Targeted Transcutaneous Stimulation to Restore Autonomic Cardiovascular Health in Veterans with Spinal Cord Injury

有针对性的经皮刺激可恢复脊髓损伤退伍军人的自主心血管健康

• 批准号: 10418182
• 负责人: Caitlyn G. Peters
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10418182
• 关键词: Activities of Daily Living; Adverse effects; Aldosterone; Applications Grants; Autonomic Dysreflexia; Autonomic nervous system; Biological Assay; Blood Flow Velocity; Blood Pressure; Blood Vessels; Cardiac; Cardiovascular Diseases; Cardiovascular Physiology; Cardiovascular system; Cerebrovascular Circulation; Cerebrovascular Disorders; Cervical spinal cord injury; Chest; Chronic; Clinical; Clinical Research; Data; Decentralization; Dependence; Electrodes; Electromyography; Equipment; Foundations; Frequencies; Functional disorder; Future; General Population; Goals; Gold; Grant; Growth; Head; Healthcare Systems; Home; Hormones; Hyperactivity; Hypotension; Hypotensives; Immobilization; Impaired cognition; Individual; Intervention; Investigation; Laboratories; Lesion; Link; Literature; Maintenance; Maps; Medical center; Mentors; Mentorship; Methodology; Methods; Morbidity - disease rate; Motor; Neighborhood Health Center; Neurostimulation procedures of spinal cord tissue; Norepinephrine; Orthostatic Hypotension; Personal Satisfaction; Physical therapy; Physiologic pulse; Physiological; Plant Roots; Plasma; Population; Process; Quality of life; Ramp; Rehabilitation therapy; Renin; Renin-Angiotensin-Aldosterone System; Reporting; Research; Research Personnel; Severities; Signal Transduction; Spinal; Spinal Cord; Spinal cord injury; Standardization; Supination; Symptoms; Testing; Training; Veterans; Width; Writing; arterial stiffness; associated symptom; base; biophysical tools; blood pressure control; blood treatment; cardiovascular disorder risk; cardiovascular effects; cardiovascular health; cerebrovascular health; cognitive function; disorder risk; effective intervention; experience; falls; improved; injured; knowledge base; mortality; neuroregulation; response; restoration; skills training; spine bone structure; statistics; transcutaneous stimulation

PROJECT SUMMARY/ABSTRACT Dr. Caitlyn Katzelnick has been working with investigators in the National Center for Spinal Cord Injury (SCI) and Immobilizing Conditions at the VA Medical Center, Bronx, NY for eight years as a senior research coordinator. Along with her Primary Mentor, Dr. Wecht, Caitlyn has been studying the effects of cardiovascular, cerebrovascular and cognitive dysfunction post SCI, and the results of her Doctoral dissertation suggest that increased arterial stiffness in individuals with SCI may relate to the degree of decentralized sympathetic cardiovascular control and increased reliance on the renin-angiotensin-aldosterone system (RAAS) for maintenance of orthostatic blood pressure (BP). Recent evidence indicates that increased arterial stiffness is an independent predictor of cardiovascular disease risk, which may contribute to the heightened cardiovascular morbidity and mortality in the SCI, compared to the general population. Increased reliance on the RAAS is believed to mitigate orthostatic falls in BP and reduce the severity of symptoms reporting; however, findings in the general population link the RAAS with vascular restructuring and remodeling. Therefore, clinical intervention to stabilize and normalize BP should be a priority in hypotensive individuals with SCI. Advances in methods of neuromodulation of the spinal processes offer a non-pharmacologic approach to restore endogenous autonomic cardiovascular control and improve orthostatic BP control. Based on our present understanding of the somatovisceral integration within the spinal cord, it is plausible that transcutaneous spinal cord stimulation (TSCS) can be targeted to excite and modulate appropriate spinal autonomic circuitry to rapidly normalize orthostatic BP; however, electrode placement and stimulation parameter mapping is needed to optimize orthostatic BP control. Therefore, our primary aim is to identify an individualized map using noninvasive TSCS of the spinal autonomic circuitry that results in an increase of seated BP. Our secondary aim is to compare BP, plasma concentrations of norepinephrine, renin and aldosterone during a head-up tilt with and without optimal TSCS. This investigation will be completed at the brand- new Center of Spinal Stimulation, located at the Kessler Foundation, which is home to our VA satellite center. Dr. Katzelnick will have access to all the necessary facilities and equipment including: TSCS, electromyography (EMG) and cardiovascular. The CDA-1 will provide Dr. Katzelnick with the advanced skill training, clinical research experience, and mentorship to facilitate her growth into an independent VA investigator. Training objectives include: 1) administering and mapping TSCS; 2) gaining an understanding of EMG recordings and analysis; and 3) assaying the RAAS hormones. Dr. Katzelnick will take academic courses to advance her knowledge base in grant writing, cardiovascular physiology, statistics, biophysics and EMG. Her mentors encompass various relevant scientific backgrounds, which converge with a similar understanding of secondary consequences after a SCI. It is anticipated that these data will begin to establish a standard methodology for TSCS mapping of spinal autonomic circuits to promote restoration of cardiovascular health, and overall well-being in Veterans with immobilizing conditions. Standardized TSCS methodology will be used in future grant applications, including a CDA-2 application, to promote improved vitality and quality of life in Veterans with SCI.

项目摘要/摘要 Caitlyn Katzelnick博士一直与国家脊柱中心的调查员合作 纽约布朗克斯市VA医疗中心的绳索损伤（SCI）和固定条件八 多年来担任高级研究协调员。凯特琳（Caitlyn）和她的主要导师威廉（Wecht） 一直在研究SCI后心血管，脑血管和认知功能障碍的影响， 她的博士学位论文的结果表明，动脉僵硬的增加 SCI的个体可能与分散的交感神经性心血管的程度有关 控制和增加对肾素 - 血管紧张素 - 醛固酮系统（RAAS）的依赖 维持体位血压（BP）。最近的证据表明增加 动脉僵硬是心血管疾病风险的独立预测指标，这可能 与SCI的心血管发病率和死亡率升高相比 一般人口。人们认为，对RAAS的依赖增加可以减轻体位降临 BP并减少症状报告的严重程度；但是，一般人口的发现 将RAA与血管重组和重塑联系起来。因此，临床干预 在患有SCI的降压患者中，稳定和标准化BP应该是优先事项。进步 脊柱过程的神经调节方法提供了一种非药物的方法 恢复内源性自主性心血管控制并改善体位性BP控制。 基于我们目前对脊髓内的躯体整合的理解， 可以将经皮脊髓刺激（TSC）靶向引起刺激和 调节适当的脊柱自主通路，以快速使体位符合体位的BP；然而， 需要放置电极的放置和刺激参数映射才能优化原位的BP 控制。因此，我们的主要目的是使用无创的个性化地图识别个性化地图 脊柱自主电路的TSC导致座椅的增加。我们的次要 目的是比较BP，在A期间的血浆浓度，去甲肾上腺素，肾素和醛固酮的血浆浓度 带有最佳TSC的头部倾斜。这项调查将在品牌上完成 - 位于凯斯勒基金会（Kessler Foundation）的新的脊柱刺激中心，这是我们VA的家园 卫星中心。 Katzelnick博士将可以使用所有必要的设施和设备 包括：TSC，肌电图（EMG）和心血管。 CDA-1将为博士提供。 Katzelnick拥有高级技能培训，临床研究经验和指导 促进她的成长成为独立的VA调查员。培训目标包括：1） 管理和映射TSC； 2）了解EMG录音和 分析; 3）分析RAAS激素。 Katzelnick博士将参加学术课程 提高她在赠款写作，心血管生理学，统计和生物物理学方面的知识基础 和emg。她的导师涵盖了各种相关的科学背景，这些科学背景与 对SCI后的次要后果的类似理解。预计这些数据 将开始建立一种标准方法，用于将脊柱自主通路映射到 促进恢复心血管健康的恢复 固定条件。标准化的TSC方法将在未来的赠款中使用 应用程序，包括CDA-2应用，以促进改善活力和生活质量 有科幻的退伍军人。