Whole-body Neuroprosthetic Approach for Incomplete Cervical Spinal Cord Injury

 描述(由申请人提供)： 脊髓损伤(SCI)，特别是颈椎损伤，是可持续的最令人衰弱的损伤之一，在退伍军人中比平民人群中更常见。恢复手功能是颈中段脊髓损伤患者的首要任务，现有的为这些患者提供手功能的替代方案是不够的。上肢神经假体已被证明为颈椎水平脊髓损伤(SCI)患者提供了更好的独立性，这明显好于通过任何其他干预措施可以实现的功能改善。神经假体使用电刺激来协调地激活瘫痪的肌肉。当与肌电控制和肌腱转移程序相结合时，神经假体最大限度地利用每个受试者自愿和瘫痪的肌肉组织，显著改善日常生活能力。然而，到目前为止，这些上肢神经假体还没有在不完全脊髓损伤的个体中系统地实施和评估。不完全脊髓损伤的个体在其自愿功能、神经支配模式和功能目标方面的异质性增加。这项建议的目标是开发一种综合策略，以最大限度地发挥颈椎不完全脊髓损伤患者的功能，重点是神经假体干预。随着时间的推移，不完全脊髓损伤与完全脊髓损伤的相对百分比一直在增加，这是由于各种因素，特别是急救和创伤治疗的改善，导致损伤脊髓中至少有部分区域得以保留。这种节制允许在受伤水平以下的自愿功能。对于一些人来说，这种多余的功能意义重大，并极大地增加了自愿功能。然而， 仍有相当数量的颈椎脊髓损伤患者被归类为“不完全”(典型的亚洲损伤评定量表B和C组)，但他们的大部分自主肌肉活动太弱，不能提供显著的功能益处。我们在这项建议中的基本假设是，通过使用肌电控制的神经假体干预，可以电子地利用这种自愿功能，为这些人提供显著增强的功能。具体地说，即使是只产生微弱抽搐反应的肌肉(肌肉等级1)也能产生容易检测到的肌电信号，可用于控制其他受刺激的肌肉。自愿控制下的每一块虚弱肌肉都为神经假体干预提供了额外的控制来源，这些新的控制来源可以被利用来控制每个人所需的多种功能。该项目的目标是：1)为不完全性脊髓损伤患者应用神经假体制定全面的筛选评估策略，2)在8名不完全脊髓损伤患者中植入先进的、完全植入的模块化神经假体系统，并评估其结果，3)通过分析家庭使用现有功能来评估植入神经假体的实用性，以及4)获得关于由于增加肢体使用而可能加强和恢复不完全性脊髓损伤患者功能的初步数据。这项提议的总体结果将是显著扩大可以从植入的神经假体系统中受益的患者群体，特别是那些颈椎不完全损伤的患者。

 DESCRIPTION (provided by applicant): Spinal cord injury (SCI), particularly at the cervical level, is one of the most debilitating injures that can be sustained, and is more common in the veteran population than the civilian population. Restoration of hand function is the top priority for individuals with mid-cervical SCI and the existing alternatives for providing hand function for these individuals are inadequate. Upper extremity neuroprostheses have been shown to provide increased independence for individuals with cervical level spinal cord injury (SCI) that is significantly better than the functional improvements that can be achieved through any other intervention. Neuroprostheses use electrical stimulation to activate paralyzed muscles in a coordinated manner. When combined with myoelectric control and tendon transfer procedures, neuroprostheses maximize the use of each subject's voluntary and paralyzed musculature to provide significant improvement in activities of daily living. However, these upper extremity neuroprostheses have not, to date, been systematically implemented and evaluated in individuals with incomplete SCI. Individuals with incomplete SCI have increased heterogeneity in their voluntary function, innervation patterns, and functional goals. The goal of this proposal is to develop a comprehensive strategy for maximizing the function that can be provided to individuals with incomplete cervical SCI, with a focus on neuroprosthetic intervention. The relative percentage of incomplete to complete SCI has been increasing over time due to a variety of factors particularly improved emergency and trauma treatment, resulting in sparing of at least some tracts in the injured cord. This sparing allows voluntary function below the level of injury. For some individuals, this spared function is significant and greatly increases voluntary function. However, there remains a substantial cohort of individuals with cervical SCI who are classified as "incomplete" (Typically ASIA Impairment Scale Group B and C) but for whom much of their voluntary muscle activity is too weak to provide a significant functional benefit. Our fundamental hypothesis in this proposal is that this voluntary function can be harnessed electronically, using myoelectrically controlled neuroprosthetic intervention, to provide significantly enhanced function for these individuals. Specifically, even muscles that produce only weak twitch responses (muscle grade 1) produce easily detectable myoelectric signals which can be utilized for the control of other stimulated muscles. Every weak muscle under voluntary control provides an additional source of control for neuroprosthetic interventions, and these new control sources can be harnessed to control multiple functions as needed for each individual. The goals of this project are to: 1) develop a comprehensive screening assessment strategy for the implementation of neuroprosthetics for incomplete cervical SCI subjects, 2) implant an advanced, fully- implanted, modular neuroprosthetic system in eight incomplete SCI subjects and evaluate the resulting functional outcomes, 3) evaluate the utility of implanted neuroprostheses through analysis of home use of the functions available, and 4) gain preliminary data regarding possible strengthening and recovery of function in incomplete SCI as a result of increased use of the extremity. The overall outcome of this proposal will be to significantly expand the patient population that can benefit from implanted neuroprosthetic systems, particularly to those with incomplete cervical SCI.