Epidural spinal cord stimulation and respiratory motor function after injury

硬膜外脊髓刺激与损伤后呼吸运动功能

• 批准号: 10583576
• 负责人: Alexander Vladimirovich Ovechkin
• 金额: $ 76.62万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583576
• 关键词: Activities of Daily Living; Acute; Blood Pressure; Breathing; COVID-19; Cardiovascular system; Chronic; Clinical; Complication; Data; Development; Effectiveness of Interventions; Electromyography; Electrophysiology (science); Evaluation; Goals; Heart Rate; Human; Individual; Injury; Knowledge; Lead; 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; novel therapeutic intervention; preservation; pressure; rehabilitation strategy; respiratory; response; restoration; standard of care; 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 by the levels of functional capacity preserved below the neurological level of injury. Our preliminary data obtained for this proposal demonstrate that electrical spinal cord stimulation applied epidurally at the lumbar level in combination with respiratory can activate and re-organize spinal motor networks for respiration. We propose to investigate respiratory motor control-related responses to epidural 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 epidural spinal cord stimulation on respiratory functional and motor control properties; and 2) Evaluate the effectiveness of epidural 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，这种干预的有效性受到功能水平的限制。 损伤神经水平以下保留的能力。我们为此提案获得的初步数据 证明在腰部水平硬膜外施加脊髓电刺激与 呼吸可以激活和重新组织呼吸的脊髓运动网络。我们建议调查 对单独硬膜外脊髓刺激和联合硬膜外脊髓刺激的呼吸运动控制相关反应 呼吸训练。通过使用表面表征呼吸肌激活模式 肌电图与肺功能和相关心血管测量相关，我们期望 确定将脊髓兴奋性提高到损伤水平以下所需的特定刺激参数 增强对受伤后保留的脊髓上中枢输入的反应，并促进神经 由呼吸训练驱动的可塑性。该假设将通过追求两个具体目标来检验：1） 评估硬膜外脊髓刺激对呼吸功能和运动控制的急性影响 特性; 2) 评估硬膜外脊髓刺激联合呼吸的有效性 训练。