High-density Surface EMG Assessment of Motor Unit Alterations of the External Anal Sphincter Associated with Aging

高密度表面肌电图评估与衰老相关的肛门外括约肌运动单位改变

• 批准号: 9566428
• 负责人: Yingchun Zhang
• 金额: $ 20.54万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9566428
• 关键词: Affect; Aging; Anatomy; Biofeedback; Communities; Defecation; Defect; Elderly; Electric Stimulation; Electromyography; Esthesia; Estimation Techniques; External anal sphincter structure; Functional disorder; Future; Goals; Image; Imaging Techniques; Individual; Injury; Intramuscular; Magnetic Resonance Imaging; Manometry; Measures; Motor; Muscle; Myopathy; Nature; Nerve; Neural Conduction; Neuropathy; Normal Range; Operative Surgical Procedures; Pattern; Phenotype; Physiological; Population; Recruitment Activity; Rectum; Reflex action; Reproducibility; Research; Rest; Spatial Distribution; Sphincter; Surface; Techniques; Testing; Therapeutic; Time; Ultrasonography; Woman; age effect; aged; clinically significant; density; imaging study; minimally invasive; nerve supply; neuromuscular; neuromuscular function; novel; predictive tools; pressure; relating to nervous system; signal processing; sphincter ani muscle structure

Abstract The external anal sphincter (EAS) is essential for maintaining fecal continence, which affects 6% to 19% of elderly individuals aged 65 years and older living in the community. Aging significantly affects anorectal function both neurogenically and myogenically. However, there is an unmet need of advanced and less- invasive approaches to quantitatively and objectively evaluate the neuromuscular function of the EAS. Anorectal imaging techniques with ultrasound or magnetic resonance imaging provide useful information in detecting anatomical defects in the EAS, but they are not capable of detecting neurogenic injuries. Intramuscular electromyography (EMG) is the only technique available for documenting neurogenic sphincter injury, but its application is limited by its highly invasive nature, poor repeatability and inability to describe global innervation. Pudendal nerve terminal motor latency has several limitations including the fact that a normal latency time does not exclude neuropathy and its clinical significance remains controversial. Anorectal manometry measures pressures of the anal sphincter muscles, sensation in the rectum, and neural reflexes that are necessary for normal bowel movements. However, normal ranges of various parameters measured are highly variable and poorly reproducible. The goal of this project is to develop a minimally invasive EAS innervation pattern characterization technique using the most recent advances in high-density (HD) surface EMG recording and signal processing techniques, to quantitatively and objectively assess the neuromuscular function of the EAS, 1) at rest when only tonic activities are present, 2) during voluntary contraction when motor units are selectively recruited, and 3) under supramaximal pudendal stimulation when all motor units are simultaneously activated, as well as to investigate specific alterations of the EAS innervation associated with aging. This research represents the first effort to quantitatively and objectively characterize the innervation patterns of the EAS under three different physiological conditions. The innervation patterns of the EAS characterized at rest, during voluntary contraction and under supramaximal pudendal nerve stimulation provide specific EAS function information associated with the resting tone, voluntary activation and global innervation of the EAS respectively. Aging effects on specific changes of the EAS innervation under these three conditions will be investigated. The proposed EAS innervation pattern characterization technique will serve as a novel phenotyping and predictive tool for anorectal dysfunctions caused by neurogenic weaknesses of the EAS. The results will advance our understanding of the pathophysiology of anorectal neuromuscular dysfunctions associated with aging, will also have clinical significance with regard to future therapeutic “choice” of biofeedback or surgical intervention.

抽象的 肛门外括约肌 (EAS) 对于维持大便失禁至关重要，影响 6% 至 19% 居住在社区的 65 岁及以上老年人。衰老显着影响肛门直肠 具有神经源性和肌源性功能。然而，高级和次要的需求尚未得到满足 定量、客观评估 EAS 神经肌肉功能的侵入性方法。 肛门直肠成像技术与超声或磁共振成像提供了有用的信息 检测 EAS 的解剖缺陷，但它们无法检测神经源性损伤。 肌内肌电图 (EMG) 是唯一可用于记录神经源性括约肌的技术 损伤，但其应用因其高度侵入性、重复性差和无法描述而受到限制 全局神经支配。阴部神经末梢运动潜伏期有几个局限性，包括 正常潜伏期并不能排除神经病变，其临床意义仍存在争议。肛肠科 测压法测量肛门括约肌的压力、直肠的感觉和神经反射 这是正常排便所必需的。但所测各项参数的正常范围 变化很大且可重复性差。 该项目的目标是开发微创 EAS 神经支配模式表征 采用高密度 (HD) 表面肌电图记录和信号处理领域最新进展的技术 技术，定量和客观地评估 EAS 的神经肌肉功能，1) 休息时 仅存在强直活动，2) 在有选择地募集运动单位的自主收缩期间，以及 3）当所有运动单位同时激活时，在超最大阴部刺激下，以及 研究与衰老相关的 EAS 神经支配的具体变化。 这项研究代表了定量和客观地表征神经支配的首次努力 三种不同生理条件下的 EAS 模式。 EAS 的神经支配模式 其特点是在休息时、随意收缩期间和在超最大阴部神经刺激下提供 与静息音、随意激活和整体神经支配相关的特定 EAS 功能信息 分别是EAS。在这三种条件下，衰老对 EAS 神经支配特定变化的影响 将被调查。所提出的 EAS 神经支配模式表征技术将作为一种新颖的 EAS 神经源性弱点引起的肛门直肠功能障碍的表型分析和预测工具。这 结果将增进我们对肛门直肠神经肌肉功能障碍病理生理学的理解 与衰老相关，对于未来的治疗“选择”也具有临床意义 生物反馈或手术干预。