Epidural spinal cord stimulation and respiratory motor function after injury

项目概要/摘要 呼吸运动控制缺陷是脊髓损伤患者发病和死亡的主要原因 损伤本研究的长期目标是制定一个呼吸康复策略， 脊髓损伤作为标准治疗。我们以前的研究结果表明，患者的呼吸功能 慢性脊髓损伤的患者可以通过使用我们原有的吸气-呼气压力阈值来改善 呼吸训练方案。然而，这种干预的有效性受到功能水平的限制。 在损伤的神经水平以下保留能力。我们为这一提议获得的初步数据 证明了在腰椎水平上电脊髓刺激结合 呼吸可以激活和重组脊髓运动网络的呼吸。我们建议调查 呼吸运动控制相关的反应，硬膜外脊髓刺激单独和联合 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指标相关，我们希望 确定在损伤水平以下增加脊髓兴奋性所需的特定刺激参数， 增强对受伤后仍然存在的脊髓上中心输入的反应，并促进神经 由呼吸训练驱动的可塑性。这一假设将通过追求两个具体目标来检验：1） 评价硬膜外脊髓刺激对呼吸功能和运动控制的急性影响 评价硬膜外脊髓电刺激联合呼吸刺激的有效性。 训练

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.