Grasping Function after Spinal Cord Injury

脊髓损伤后的抓握功能

• 批准号: 10407497
• 负责人: Monica A Perez
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10407497
• 关键词: Acoustics; Affect; Amyotrophic Lateral Sclerosis; Animals; Area; Behavior; Behavioral; Brain; Brain Stem; Caregivers; Caring; Cervical spinal cord injury; Cervical spinal cord structure; Data; Dorsal; Eating; Effectiveness; Fingers; Functional Magnetic Resonance Imaging; Future; Goals; Hand; Hand functions; Human; Impairment; Individual; Injury; Intervention; Investigation; Knowledge; Lesion; Life; Loudness; Measures; Methods; Motor; Motor Cortex; Motor Evoked Potentials; Movement; Multiple Sclerosis; Muscle; Neuronal Plasticity; Neurons; Outcome; Output; Pathway interactions; Persons; Physiologic pulse; Physiological; Protocols documentation; Quality of life; Reaction Time; Recovery; Rehabilitation therapy; Residual state; Spinal cord injury; Sterile coverings; Stimulus; Testing; Time; Training; Transcranial magnetic stimulation; Veterans; Work; Writing; experimental study; finger movement; grasp; hand rehabilitation; improved; indexing; motor disorder; motor impairment; noninvasive brain stimulation; novel; novel strategies; operation; post stroke; rehabilitation strategy; repetitive transcranial magnetic stimulation; skills; success; transmission process

Grasping behaviors, which are essential for daily-life functions, are largely impaired in individuals with cervical spinal cord injury (SCI). Although rehabilitative interventions have shown success in improving the ability to grasp following injury their overall effects remain limited. The goals of this proposal are to examine the contribution of physiological pathways to the control of grasping behaviors after cervical SCI, and to maximize the recovery of grasping by using tailored non-invasive stimulation protocols with motor training. We propose to study two basic grasping behaviors: a precision grip and a power grip. These behaviors are crucial because they provide the basis for a number human prehensile manipulations and are also necessary skills for eating, writing, dressing, and many other functions. Thus, our results may have a direct impact on the quality of life for veterans and their caregivers by enhancing their independence and level of care. In Aim 1, we will investigate the contribution of corticospinal and brainstem pathways to the control of hand muscles involved in precision and power grip after cervical SCI. Transcranial magnetic stimulation (TMS) will be used to examine transmission in corticospinal and intracortical pathways targeting finger muscles and an acoustic startle stimulus with and without TMS will be used to examine the contribution from brainstem pathways. Functional magnetic resonance imaging (fMRI) will be used to further assess changes in brain activity during these hand motor tasks. In Aim 2, we propose to enhance the recovery of grasping by using novel tailored protocols of non-invasive repetitive TMS targeting late indirect (I) descending volleys (iTMS) and an acoustic startle stimuli. iTMS and startle will be used during precision and power grip movements in a task-dependent manner to induce cortical and subcortical plasticity and enhance voluntary output of hand muscles (Aim 2a). Later, iTMS and startle will be applied in a task-dependent manner during a motor training task that involves precision and power grip (Aim 2b). These unique approaches aim at promoting neuroplasticity during functionally relevant grasping movements has not been used before. The proposed experiments will provide new knowledge on mechanisms of grasping functions which will be used to guide functionally-relevant plasticity-inducing protocols to enhance recovery of hand function. The absence of well-accepted treatments for grasping motor impairments for veterans with cervical SCI and the limited behavioral gains of present interventions underline the importance of these investigations.

对于日常生活功能至关重要的抓握行为在患有以下疾病的个体中很大程度上受到损害 颈脊髓损伤（SCI）。尽管康复干预已在提高能力方面取得了成功 要了解受伤后的情况，它们的总体影响仍然有限。该提案的目标是审查 生理途径对颈椎 SCI 后抓握行为控制的贡献，并最大化 通过使用定制的非侵入性刺激方案和运动训练来恢复抓握能力。我们建议 研究两种基本的抓握行为：精确抓握和强力抓握。这些行为至关重要，因为它们 为许多人类抓握操作提供了基础，也是饮食、写作、 穿衣等多种功能。因此，我们的结果可能会对退伍军人的生活质量产生直接影响 和他们的照顾者，通过提高他们的独立性和护理水平。 在目标 1 中，我们将研究皮质脊髓和脑干通路对控制 手部肌肉参与颈椎 SCI 后的精确握力和力量握力。经颅磁刺激（TMS） 将用于检查针对手指肌肉的皮质脊髓和皮质内通路的传输以及 使用和不使用 TMS 的声惊吓刺激将用于检查脑干通路的贡献。 功能磁共振成像（fMRI）将用于进一步评估期间大脑活动的变化 这些手部运动任务。在目标 2 中，我们建议通过使用新颖的定制方法来增强抓取的恢复 针对晚期间接 (I) 下降截击 (iTMS) 和声学的非侵入性重复 TMS 协议 惊吓刺激。 iTMS 和 startle 将用于任务相关的精确和力量握力运动 诱导皮质和皮质下可塑性并增强手部肌肉的自主输出（目标 2a）。 随后，iTMS 和 startle 将以任务相关的方式应用于运动训练任务，其中涉及 精确度和力量握力（目标 2b）。这些独特的方法旨在促进功能性神经可塑性 以前没有使用过相关的抓取动作。 所提出的实验将提供有关抓取功能机制的新知识，这将 用于指导功能相关的可塑性诱导方案，以增强手部功能的恢复。这 对于颈椎 SCI 退伍军人的抓握运动障碍，缺乏公认的治疗方法 目前干预措施的行为收益有限，凸显了这些调查的重要性。