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The potential for transcranial direct current stimulation to restore motor function in the vegetative state

经颅直流电刺激恢复植物人运动功能的潜力

基本信息

批准号：
MR/P02596X/1
负责人：
Davinia Fernández Espejo
金额：
$ 92.31万
依托单位：
University of Birmingham
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2017
资助国家：
英国
起止时间：
2017 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FP02596X%2F1
关键词：
potential transcranial direct current stimulation

项目摘要

Recent improvements in the provision of intensive care have increased the chances of surviving the most severe brain injuries. Many of these patients progress to a state in which awareness and external responsiveness are either absent (i.e., the vegetative state) or greatly reduced (i.e., the minimally conscious state). It is now known that some of these patients retain a much higher level of awareness than could be expected by their clinical diagnoses, but they are simply unable to show it with their behaviours - trapped in their unresponsive bodies. Recently, my own research has provided an explanation for what happens in the brain to cause this unresponsive behaviour. Specifically, I identified a partial disruption in the flow of information between two brain regions that need to work together to allow for the voluntary control of movement, suggesting for the first time a potential target for interventions to restore motor control to those patients who, despite their diagnoses, retain a level of awareness. This project is aimed at assessing the potential for a non-invasive form of electrical brain stimulation, known as transcranial direct current stimulation (tDCS), to modulate the activity of the brain regions that control movement, and increase motor responsiveness as a result. In the proposed studies, healthy volunteers will receive tDCS, over different target regions and with different parameters (e.g., number of sessions, with / without an accompanying task, etc.), while their neural activity is recorded with functional magnetic resonance imaging (fMRI). By combining tDCS with fMRI, and using advanced analysis methods, I will be able to characterize the changes that occur in the relationships between the different regions in the motor network as a result of stimulation. This research has three primary objectives. First, I will map out the effects of tDCS over the brain motor network of interest. Second, I will explore potential enhancements in the effects of the stimulation with the use of multiple sessions and simultaneous stimulation and motor practice. Finally, I will investigate whether specific characteristics of the brain anatomy or function can predict the degree to which an individual will respond to the stimulation. The outcomes of this research will inform a longer-term research programme, with subsequent applications in groups of vegetative and minimally conscious patients themselves, with the final goal of developing effective and available interventions to treat these conditions. If successful, this programme will have a profound impact on the lives of the patients, and their families and care-givers, by providing the patients with a physical means of interacting with the world for the first time since their injuries.

最近在提供重症监护方面的改进增加了最严重脑损伤的存活机会。这些患者中的许多进展到其中意识和外部反应性或者缺失的状态（即，植物人状态）或大大减少（即，最低意识状态）。现在我们知道，这些患者中的一些人保持着比他们的临床诊断所预期的更高的意识水平，但他们只是无法通过他们的行为表现出来-被困在他们没有反应的身体中。最近，我自己的研究为大脑中发生的事情提供了一个解释，导致这种反应迟钝的行为。具体来说，我发现了两个大脑区域之间的信息流部分中断，这两个区域需要一起工作才能对运动进行自愿控制，这首次表明了一个潜在的干预目标，以恢复运动控制那些患者，尽管他们的诊断，保持一定的意识水平。该项目旨在评估一种非侵入性形式的脑电刺激（称为经颅直流电刺激（tDCS））的潜力，以调节控制运动的大脑区域的活动，并因此增加运动反应性。在拟议的研究中，健康志愿者将在不同的靶区域和不同的参数（例如，会话数量，有/没有附带任务等），同时用功能性磁共振成像（fMRI）记录他们的神经活动。通过将tDCS与fMRI结合起来，并使用先进的分析方法，我将能够描述运动网络中不同区域之间的关系因刺激而发生的变化。这项研究有三个主要目标。首先，我将绘制出tDCS对感兴趣的大脑运动网络的影响。第二，我将探索潜在的增强效果的刺激与使用多个会议和同时刺激和运动练习。最后，我将研究大脑解剖结构或功能的特定特征是否可以预测个体对刺激的反应程度。这项研究的结果将为一个长期的研究计划提供信息，随后将应用于植物人和最低意识患者群体，最终目标是制定有效和可用的干预措施来治疗这些疾病。如果成功，这一方案将对病人及其家属和护理人员的生活产生深远的影响，因为这将使病人自受伤以来首次与世界互动。