Surgical and Rehabilitative Management of Facial Nerve Injury

面神经损伤的手术和康复治疗

• 批准号: 7949153
• 负责人: THERESA A HADLOCK
• 金额: $ 35.71万
• 依托单位: MASSACHUSETTS EYE AND EAR INFIRMARY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7949153
• 关键词: Affect; Anatomy; Animals; Architecture; Axon; Behavior; Behavioral; Blinking; Cell Volumes; Computer Assisted; Computers; Contralateral; Data; Denervation; Distal; Eating; Electric Stimulation; Elements; Face; Facial Expression; Facial Muscles; Facial Nerve Injuries; Facial nerve structure; Fibrosis; Goals; Human; Injury; Intervention; Laboratories; Learning; Measurement; Measures; Mechanical Stimulation; Mechanics; Methodology; Methods; Modality; Motivation; Motor; Motor Endplate; Motor output; Movement; Muscle; Muscle Cells; Muscular Atrophy; Natural regeneration; Nerve; Nerve Regeneration; Neurologic; Operative Surgical Procedures; Oral; Patient Participation; Patients; Peripheral nerve injury; Phase; Rattus; Recovery; Recovery of Function; Regimen; Rehabilitation therapy; Rewards; Robot; Rodent; Rodent Model; Schedule; Scheme; Sensory; Side; Source; System; Techniques; Therapeutic; Time; Training Programs; United States; Vibrissae; afferent nerve; axon regeneration; base; design; disability; improved; injured; injury and repair; nerve injury; nerve supply; neuron apoptosis; programs; promoter; psychologic; public health relevance; repaired; restoration; social; synergism; therapy design

DESCRIPTION (provided by applicant): Motor nerve injuries are often devastating; even the most sophisticated repair of an injured nerve rarely leads to satisfactory restoration of function. Damage to the facial nerve is particularly disabling because the ability to blink, eat, speak, and communicate through facial expressions are all dramatically affected. The associated severe facial disfigurement also has profound social and psychological consequences. Over the past five years, our laboratory has created a highly quantitative methodology for real-time measurement of recovery from facial nerve injury in the rodent. With this system we have demonstrated that several pharmacologic agents accelerate recovery, several do not, and that certain types of mechanical and electrical stimulation to the muscles and nerves, respectively, both accelerate and improve recovery from facial nerve injury. Recent findings in the field of rehabilitation strongly suggest that robot- or computer-assisted rehabilitation methods improve motor recovery after neurologic injury, particularly when the elements of motivation and learning are introduced into the therapeutic paradigm. By incorporating data from the precise level of patient function at any given point in recovery, and assuring patient participation via motivational strategies, customized sensorimotor rehabilitation has proven more effective than simple passive assistance therapies, which provide mechanical assistance irrespective of the subject's level of function. In this proposal, we apply and compare several different rehabilitative modalities to the regenerating rodent facial nerve after both axonotmesis (crush) and neurotmesis (cut) injuries. We will delivery oral reward therapy through successive approximations, in order to introduce the motivational element demonstrated to be an important factor in human motor recovery. We will also deliver different forms of passive assistance therapy (mechanical stimulation) to denervated muscles. We will compare fixed-schedule passive assistance therapy with customized, dynamic passive assistance therapy designed to respond to the rodent's normal and recovering behavior (i.e. externally moving the rat's anatomy in concert with their intended motor output), and will also examine combinations of both modalities together. In addition, we will examine the effect of preserving facial muscle architecture, via coaptation of a sensory nerve to the denervated muscle, on overall recovery following facial nerve injury and repair. PUBLIC HEALTH RELEVANCE: Peripheral nerve injuries are a source of enormous disability in the United States; the discovery of more effective ways of accelerating and improving recovery from these injuries would be of enormous benefit. Using a rodent model, we propose to employ computer-assisted, patient-specific sensory and motor rehabilitative therapy following facial nerve injury and repair, to measure its benefit and maximize its effect.

描述（由申请人提供）：运动神经损伤通常是毁灭性的；即使是最复杂的受伤神经修复，也很少导致功能的恢复令人满意。对面神经的损害特别是残疾，因为眨眼，饮食，说话和通过面部表情进行交流的能力都受到了巨大影响。相关的严重面部毁容也具有深远的社会和心理后果。在过去的五年中，我们的实验室创建了一种高度定量的方法，用于实时测量啮齿动物中面神经损伤的恢复。通过该系统，我们已经证明了几种药理学剂加速恢复，几个没有，并且分别对肌肉和神经的某些类型的机械和电刺激都加速并改善了面部神经损伤的恢复。康复领域的最新发现强烈表明，机器人或计算机辅助的康复方法可改善神经系统损伤后的运动恢复，尤其是当将动机和学习元素引入治疗范式中时。通过在康复中任何给定的任何点中合并患者功能的准确水平，并通过动机策略确保患者参与的数据，定制的感觉运动康复比简单的被动辅助疗法更有效，这些疗法与受试者功能水平无关。在此提案中，我们将几种不同的康复方式与轴突症（粉碎）和神经损伤（切割）损伤后的再生啮齿动物面神经进行了比较。我们将通过连续近似进行口腔奖励治疗，以引入激励元素，这是人类运动恢复的重要因素。我们还将提供不同形式的被动辅助疗法（机械刺激）来消除肌肉。我们将比较固定安排的被动辅助治疗与旨在应对啮齿动物正常和恢复行为的定制的，动态的被动辅助疗法（即外部移动大鼠的解剖结合其预期的运动输出），还将一起检查两种方式的组合。此外，我们将通过将感觉神经赋予被取消的肌肉，对面部神经损伤和修复后的整体恢复来检查保持面部肌肉结构的影响。 公共卫生相关性：外周神经损伤是美国巨大残疾的根源；发现更有效的加速和改善这些伤害恢复的方法将带来巨大的好处。使用啮齿动物模型，我们建议在面部神经损伤和修复后采用计算机辅助，特定于患者的感觉和运动康复治疗，以衡量其益处并最大程度地提高其效果。