Neuromuscular Mechanisms Underlying Poor Recovery from Whiplash Injuries

颈部扭伤恢复不良的神经肌肉机制

基本信息

批准号：
8762001
负责人：
James Matthew Elliott
金额：
$ 31.9万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
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：
2014-09-01 至 2019-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8762001
关键词：
Accident and Emergency department Adult American Ankle Anxiety Behavioral Biological Biological Factors Biomechanics Caring Centers for Disease Control and Prevention (U.S.)Cervical Chronic Clinical Combined Modality Therapy Complex Data Development Disease Education Emergency Medicine Employee Strikes Etiology Evaluation Fatty acid glycerol esters Foundations Functional disorder Future Goals Health Care Costs Hospitals Image Individual Injury Intervention Knowledge Leg Living Costs Lower Extremity Magnetic Resonance Imaging Measures Mediating Medical Mental Depression Methods Minority Modeling Motor Motor Neurons Motor Pathways Motor Vehicles Muscle Muscle Fatigue Muscle Weakness Muscular Atrophy Neck Nerve Degeneration Neural Pathways Outcome Pain Patients Pharmaceutical Preparations Physical therapy Physiological Play Process Psychosocial Factor Quality of life Recovery Recovery of Function Regimen Rehabilitation therapy Research Risk Role Science Sensory Signs and Symptoms Skeletal muscle structure of neck Spinal Spinal Cord Spinal cord injury Staging Study Subject Symptoms Testing Time United States Ursidae Family Whiplash Injuries Work base cohort coping cost disability expectation functional disability functional outcomes high risk improved injured interest neuromuscular neurophysiology novel prognostic psychologic psychological distress psychosocial public health relevance relating to nervous system social spinal pathway treatment strategy vehicular accident

项目摘要

DESCRIPTION (provided by applicant): Data from the Centers for Disease Control indicates that over 4-million adult drivers and passengers are treated in US emergency medicine departments annually for whiplash as the result of a motor-vehicle accident. While it is expected that many (> 50%) will recover within the first 2-3 months post injury, some (25%) will never fully recover. Estimated costs for medical and rehabilitative care for the 25% patients with poor functional recovery are ~$100 Billion annually and no treatments have shown to positively influence their outcomes. Unfortunately, in the vast majority of whiplash cases, structural damage on objective imaging is rarely present. Currently, the prevailing opinion is that poor functional recovery is largely influenced by social, psychological and behavioral factors and not biological. While this may be the case in some, our pilot data and previous work has, as a first, demonstrated the rapid and early expression of muscle fatty infiltrates on MRI, signs of disturbed descending control, and muscle weakness in the 25% of individuals with whiplash associated disorders (WAD) with poor functional recovery. The 75% of individuals that recover spontaneously following a whiplash do not manifest such signs and symptoms, suggesting a more severe injury with a biological etiology, in the chronic group. These complex signs and symptoms bear striking similarities to non-WAD patients with incomplete spinal cord injury (iSCI); raising the possibility that chronic WAD is an expression of an initial mild injury to the spinal cord. Both groups present with a paralleled expression of muscle fatty infiltrates, signs of disturbed descending control, psychological distress, and muscle weakness. As such, the goal of this proposal is to test our central hypothesis that chronic WAD is an expression of a mild iSCI. We propose to combine biomechanical, electrophysiological and radiological measures to demonstrate that losses in spinal neural substrate, increased fatty infiltrates in select neck and lower extremity muscles, and the inability to properly activate ankle muscles in patients with chronic WAD is an expression of a mild iSCI. The long-term goals of this research is to improve outcomes in WAD, but before this can be realized, it is crucial we 1) understand the neurophysiological mechanisms underlying poor functional recovery in the 25% of individuals with a seemingly more complex injury and 2) consider and integrate the bio-psycho-social drivers of the clinical course on a patient-by-patient basis. This new knowledge will set the stage for future studies investigating more objective and integrated assessments as well as the development of targeted science-based interventions for a cohort that does not respond well to current intervention strategies.

描述（由申请人提供）：美国疾病控制中心的数据表明，每年有超过 400 万成年驾驶员和乘客因机动车事故造成颈部扭伤而在美国急诊医学部门接受治疗。虽然预计许多人 (> 50%) 将在受伤后的前 2-3 个月内康复，但有些人 (25%) 永远不会完全康复恢复。 25% 功能恢复不佳的患者每年的医疗和康复护理费用估计约为 1000 亿美元，而且没有任何治疗方法可以对其结果产生积极影响。不幸的是，在绝大多数颈部扭伤病例中，很少出现客观成像的结构损伤。目前，普遍的观点是功能恢复不良很大程度上是受到社会、心理和行为因素的影响，而不是生物因素。虽然某些人可能会出现这种情况，但我们的试验数据和之前的工作首先证明了 MRI 上肌肉脂肪浸润的快速和早期表达、下降控制紊乱的迹象以及 25% 的个体中的肌肉无力。颈椎扭伤相关疾病（WAD），功能恢复不良。 75% 的颈椎扭伤后自行恢复的个体并没有表现出此类体征和症状，这表明慢性组中存在更严重的生物病因损伤。这些复杂的体征和症状与不完全脊髓损伤 (iSCI) 的非 WAD 患者有着惊人的相似之处；增加了慢性 WAD 是脊髓最初轻度损伤的表现的可能性。两组均出现肌肉脂肪浸润的平行表达，下降控制紊乱、心理困扰和肌肉无力。因此，本提案的目标是检验我们的中心假设，即慢性 WAD 是轻度 iSCI 的表现。我们建议结合生物力学、电生理学和放射学措施来证明慢性 WAD 患者的脊髓神经基质损失、特定颈部和下肢肌肉脂肪浸润增加以及无法正确激活踝关节肌肉是轻度 iSCI 的表现。这项研究的长期目标是改善 WAD 的结果，但在实现这一目标之前，至关重要的是我们 1) 了解 25% 的看似更复杂损伤的个体功能恢复不良的神经生理学机制，以及 2 ）根据每个患者的情况考虑并整合临床过程的生物心理社会驱动因素。这些新知识将为未来的研究将调查更客观和综合的评估，并针对当前干预策略反应不佳的人群制定有针对性的基于科学的干预措施。