Surgical and Rehabilitative Management of Facial Nerve Injury

描述（由申请人提供）：运动神经损伤往往是毁灭性的；即使是最复杂的修复损伤的神经很少导致令人满意的功能恢复。面部神经的损伤尤其严重，因为眨眼、吃饭、说话和通过面部表情进行交流的能力都会受到严重影响。相关的严重面部毁容也有深刻的社会和心理后果。在过去的五年中，我们的实验室创造了一种高度定量的方法来实时测量啮齿动物面神经损伤的恢复情况。有了这个系统，我们已经证明了几种药物可以加速恢复，有些则不能，并且分别对肌肉和神经进行某些类型的机械和电刺激，都可以加速和改善面神经损伤的恢复。最近在康复领域的研究结果强烈表明，机器人或计算机辅助康复方法可以改善神经损伤后的运动恢复，特别是当动机和学习元素被引入治疗范式时。通过整合患者在康复过程中任何给定点的精确功能水平的数据，并通过激励策略确保患者参与，定制的感觉运动康复已被证明比简单的被动辅助疗法更有效，后者提供机械辅助，而不考虑受试者的功能水平。在这个提议中，我们应用并比较了几种不同的康复方式来再生轴索损伤（挤压）和神经损伤（割伤）的啮齿动物面神经。我们将通过连续近似来提供口服奖励疗法，以引入被证明是人类运动恢复的重要因素的动机因素。我们也将提供不同形式的被动辅助治疗（机械刺激）去神经肌肉。我们将比较固定时间表的被动辅助治疗与定制的动态被动辅助治疗，旨在响应啮齿动物的正常和恢复行为（即，外部移动大鼠的解剖结构以配合其预期的运动输出），并将检查两种方式的组合。此外，我们将研究通过感觉神经与失神经支配肌肉的接合来保留面部肌肉结构对面神经损伤和修复后整体恢复的影响。

DESCRIPTION (provided by applicant): Motor nerve injuries are often devastating; even the most sophisticated repair of an injured nerve rarely leads to satisfactory restoration of function. Damage to the facial nerve is particularly disabling because the ability to blink, eat, speak, and communicate through facial expressions are all dramatically affected. The associated severe facial disfigurement also has profound social and psychological consequences. Over the past five years, our laboratory has created a highly quantitative methodology for real-time measurement of recovery from facial nerve injury in the rodent. With this system we have demonstrated that several pharmacologic agents accelerate recovery, several do not, and that certain types of mechanical and electrical stimulation to the muscles and nerves, respectively, both accelerate and improve recovery from facial nerve injury. Recent findings in the field of rehabilitation strongly suggest that robot- or computer-assisted rehabilitation methods improve motor recovery after neurologic injury, particularly when the elements of motivation and learning are introduced into the therapeutic paradigm. By incorporating data from the precise level of patient function at any given point in recovery, and assuring patient participation via motivational strategies, customized sensorimotor rehabilitation has proven more effective than simple passive assistance therapies, which provide mechanical assistance irrespective of the subject's level of function. In this proposal, we apply and compare several different rehabilitative modalities to the regenerating rodent facial nerve after both axonotmesis (crush) and neurotmesis (cut) injuries. We will delivery oral reward therapy through successive approximations, in order to introduce the motivational element demonstrated to be an important factor in human motor recovery. We will also deliver different forms of passive assistance therapy (mechanical stimulation) to denervated muscles. We will compare fixed-schedule passive assistance therapy with customized, dynamic passive assistance therapy designed to respond to the rodent's normal and recovering behavior (i.e. externally moving the rat's anatomy in concert with their intended motor output), and will also examine combinations of both modalities together. In addition, we will examine the effect of preserving facial muscle architecture, via coaptation of a sensory nerve to the denervated muscle, on overall recovery following facial nerve injury and repair. PUBLIC HEALTH RELEVANCE: Peripheral nerve injuries are a source of enormous disability in the United States; the discovery of more effective ways of accelerating and improving recovery from these injuries would be of enormous benefit. Using a rodent model, we propose to employ computer-assisted, patient-specific sensory and motor rehabilitative therapy following facial nerve injury and repair, to measure its benefit and maximize its effect.