Spinal Cord Stimulation for Functional Recovery in Humans with Tetraplegia

摘要/摘要 手臂和手的活动对于日常生活功能是必不可少的，对于患有颈椎疾病的退伍军人来说，这些活动很大程度上是受损的 脊髓损伤(SCI)。关于经皮电脊椎治疗的效果，已有报道称前景看好。 然而，刺激(TESS)对手臂和手的功能恢复的影响仍然有限，这种方法 尚未进入临床实践。我们的具体目标是：1)研究TESS对人体的生理影响 颈脊髓损伤后的上肢肌肉，以及2)通过量身定制的方法最大限度地恢复手臂和手的功能 TESS以特定任务的方式与运动训练相结合。我们专注于伸手和抓握动作 因为它们在日常生活活动中的重要性。因此，我们的结果可能会直接影响到 通过提高退伍军人及其照顾者的独立性和护理水平，改善他们的生活。 [在目标1中，我们将研究TESS对皮质和皮质下神经元通路的影响，包括 网状脊髓通路，初级运动皮质的皮质内抑制，以及它们之间的相互作用。经颅 磁刺激(TMS)将被用来检查初级大脑皮质内通路的传输。 运动皮质和响亮的声学刺激将被用来进行网状脊髓输入。在目标2中，我们建议 以特定任务的方式应用TESS最大限度地发挥TESS对手臂和手功能恢复的作用 在动作的伸展或抓握阶段，随后进行集中练习。苔丝会的 使用一种新的闭环范例来应用，该范例依赖于持续的运动学信号来触发刺激 慢性颈椎损伤退伍军人的任务依赖方式培训活动将侧重于内在和 手和手臂的外部肌肉运动使用虚拟现实RAPAEL智能手套。这些独特的 旨在通过有针对性的任务在功能相关运动中促进神经可塑性的方法- 特指的苔丝以前从未被使用过。 拟议中的实验将提供有关上肢功能控制的新知识，这些知识将被用于 指导功能相关的可塑性诱导方案，以促进手和手臂功能的恢复。这个 患有颈椎脊髓损伤的退伍军人缺乏公认的上肢运动障碍治疗方法 目前干预措施的有限行为收益强调了这些调查的重要性。

Abstract/summary Arm and hand movements are essential for daily-life functions and are largely impaired in veterans with cervical spinal cord injury (SCI). Promising results have been reported on the effects of transcutaneous electrical spinal stimulation (TESS) on arm and hand functional recovery, however, the effects remain limited and this method has not yet entered clinical practice. Our specific goals are to: 1) examine physiological effects of TESS on upper-limb muscles after cervical SCI, and 2) maximize the recovery of arm and hand function by using tailored TESS in a task-specific manner combined with motor training. We focus on reaching and grasping movements because of their importance in daily life activities. Thus, our results may have a direct impact on the quality of life of veterans and their caregivers by enhancing their independence and level of care. [In Aim 1, we will investigate the effects of TESS on cortical and subcortical neuronal pathways including the reticulospinal pathway, intracortical inhibition in the primary motor cortex, and in their interaction. Transcranial magnetic stimulation (TMS) will be used to examine transmission in intracortical pathways within the primary motor cortex and a loud acoustic stimuli will be used to engage reticulospinal inputs. In Aim 2, we propose to maximize the effects of TESS on recovery of arm and hand function by applying TESS in a task-specific manner during the reaching or the grasping phases of movements followed up by massed practice training. TESS will be applied using a novel closed-loop paradigm that relies on ongoing kinematic signals to trigger stimulation in a task-dependent manner in Veterans with chronic cervical SCI.] Training activities will focus on intrinsic and extrinsic muscles of the hand and arm movements using the virtual reality RAPAEL Smart Glove. These unique approaches aiming at promoting neuroplasticity during functionally relevant movements using targeted task- specific TESS have not been used before. The proposed experiments will provide new knowledge on the control of upper-limb functions, which will be used to guide functionally-relevant plasticity-inducing protocols to enhance recovery of hand and arm function. The absence of well-accepted treatments for upper-limb motor impairments for veterans with cervical SCI and the limited behavioral gains of present interventions underline the importance of these investigations.