Neuromodulatory rehabilitation for respiratory motor function in individuals with chronic spinal cord injury

慢性脊髓损伤患者呼吸运动功能的神经调节康复

• 批准号: 10635519
• 负责人: Alexander Vladimirovich Ovechkin
• 金额: $ 37.14万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-10 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10635519
• 关键词: Activities of Daily Living; Acute; Blood Pressure; Breathing; COVID-19; Cardiovascular system; Chronic; Clinical; Complication; Cutaneous; Data; Development; Effectiveness of Interventions; Electromyography; Electrophysiology (science); Evaluation; Goals; Heart Rate; Human; Individual; Injury; Knowledge; Lesion; Lung; Measures; Methods; Modality; Morbidity - disease rate; Motor; Muscle; Neurologic; Neuronal Plasticity; Neurostimulation procedures of spinal cord tissue; Patients; Pattern; Physiological; Population; Property; Protocols documentation; Public Health; Pulmonary function tests; Randomized Controlled Clinical Trials; Rehabilitation therapy; Research; Respiration; Respiration Disorders; Respiratory Muscles; Respiratory physiology; Spinal; Spinal Cord; Spinal Cord Lesions; Spinal cord injury; Surface; Testing; Therapeutic Effect; Time; Training; Vertebral column; Work; comparative; design; disability; effectiveness evaluation; evidence base; fighting; follow-up; functional improvement; functional outcomes; improved; kinematics; mortality; motor control; neural network; neuroregulation; novel therapeutic intervention; preservation; pressure; rehabilitation strategy; respiratory; response; restoration; standard of care; transcutaneous stimulation; voltage

Project Summary/Abstract Respiratory motor control deficit is the leading cause of morbidity and mortality in patients with spinal cord injury. The long-term goal of this research is to develop a rehabilitation strategy for respiration in patients with spinal cord injury as a standard of care. Our previous findings demonstrate that respiratory function in patients with chronic spinal cord injury can be improved by using our original inspiratory-expiratory pressure threshold respiratory training protocol. However, the effectiveness of this intervention is limited to the amount of functional capacity preserved below the neurological level of injury. Our preliminary data obtained for this proposal demonstrate that electrical spinal cord stimulation applied non-invasively to target spinal respiratory circuits in combination with respiratory training can activate and re-organize spinal motor networks for respiration. We propose to investigate respiratory motor control-related responses to transcutaneous spinal cord stimulation alone and in combination with respiratory training. By characterization of respiratory muscle activation patterns using surface electromyography in association with pulmonary functional and related cardiovascular measures, we expect to determine specific stimulation parameters needed to increase spinal excitability below level of injury to enhance responses to the input from supraspinal centers that remain after injury and to promote the neural plasticity driven by the respiratory training. This hypothesis will be tested by pursuing two Specific Aims: 1) Evaluate the acute effects of transcutaneous spinal cord stimulation on respiratory functional and motor control properties; and 2) Evaluate the effectiveness of transcutaneous spinal cord stimulation combined with respiratory training.

项目概要/摘要 呼吸运动控制缺陷是脊髓患者发病和死亡的主要原因 受伤。这项研究的长期目标是为患有呼吸困难的患者制定呼吸康复策略 脊髓损伤作为护理标准。我们之前的研究结果表明患者的呼吸功能 慢性脊髓损伤可以通过使用我们原始的吸气-呼气压力阈值来改善 呼吸训练协议。然而，这种干预措施的有效性仅限于干预措施的数量。 功能能力保留在损伤的神经水平以下。我们为此获得的初步数据 该提案表明，脊髓电刺激可无创地应用于目标脊髓呼吸 循环与呼吸训练相结合可以激活和重新组织脊髓运动网络 呼吸。我们建议研究经皮脊髓的呼吸运动控制相关反应 单独或与呼吸训练相结合的脊髓刺激。通过呼吸肌的表征 使用表面肌电图激活模式与肺功能和相关 心血管措施，我们期望确定增加脊柱所需的特定刺激参数 低于损伤水平的兴奋性，以增强对损伤后保留的脊髓上中枢输入的反应 损伤并促进呼吸训练驱动的神经可塑性。这个假设将被检验 追求两个具体目标：1）评估经皮脊髓刺激对 呼吸功能和运动控制特性； 2) 评估经皮脊柱的有效性 脊髓刺激与呼吸训练相结合。