SPINAL CORD STIMULATION TO RESTORE COUGH

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。颈椎和胸椎脊髓损伤的患者通常有大部分呼气肌麻痹，因此缺乏正常的咳嗽机制。因此，这些患者中的大多数患有清除气道分泌物的能力明显降低，这是导致反复呼吸道感染发展的一个因素。由于大多数患者损伤水平以下的脊髓是完整的，脊髓的运动神经元和支配呼气肌的周围神经肌肉系统是完整的。因此，这些肌肉可以通过脊髓根的电刺激而被电激活，从而产生功能性有效的咳嗽。根据研究者的假设，下胸脊髓刺激（SCS）将导致产生正常咳嗽特征的大气道正压和呼气流速峰值。因此，这种方法有可能产生脊髓损伤患者的有效咳嗽机制。18例脊髓损伤患者将被纳入本研究。将进行完整的病史和体格检查，胸部x光检查和心电图检查。患者的初始测试将包括测量自发潮气量、肺活量和呼吸肌力量，由最大吸气和呼气压力决定。然后将脊髓盘电极和射频接收器放置在手术室。刺激参数一开始设置得很低，然后逐渐增加。脊髓刺激的有效性将通过测量气道和胃压力、呼气量、呼气流速和腹部肌电图记录来评估。训练的全部益处通常需要至少6-8周的时间来优化其他呼吸肌的功能。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Patients with cervical and thoracic spinal cord injuries often have paralysis of a major portion of their expiratory muscles and therefore, lack a normal cough mechanism. Consequently, most of these patients suffer from a markedly reduced ability to clear airway secretions, a factor which contributes to the development of recurrent respiratory tract infections. Since the spinal cord below the level of injury is intact in most patients, the motor neurons of the spinal cord and peripheral neuromuscular system innervating the expiratory muscles are intact. These muscles, therefore, can be electrically activated by the electrical stimulation of the spinal roots to produce a functionally effective cough. It the hypothesis of the investigators that lower thoracic spinal cord stimulation (SCS) will result in the generation of large positive airway pressures and peak expiratory flow rates characteristic of a normal cough. This methodology, therefore, has the potential to produce an effective cough mechanism in spinal cord injured patients. Eighteen patients with spinal cord injury will be recruited into this study. A complete history and physical examination, chest x-ray and ECG will be performed. Patients initial testing will include measurement of spontaneous tidal volume, vital capacity and respiratory muscle strength as determined by maximum inspiratory and expiratory pressures. Spinal cord disc electrode and radiofrequency receiver will then be placed in the operating room. Stimulus parameters will be set very low initially and gradually increased. The effectiveness of spinal cord stimulation will be assessed by measurements of airway and gastric pressures, expired volume, expiratory flow rate, and abdominal EMG recordings. The full benefit of training usually requires a minimum of 6-8 weeks to optimize the function of other respiratory muscles.