Evaluating Neural Adaptation after Tendon Transfer and Task-based Training in SCI

评估 SCI 肌腱转移和基于任务的训练后的神经适应

• 批准号: 9085129
• 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: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9085129
• 关键词: Acute; Address; Area; Base of the Brain; Biofeedback; Brain; Caring; Cervical; Cervical spine; Chronic; Data; Distal; Education; Effectiveness; Elbow; Evaluation; Feedback; Flexor; Functional Magnetic Resonance Imaging; Future; Goals; Hand; Home environment; Image; Individual; Injury; Intervention; Investigation; Isometric Exercise; Lateral; Lead; Learning; Length of Stay; Location; Measurement; Measures; Medical; Motor; Motor Cortex; Muscle; Neural Pathways; Operative Surgical Procedures; Outcome; Outcome Measure; Paralysed; Participant; Patient Self-Report; Patients; Pattern; Performance; Persons; Pilot Projects; Population; Postoperative Period; Posture; Procedures; Production; Protocols documentation; Psychological Transfer; Quadriplegia; Quality of life; Recovery; Recovery of Function; Rehabilitation therapy; Research Design; Specificity; Spinal cord injury; Spinal cord injury patients; Techniques; Tendon Transfer; Tendon structure; Thumb structure; Training; Training Programs; Translating; United States; Upper Extremity; Wit; Work; base; blood oxygen level dependent; conventional therapy; cost; design; evidence base; functional gain; functional outcomes; functional status; grasp; improved; motor control; motor learning; neural patterning; neuroadaptation; neuroimaging; neuromuscular system; novel; programs; prospective; public health relevance; relating to nervous system; response; secondary analysis; sensory cortex; successful intervention; tool

 DESCRIPTION (provided by applicant): A common procedure to restore lateral pinch strength to persons with C5/6 tetraplegia is to transfer the distal tendon of the brachioradialis muscle to the tendon of the paralyzed flexor pollicis longus muscle (Br to FPL). Conventional post-surgical care is not well defined and some individuals are discharged before receiving a directed therapy program due to limitations in hospital stay. After surgery, the transferred Br is not fully activated to perform pinch tasks. Undoubtedly, this is one factor that leads to a range of functional outcomes, despite a successful surgery, that may be addressed by a focused re-training program. The mechanism(s) underlying successful re-training of the transferred muscle to perform a new task are unknown and may involve both motor and neural adaptation. Recent evidence suggests that task-based therapy can result in improved upper limb function by strengthening the existing neural connections and/or forming new ones. The proposed study will assess the neural response to a task-based therapy program for muscle re-education for Br to FPL tendon transfer recipients. This proposed pilot project is a critical step towards the broader objective to improve functional outcomes of tendon transfer procedures in tetraplegia. The purpose of the study is to obtain pilot data consisting of functional magnetic resonance imaging (fMRI) and functional performance measures to evaluate neural predictors and correlates of successful muscle re- education after tendon transfer. The participants will have chronic cervical SCI and have received a tendon transfer or meet the surgical criteria for transfer surgery. Patterns of neural activity from Br to FPL transfer recipients will be assessed (i) in those with poor versus good outcomes and (ii) before and after participating in the task-based therapy program designed to improve voluntary activation of the transferred Br in functional pinch tasks. Functional performance measures include quantitative electromyographic (EMG) measures of voluntary activation of the transferred Br, maximum effort pinch force in selected functional tasks, and a self- reported performance measure. The specific objectives are to: evaluate muscle re-education after Br to FPL transfer in individuals with good and poor outcomes, and to determine if the pattern of neural activity after the training program is comparable to those individuals wit higher pinch force measurements. The task-based training program is part of an ongoing study to improve Br to FPL surgical outcomes and preliminary results indicate positive changes in pinch force production and activation of the transferred Br in coordination with proximal muscles during functional tasks. Neuroimaging techniques, such as functional magnetic resonance imaging (fMRI) have become important tools for understanding plasticity in the neuromuscular system and for assessing the neural changes in response to novel interventions. We propose that a directed task-based training program after Br to FPL transfer will drive neural changes that impact functional (pinch) ability. Establishing this relationship will allow for increased understanding of the mechanisms of successful interventions in patients and will suggest brain based dynamics that could be the focus of future treatments, such as biofeedback or brain stimulation. A more effective post-surgical rehabilitation program will lead to improved long-term functional outcomes following tendon-transfer 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. 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 surgical outcomes through task-based training.

 描述（由申请人提供）： 恢复 C5/6 四肢瘫痪患者侧向捏力的常见手术是将肱桡肌远端肌腱转移至瘫痪的屈肌长肌腱（Br 至 FPL）。传统的术后护理尚无明确定义。有些人由于住院时间的限制，在接受定向治疗计划之前就出院了，转移的 Br 没有完全激活来执行捏夹任务，这就是其中之一。尽管手术成功，但导致一系列功能结果的因素可以通过集中的再训练计划来解决。成功地再训练转移的肌肉以执行新任务的机制尚不清楚，并且可能是这样的。最近的证据表明，基于任务的治疗可以通过加强现有的神经连接和/或形成新的神经连接来改善上肢功能。用于肌肉再教育 Br 至 FPL 肌腱转移这个拟议的试点项目是朝着更广泛的改善目标迈出的关键一步。 四肢瘫痪肌腱移植手术的功能结果是获得由功能性磁共振成像（fMRI）和功能表现测量组成的初步数据，以评估肌腱移植后成功肌肉再教育的神经预测因子和相关性。患有慢性颈椎 SCI 并已接受肌腱移植或符合从 Br 到 FPL 移植接受者的神经活动模式的评估将在 (i) 预后不良与良好的患者中进行评估，以及 (ii) 在移植手术之前和之后进行评估。参加基于任务的治疗计划，旨在改善功能性捏任务中转移的 Br 的自愿激活 功能表现测量包括转移的 Br 的自愿激活的定量肌电图 (EMG) 测量、选定功能任务中的最大捏力以及自我调节。报告的具体目标是：评估从 Br 转移到 FPL 后结果良好和较差的个体的肌肉再教育，并确定训练计划后的神经活动模式是否与那些具有较高捏力的个体具有可比性。基于任务的训练。该项目是一项正在进行的研究的一部分，该研究旨在改善 Br 至 FPL 手术结果，初步结果表明，在功能性任务期间，捏力产生和转移的 Br 与近端肌肉协调的激活发生了积极变化，例如功能性磁共振成像 (fMRI)。 ）已成为理解神经肌肉系统可塑性和评估对新干预措施的神经变化的重要工具，我们建议在 Br 到 FPL 转移后进行基于任务的定向训练计划将驱动影响功能（捏）能力的神经变化。 .建立这种关系将有助于加深对患者成功干预机制的理解，并表明基于大脑的动力学可能成为未来治疗的重点，例如生物反馈或大脑刺激，更有效的术后康复计划将导致长期改善。 - 急性和慢性脊髓损伤患者肌腱移植后的长期功能结果将用于更广泛的研究设计，以对从拟议试点中获得的重点康复干预的效果进行前瞻性调查。 研究将用于提出假设和统计能力，以指导全面研究，以评估通过基于任务的培训改善手术结果的能力。