运动潜伏期有几个局限性，包括一个事实 正常的潜伏期不排除神经病，其临床意义仍然存在争议。厌食 测量法测量肛门括约肌的压力，直肠的感觉和神经反射 这是正常的排便运动所必需的。但是，测量的各种参数的正常范围 高度可变且再现不佳。 该项目的目的是开发一种微创的EAS神经支配模式表征 使用高密度（HD）表面EMG记录和信号处理的最新进展的技术 技术，定量和客观地评估EAS的神经肌肉功能，1）在静止 只有补品活动，2）在自愿收缩期间，当运动单元被选择性地招募时，并且 3）当所有电动机单位被简单地激活时，以及 研究与衰老相关的EAS神经的特定改变。 这项研究代表了定量和客观地表征神经的第一个努力 在三种不同的物理条件下EA的模式。 EAS的神经支配模式 在休息时，在自愿收缩和在超大巨大神经刺激下的表征 特定的EAS功能信息与静息音，自愿激活和全局神经有关 EAS分别。在这三个条件下对EAS神经的特定变化的衰老影响 将被调查。提出的EAS神经支配模式表征技术将作为一种新颖 EAS神经源性弱点引起的厌恶功能障碍的表型和预测工具。这 结果将提高我们对厌食神经肌肉功能障碍的病理生理学的理解 与衰老相关，还将在未来的治疗性“选择”方面具有临床意义 生物反馈或手术干预。