Spinal Cord Stimulation for Functional Recovery in Humans with Tetraplegia

摘要/概要 手臂和手部运动对于日常生活功能是必不可少的，并且在患有颈椎病的退伍军人中很大程度上受到损害。 脊髓损伤（SCI）。经皮脊髓电刺激的效果已被报道， TESS对手臂和手功能恢复的影响，然而，这种方法仍然有限， 尚未进入临床实践。我们的具体目标是：1）检查TESS的生理效应， 2）通过使用量身定制的方法，最大限度地恢复手臂和手的功能， TESS以特定任务的方式结合运动训练。我们专注于达到和把握动作 因为它们在日常生活活动中的重要性。因此，我们的研究结果可能会直接影响 通过提高退伍军人及其照顾者的独立性和照顾水平，改善他们的生活。 [In目的1，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，在初级运动皮质皮质内抑制，以及它们的相互作用。经颅 磁刺激（TMS）将被用来检查传输在皮质内的途径内的主要 运动皮层和响亮的声音刺激将用于参与网状脊髓输入。在目标2中，我们建议 通过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 在动作的到达或抓握阶段，然后进行集中练习训练。TESS将 使用一种新的闭环范例来应用，该范例依赖于正在进行的运动学信号来触发刺激， 慢性颈脊髓损伤退伍军人的任务依赖性方式。培训活动将侧重于内在和 使用虚拟现实RAPAEL智能手套进行手部和手臂运动的外部肌肉。这些独特 旨在使用目标任务在功能相关运动期间促进神经可塑性的方法- 以前没有使用过特定TESS。 这些实验将为上肢功能的控制提供新的知识， 指导功能相关的可塑性诱导方案，以促进手部和手臂功能的恢复。的 对于颈椎脊髓损伤的退伍军人，上肢运动障碍缺乏公认的治疗方法， 目前干预措施的有限行为收益突出了这些调查的重要性。

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.