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: 8919542
• 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/8919542
• 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; Relative (related person); 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; meetings; motor control; motor learning; nerve injury; neural patterning; neuroadaptation; neuroimaging; neuromuscular system; novel; programs; prospective; public health relevance; relating to nervous system; response; 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C5/6四倍体患者外侧捏强度的常见程序是将臂肌肌肉的独特肌腱转移到瘫痪的屈肌长肌长肌（BR到FPL）的肌腱。传统的手术后护理没有很好地定义，并且由于住院住院的限制，在接受定向治疗计划之前，有些人已出院。手术后，转移的BR并未完全激活以执行紧缩任务。毫无疑问，这是导致一系列功能结果的一个因素，即目的地成功的手术，可以通过集中的重新训练计划来解决。转移肌肉执行新任务的成功重新训练的基本机制尚不清楚，并且可能涉及运动和神经适应。最近的证据表明，基于任务的治疗可以通过加强现有神经连接和/或形成新的神经联系来改善上肢功能。拟议的研究将评估对基于任务的治疗计划的中性反应，用于BR对FPL肌腱转移受体的肌肉再教育。这个提出的试点项目是朝着更广泛的目标迈出的关键一步 四边形的肌腱转移程序的功能结果。该研究的目的是获取由功能磁共振成像（fMRI）和功能性能度量组成的试验数据，以评估肌腱转移后成功肌肉再教育的神经预测因子和相关性。参与者将拥有慢性宫颈SCI，并接受了肌腱转移或符合用于转移手术的手术标准。将评估从BR到FPL转移受体的神经元活动模式（i）在参加基于任务的治疗计划之前和之后（ii）旨在改善功能性捏合任务中转移的BR自愿激活的基于任务的治疗计划之前和之后。功能性能度量包括定量肌电图（EMG）的自愿激活的测量，转移的BR的自愿激活，选定功能任务中的最大努力和自我报告的性能度量。具体目标是：评估BR后BR后肌肉重新教育对良好和不良结果的个体中的FPL转移，并确定训练计划后的神经元活动模式是否与那些具有更高捏合力测量的个体相媲美。基于任务的培训计划是一项正在进行的研究的一部分，旨在改善FPL外科手术结果，并初步结果表明，在功能任务期间，在与近端肌肉协调方面，捏力产生和转移BR的激活发生了正变化。神经影像技术（例如功能磁共振成像（fMRI））已成为了解神经肌肉系统中可塑性的重要工具，并评估了对新干预措施的响应神经变化。我们建议，BR向FPL转移后的基于任务的基于任务的培训计划将推动影响功能（PINCH）能力的神经元变化。建立这种关系将使人们对患者成功干预措施的机制增加了解，并建议基于大脑的动态，这可能是将来治疗的重点，例如生物反馈或脑刺激。急性和慢性脊髓损伤患者的肌腱转移后，一项更有效的手术后康复计划将导致长期功能结果改善。这些数据将用于更广泛的研究设计，以期对重点康复干预的影响进行前瞻性投资。从拟议的飞行员那里获得的信息 研究将用于开发假设和统计能力，以指导一项全面研究，以评估通过基于任务的培训改善手术结果的能力。