Whole-body Neuroprosthetic Approach for Incomplete Cervical Spinal Cord Injury

全身神经修复方法治疗不完全颈脊髓损伤

• 批准号: 8865886
• 负责人: KEVIN L. KILGORE
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8865886
• 关键词: Activities of Daily Living; Address; Algorithms; Cervical; Cervical spinal cord injury; Communities; Data; Devices; Diagnosis; Electric Stimulation; Emergency Situation; Goals; Hand; Hand functions; Heterogeneity; Home environment; Impairment; Implant; Individual; Injury; Intervention; Lead; Limb structure; Measurement; Motor; Muscle; Muscle Contraction; Neck; Operative Surgical Procedures; Outcome; Paralysed; Pattern; Population; Procedures; Process; Recovery; Recovery of Function; Relative (related person); Residual state; Screening procedure; Secondary to; Signal Transduction; Skeletal Muscle; Source; Spinal Cord; Spinal cord injury; System; Technology; Tendon Transfer; Testing; Time; Training; Trauma; Upper Extremity; Veterans; arm movement; cohort; design; functional improvement; functional outcomes; implantation; improved; injured; muscle strength; myoelectric control; nerve supply; neuroprosthesis; patient population; public health relevance; response; restoration; screening

 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.

 描述（由申请人提供）： 脊髓损伤（SCI），尤其是在宫颈水平上，是最令人衰弱的伤害之一，比平民在退伍军人人口中更为普遍。恢复手部功能是中颈SCI的个体的头等大事，为这些人提供手部功能的现有替代方案不足。已证明上肢神经前肢为宫颈水平脊髓损伤（SCI）的个体提供了增加的独立性，这比通过任何其他干预措施可以实现的功能改善要好得多。神经假体使用电刺激以协调的方式激活瘫痪的肌肉。当与肌电控制和肌腱转移程序结合使用时，神经phip虫最大化了每个受试者的自愿和瘫痪的肌肉的使用，以显着改善日常生活活动。但是，迄今为止，这些上肢神经前肢尚未在不完整的SCI的个体中进行系统地实施和评估。 SCI不完整的个体在自愿功能，神经模式和功能目标方面具有增加的异质性。该提案的目的是制定一项综合策略，以最大程度地提高可提供不完整宫颈SCI的个体的功能，重点是神经假体干预。由于多种因素特别改善了紧急和创伤治疗，不完整的SCI的相对百分比随着时间的推移而增加，导致受伤的绳索中至少有一些区域。这种保证使自愿功能低于伤害水平。对于某些人而言，这种幸免的功能是显着的，并且大大增加了自愿功能。然而， 仍有大量的具有宫颈SCI的个体，这些人被归类为“不完整”（通常是亚洲损害量表B和C组），但他们的许多自愿性肌肉活动都太弱了，无法提供显着的功能益处。我们在此提案中的基本假设是，使用肌电控制神经假体干预措施可以通过电子利用这种自愿功能，从而为这些人提供了显着增强的功能。具体而言，即使仅产生弱抽搐反应（肌肉1级）的肌肉也会产生易于检测的肌电信号，这些信号可用于控制其他刺激的肌肉。自愿控制下的每个弱肌肉都为神经假体干预提供了额外的控制源，并且可以利用这些新的控制源来根据需要控制多个功能。 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）获取有关由于增加肢体使用而导致功能不完整的功能不完整SCI的初步数据。该提案的总体结果将是显着扩大可以从植入的神经假体系统中受益的患者人群，尤其是对于那些不完整的宫颈SCI的患者。