Respiratory motor control and blood pressure regulation after spinal cord injury

脊髓损伤后的呼吸运动控制和血压调节

基本信息

批准号：
8688329
负责人：
Alexander Vladimirovich Ovechkin
金额：
$ 29.4万
依托单位：
UNIVERSITY OF LOUISVILLE
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-06-07 至 2016-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8688329
关键词：
Activities of Daily Living Affect Area Autonomic nervous system Baroreflex Blood Blood Pressure Breathing Cardiac Output Cardiovascular Physiology Cardiovascular system Catecholamines Cause of Death Chronic Clinic Control Groups Data Diagnosis Diastolic blood pressure Educational Intervention Effectiveness Electromyography Exercise Face Frequencies Functional disorder Goals Health Heart Heart Rate Hypotension Individual Injury Laboratories Location Lung Measurement Measures Motor Muscle Muscle Weakness Neurologic Orthostatic Hypotension Outcome Outcome Measure Paralysed Paresis Participant Performance Persons Physiological Play Population Posture Procedures Pulmonary Function Test/Forced Expiratory Volume 1 Quality of life Recovery Recruitment Activity Regulation Rehabilitation therapy Research Resistance Respiration Respiratory Insufficiency Respiratory Muscles Respiratory Paralysis Respiratory physiology Response Latencies Rest Role Secondary to Severities Skin Spinal Cord Lesions Spinal cord injury Spirometry Stress Stress Tests Surface Techniques Testing Therapeutic Intervention Time Training Training Technics Venous Vital capacity base blood pressure regulation cardiopulmonary system clinically relevant cost density experience follow-up functional outcomes improved motor control motor function improvement muscle strength novel novel therapeutic intervention pressure programs pulmonary function rehabilitation strategy respiratory response

项目摘要

DESCRIPTION (provided by applicant): Many individuals with chronic spinal cord injury (SCI) face the challenge of managing their unstable blood pressure which frequently results in persistent hypotension due to decreased cardiac output and autonomic nervous system dysfunction. In addition, blood pooling in the lower body during upright posture leads to a further decrease in blood pressure known as orthostatic hypotension. These conditions severely impact the overall health of SCI individuals, delay their participation in rehabilitative treatment, limit the effectiveness of such treatment, and significantly interfere with activities of daily living. In our clinic that utilizes activity-based therapy programs, we have observed that one of the most common impediments to full participation in these programs was orthostatic hypotension. Further, orthostatic intolerance increases the cost and decreases the efficacy of rehabilitative treatment. Another common impediment to rehabilitation after SCI is respiratory insufficiency due to paresis and paralysis of respiratory muscles. Physiologically, these respiratory and cardiovascular dysfunctions are closely related. Data from our laboratory show that resting blood pressure correlates positively with pulmonary function outcomes and the location and severity of spinal cord lesion. These relationships could be due to better venous return to the heart as a result of higher negative intrapleural pressure and/or higher sympathetic tone due to better baroreflex response in individuals with better inspiratory and expiratory motor control. Our preliminary data showed that respiratory motor function after SCI can be improved by respiratory muscle training (RMT), a rehabilitative technique based on the breathing with resistance exercise. We observed that resting blood pressure and orthostatic tolerance were also improved after RMT in individuals with SCI. Therefore, for the current proposal, we hypothesize that RMT will improve blood pressure regulation in individuals with chronic SCI. We will examine the response of physiological regulatory mechanisms to RMT. Based on statistical power analysis, forty five individuals who have chronic SCI will be recruited for this study over a four-year period. All subjects will have been diagnosed as having respiratory function deficits and orthostatic hypotension. We will evaluate pulmonary and cardiovascular function using spirometry, respiratory muscle strength, sympathetic skin response tests, and surface electromyography of respiratory muscles. In addition, we will use continuous beat-to-beat recording of systemic arterial blood pressure, heart rate, cardiac output, and the measurements of blood catecholamines level during orthostatic stress test. Autonomic regulation outcomes will be calculated from beat-to-beat blood pressure and heart rate frequency composition analysis. We will also evaluate Spinal Cord Injury Independence (SCIM-III) and quality of life (CHART) measures. These outcomes will be obtained before a total of 20 RMT sessions lasting 45 minutes each / 5 days per week, immediately after RMT, and during 6-month follow-up period in 35 research participants forming the experimental group. Another 10 individuals, serving as a control group, will undergo the same procedures, except the RMT intervention, during the same time course. This technique as a therapeutic intervention in order to improve the blood pressure regulation and investigate its mechanisms in individuals with SCI has never been tested before. The results of this study will have direct effect on the SCI population by improving our understanding of the mechanisms of pulmonary function and blood pressure regulation and offering a pathophysiologically based rehabilitation strategy.

描述（由申请人提供）：许多患有慢性脊髓损伤（SCI）的人面临着管理不稳定血压的挑战，由于心脏输出降低和自主神经系统功能障碍，因此经常导致持续性低血压。此外，在直立姿势下，下半身的血液聚集会导致被称为体位性低血压的血压进一步降低。这些疾病严重影响了SCI个人的整体健康状况，延迟了他们参与康复治疗，限制了这种治疗的有效性，并严重干扰了日常生活的活动。在利用基于活动的治疗计划的诊所中，我们观察到，充分参与这些计划的最常见障碍之一是体位性低血压。此外，体位不宽容会增加成本并降低康复治疗的疗效。 SCI后康复的另一个常见障碍是由于减轻和麻痹呼吸道肌肉而导致的呼吸功能不全。从生理上讲，这些呼吸道和心血管功能障碍密切相关。我们实验室的数据表明，静息血压与肺功能结果和脊髓病变的位置和严重程度正相关。这些关系可能是由于较高的负面胸腔内压力和/或较高的交感神经声音导致更好的静脉恢复到心脏，这是由于具有更好的灵感和发达运动控制的个体的降压反应而引起的。我们的初步数据表明，SCI后的呼吸运动功能可以通过呼吸道肌肉训练（RMT）改善，这是一种基于抗抑郁运动的呼吸技术。我们观察到SCI患者RMT后还提高了静息血压和体位耐受性。因此，对于当前的建议，我们假设RMT将改善慢性SCI患者的血压调节。我们将研究生理调节机制对RMT的反应。基于统计功率分析，将在四年的时间内招募45名患有慢性SCI的人。所有受试者都将被诊断为呼吸功能缺陷和体位低血压。我们将使用肺活量测定法，呼吸肌强度，交感性皮肤反应测试以及呼吸肌肉表面肌电图评估肺和心血管功能。此外，我们将使用全身性动脉血压，心率，心输出量以及在体位压力测试期间对血液儿茶酚胺水平的测量进行连续的搏动到孔记录。自主调节结果将根据Beat-Beat血压和心率频率组成分析计算。我们还将评估脊髓损伤独立性（SCIM-III）和生活质量（图表）措施。这些结果将在总共20个RMT会话之前获得持续时间为每周45分钟 /每周，rmt之后的5天，以及在35个研究参与者组成实验组的6个月随访期间。在同一时期课程中，另外10个人将作为对照组，除RMT干预外，还将接受相同的程序。该技术是一种治疗干预措施，以改善血压调节并研究SCI患者的机制，从未进行过测试。这项研究的结果将通过提高我们对肺功能和血压调节机制的理解并提供基于病理生理学的康复策略来直接影响SCI人群。

项目成果

期刊论文数量（13）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Response to Letter to the Editor regarding "Effects of respiratory training on heart rate variability and baroreflex sensitivity in individuals with chronic spinal cord injury".

回复关于“呼吸训练对慢性脊髓损伤个体心率变异性和压力反射敏感性的影响”的致编辑信。

DOI：
10.1016/j.apmr.2018.01.001
发表时间：
2018
期刊：
Archives of physical medicine and rehabilitation
影响因子：
4.3
作者：
LeggDitterline,BonnieE;Asian,SevdaC;Randall,DavidC;Harkema,SusanJ;Castillo,Camilo;Ovechkin,AlexanderV
通讯作者：
Ovechkin,AlexanderV

Respiratory functional and motor control deficits in children with spinal cord injury.