Grasping Function after Spinal Cord Injury

抓握行为是日常生活中必不可少的功能，在患有 颈脊髓损伤（SCI）。虽然康复干预在提高能力方面取得了成功， 在受伤后抓握，它们的总体效果仍然有限。本提案的目标是审查 生理通路对颈椎SCI后抓握行为控制的贡献， 通过使用定制的非侵入性刺激方案和运动训练来恢复抓握。我们建议 研究两种基本的抓握行为：精确抓握和有力抓握。这些行为至关重要，因为它们 它为人类的许多智能操作提供了基础，也是吃饭，写字， 化妆品，还有很多其他的功能。因此，我们的研究结果可能会对退伍军人的生活质量产生直接影响 通过提高他们的独立性和护理水平， 在目标1中，我们将研究皮质脊髓和脑干通路在控制脑缺血中的作用。 颈脊髓损伤后手部肌肉参与精确性和力量性抓握。经颅磁刺激（TMS） 将用于检查针对手指肌肉的皮质脊髓和皮质内通路的传输， 将使用有和没有TMS的声惊吓刺激来检查来自脑干通路的贡献。 功能性磁共振成像（fMRI）将用于进一步评估大脑活动的变化， 这些手部运动任务。在目标2中，我们建议通过使用新的定制的抓取来提高抓取的恢复。 针对晚期间接（I）下行截击（iTMS）的非侵入性重复TMS方案和声学 惊吓刺激iTMS和惊吓将在任务相关的精确和有力的抓握运动中使用， 以诱导皮质和皮质下可塑性并增强手部肌肉的随意输出的方式（目的2a）。 稍后，iTMS和惊吓将在运动训练任务期间以任务依赖的方式应用， 精确和有力的抓地力（目标2b）。这些独特的方法旨在促进神经可塑性， 以前没有使用过相关的抓取动作。 所提出的实验将提供关于抓取功能机制的新知识， 用于指导功能相关的可塑性诱导方案，以增强手功能的恢复。的 对于颈椎脊髓损伤的退伍军人，缺乏公认的抓握运动障碍治疗方法， 目前干预措施的有限行为收益突出了这些调查的重要性。

Grasping behaviors, which are essential for daily-life functions, are largely impaired in individuals with cervical spinal cord injury (SCI). Although rehabilitative interventions have shown success in improving the ability to grasp following injury their overall effects remain limited. The goals of this proposal are to examine the contribution of physiological pathways to the control of grasping behaviors after cervical SCI, and to maximize the recovery of grasping by using tailored non-invasive stimulation protocols with motor training. We propose to study two basic grasping behaviors: a precision grip and a power grip. These behaviors are crucial because they provide the basis for a number human prehensile manipulations and are also necessary skills for eating, writing, dressing, and many other functions. Thus, our results may have a direct impact on the quality of life for veterans and their caregivers by enhancing their independence and level of care. In Aim 1, we will investigate the contribution of corticospinal and brainstem pathways to the control of hand muscles involved in precision and power grip after cervical SCI. Transcranial magnetic stimulation (TMS) will be used to examine transmission in corticospinal and intracortical pathways targeting finger muscles and an acoustic startle stimulus with and without TMS will be used to examine the contribution from brainstem pathways. Functional magnetic resonance imaging (fMRI) will be used to further assess changes in brain activity during these hand motor tasks. In Aim 2, we propose to enhance the recovery of grasping by using novel tailored protocols of non-invasive repetitive TMS targeting late indirect (I) descending volleys (iTMS) and an acoustic startle stimuli. iTMS and startle will be used during precision and power grip movements in a task-dependent manner to induce cortical and subcortical plasticity and enhance voluntary output of hand muscles (Aim 2a). Later, iTMS and startle will be applied in a task-dependent manner during a motor training task that involves precision and power grip (Aim 2b). These unique approaches aim at promoting neuroplasticity during functionally relevant grasping movements has not been used before. The proposed experiments will provide new knowledge on mechanisms of grasping functions which will be used to guide functionally-relevant plasticity-inducing protocols to enhance recovery of hand function. The absence of well-accepted treatments for grasping motor impairments for veterans with cervical SCI and the limited behavioral gains of present interventions underline the importance of these investigations.