Neuromuscular Electrical Stimulation and Mobility in Multiple Sclerosis

多发性硬化症的神经肌肉电刺激和活动能力

• 批准号: 8677061
• 负责人: ROGER M. ENOKA
• 金额: $ 7.97万
• 依托单位: UNIVERSITY OF COLORADO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8677061
• 关键词: Action Potentials; Acute; Address; Affect; Aftercare; Axon; Blinded; Classification; Development; Diagnosis; Disabled Persons; Disease; Effectiveness; Effectiveness of Interventions; Electric Stimulation; Esthesia; Exercise; Exhibits; Feasibility Studies; Future; Goals; Health; Health Professional; Impairment; Individual; Inflammation; International; Intervention; Knowledge; Leg; Length; Life Style; Measures; Motor; Multiple Sclerosis; Muscle; Muscle Contraction; Nerve; Nerve Degeneration; Nervous system structure; Neuraxis; Neurons; Outcome; Participant; Patients; Performance; Persons; Physical activity; Physical therapy exercises; Physiologic pulse; Protocols documentation; Quality of life; Randomized; Recovery of Function; Research Design; Sensory; Signal Transduction; Spinal; Stimulus; Therapeutic Uses; Training; Walking; Work; base; burden of illness; clinical Diagnosis; clinically significant; conditioning; disability; femoral nerve; follow-up; functional restoration; gray matter; healthy volunteer; improved; innovation; motor function recovery; neuromuscular; neuromusculoskeletal; novel; physical conditioning; primary outcome; programs; public health relevance; secondary outcome; sedentary; spinal pathway; white matter

DESCRIPTION (provided by applicant): The progressive decline in mobility that occurs with multiple sclerosis (MS) is attributable to two factors: a reduction in the ability of the nervous system to generate adequate muscle activation signals and a decrease in the level of physical conditioning that results from the development of a more sedentary lifestyle. Exercise programs can provide some relief by reducing the level of deconditioning, but only for individuals with low levels of disability. There are no effective countermeasures for persons with MS who are moderately disabled with limitations in walking performance. To address this knowledge gap, we will examine the effectiveness of an intervention that evokes involuntary contractions in leg muscles with a novel form of neuromuscular electrical stimulation (NMES). Conventional NMES mainly activates motor axons using narrow (0.2-0.5 ms) stimulus pulses, but does not improve the walking performance of persons with MS. As an alternative approach, we will use wide (1 ms) stimulus pulses to activate both motor and sensory axons and thereby modulate the excitability of spinal and cortical neurons to promote the recovery of motor function in the nervous system. The primary outcome will be walking endurance, which will be quantified as the distance walked in 6 min. The participants (n = 30, 18-55 yrs) will be individuals diagnosed with MS who exhibit a clinically defined moderate level of disability. The research design comprises a 6 week (18 sessions), randomized, evaluator-blinded comparison of narrow- and wide-pulse NMES treatment on walking performance and then retention of the gains in walking endurance during 6 months of follow-up. Based on the demonstrated acute effects of wide-pulse NMES in healthy volunteers, the intervention will comprise stimulation of each leg individually with 30 trains of stimulation (20 s on, 20 s off) with a well-tolerated current that elicits a submaximal force (~20% maximum). We will evaluate two hypotheses: H1: Treatment of moderately disabled MS patients with wide-pulse NMES will improve walking endurance more than treatment with narrow-pulse NMES. H2: Improvements in walking endurance will be associated with elevated levels of habitual physical activity that will be retained longer after the treatment ends for the wide-pulse NMES group compared with the narrow-pulse NMES group. We expect wide-pulse NMES to produce greater improvement in walking endurance than narrow-pulse NMES and the gains to be associated with: (1) sustained electromyographic (EMG) activity in leg muscles during walking; (2) improved walking economy; and (3) increases in stride length. If wide-pulse NMES can elicit clinically significant improvements in mobility and quality of life for persons with moderate disability, clinicians will be able to prescribe a meaningful strategy for this underserved group of MS patients. Moreover, the intervention may delay the development of disability in individuals who are less affected by the disease. The outcomes of this feasibility study will suggest directions for subsequent R01 projects.

描述（由申请人提供）：多发性硬化症（MS）发生的活动性进行性下降可归因于两个因素：神经系统产生足够肌肉激活信号的能力降低和久坐生活方式发展导致的身体调节水平降低。锻炼计划可以通过降低失调水平来提供一些缓解，但仅适用于低水平残疾的个人。对于行走能力受限的中度残疾MS患者，没有有效的对策。为了解决这一知识差距，我们将研究一种新形式的神经肌肉电刺激（NMES）引起腿部肌肉不自主收缩的干预措施的有效性。传统的NMES主要使用窄（0.2-0.5 ms）刺激脉冲激活运动轴突，但不能改善MS患者的行走性能。作为替代方法，我们将使用宽（1 ms）刺激脉冲激活运动和感觉轴突，从而调节脊髓和皮层神经元的兴奋性，以促进神经系统运动功能的恢复。主要结局将是步行耐力，其将被量化为6分钟内步行的距离。参与者（n = 30，18-55岁）将被诊断为MS并表现出临床定义的中度残疾水平的个体。研究设计包括6周（18次）、随机、评估者盲法比较窄脉冲和宽脉冲NMES治疗对步行能力的影响，然后在6个月的随访期间保持步行耐力的增加。基于宽脉冲NMES在健康志愿者中的急性效应，干预将包括使用30串刺激（20 s开，20 s关）单独刺激每条腿，耐受性良好的电流可激发次最大力（最大约20%）。我们将评估两个假设：H1：宽脉冲NMES治疗中度残疾MS患者比窄脉冲NMES治疗更能改善步行耐力。H2：步行耐力的改善将与治疗后保持更长时间的习惯性体力活动水平升高相关 与窄脉冲NMES组相比，宽脉冲NMES组结束。我们预计宽脉冲NMES比窄脉冲NMES在步行耐力方面产生更大的改善，并且与以下因素相关：（1）步行过程中腿部肌肉的持续肌电图（EMG）活动;（2）改善步行经济性;（3）步长增加。如果宽脉冲NMES可以引起中度残疾患者的活动性和生活质量的临床显著改善，临床医生将能够为这一服务不足的MS患者群体开出有意义的策略。此外，干预措施可能会延迟受疾病影响较小的个人的残疾发展。这种可行性的结果 研究将为随后的R 01项目提出方向。