Influence of neuromodulatory input on ankle control and spasticity in persons with spinal cord injury.

神经调节输入对脊髓损伤患者踝关节控制和痉挛的影响。

• 批准号: 9904968
• 负责人: Jasmine Hope
• 金额: $ 4.5万
• 依托单位: SHEPHERD CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9904968
• 关键词: 3-Dimensional; Address; Ankle; Biomechanics; Clonus; Corticospinal Tracts; Development; Disease; Drops; Electrophysiology (science); Equilibrium; Exhibits; Flexor; Foundations; Gait; Generations; Goals; Hyperreflexia; Impairment; Individual; Intervention; Isometric Exercise; Knowledge; Learning; Lifting; Lower Extremity; Measures; Motor; Motor Neurons; Motor output; Muscle; Muscle Contraction; Neurologic; Operant Conditioning; Outcome; Outcome Study; Paresis; Pattern; Performance; Persons; Phase; Productivity; Protocols documentation; Public Health; Quality of life; Reflex action; Reflex control; Rehabilitation therapy; Research; Role; Sample Size; Soleus Muscle; Spasm; Spastic Gait; Spinal; Spinal cord injury; Testing; Toes; Training; Training Activity; Transcranial magnetic stimulation; Upper Extremity; Volition; Walking; ankle joint dorsiflexor; data acquisition; fall risk; foot; functional outcomes; improved; improved mobility; innovation; insight; kinematics; motor control; muscle stiffness; neuromechanism; neurophysiology; neuroregulation; rehabilitation strategy; relating to nervous system; sensor; spasticity; spinal reflex; therapy outcome; tibialis anterior muscle; vibration

People with spinal cord injury (SCI) may have some walking ability, however, they are often challenged with a spastic gait pattern, characterized by poor voluntary control of the muscles that lift the foot (dorsiflexors) and spasms of the muscles that control push-off (plantar flexors). Both deficits contribute to impaired ability to achieve foot-ground clearance, making walking laborious and unstable. Two major neural contributors to spastic gait include disrupted descending corticospinal tract (CST) drive to the ankle dorsiflexors and impaired modulation of the plantar flexor spinal reflex circuit (SRC). It is still unknown whether diminished descending volitional drive or impairment of reflex modulation contributes more to spastic gait. Afferent input has a strong neuromodulatory effect on the excitability of both the CST and SRC. Whole body vibration (WBV) is a robust form of afferent input that provides a probe to understand the neurophysiologic mechanisms underlying spastic gait. The long-term goal of this research is to develop rehabilitation strategies to enhance walking function and mobility in persons with SCI by improving ankle control. The overall objective of this proposal is to understand the roles of the CST and SRC in volitional and reflex control of the ankle. The rationale for this project is that understanding the neurophysiological contributions to increased volitional control and decreased spasticity in the ankles will be the first step to developing important non-invasive rehabilitation strategies to improve spastic gait in persons with SCI and other upper motor neuron disorders. The central hypothesis is that improvements in ankle function will have a greater association with changes in the CST than with changes in SRC modulation, as corticospinal drive influences both volitional control and reflex modulation. Using WBV to activate cortical and spinal circuits, the central hypothesis will be tested via two specific aims: 1) Determine the contribution of dorsiflexors CST and plantar flexor SRC excitability to ankle volitional control in individuals with SCI; and 2) Determine the contribution of dorsiflexors CST and plantar flexor SRC excitability to ankle spasticity in individuals with SCI. The proposed research is innovative, because there has yet to be a study examining how an intervention that targets the CST and SRC simultaneously, impacts the different components of spastic gait after SCI. Understanding the mechanisms underlying spastic gait is significant because it provides a foundation for the development of targeted non-invasive therapies to increase the functional outcomes of the people impacted by this impaired gait pattern. Overall, the knowledge gained in this proposal will provide more insight in the underlying mechanisms of ankle control and spasticity in persons with SCI.

脊髓损伤 (SCI) 患者可能有一定的行走能力，但他们经常面临以下挑战： 痉挛步态，其特征是抬脚肌肉（背屈肌）的自主控制能力差 控制推出的肌肉（跖屈肌）痉挛。这两种缺陷都会导致能力受损 足部离地间隙过大，导致行走费力且不稳定。两个主要的神经贡献者 痉挛步态包括皮质脊髓下行束 (CST) 驱动至踝关节背屈肌的中断和受损 足底屈肌脊髓反射回路（SRC）的调节。下降是否减弱仍不得而知 意志驱动或反射调节受损更容易导致痉挛步态。传入输入有很强的 对 CST 和 SRC 兴奋性的神经调节作用。全身振动 (WBV) 是一种稳健的 传入输入的形式，为了解痉挛背后的神经生理机制提供了一个探针 步态。这项研究的长期目标是制定康复策略以增强步行功能和 通过改善踝关节控制来改善 SCI 患者的活动能力。该提案的总体目标是了解 CST 和 SRC 在踝关节的意志和反射控制中的作用。该项目的理由是 了解神经生理学对增加意志控制和减少痉挛的贡献 脚踝将是制定重要的非侵入性康复策略以改善痉挛的第一步 SCI 和其他上运动神经元疾病患者的步态。中心假设是改进 与 SRC 的变化相比，踝关节功能的变化与 CST 的变化有更大的关联 调制，因为皮质脊髓驱动影响意志控制和反射调制。使用 WBV 来 激活皮质和脊髓回路，中心假设将通过两个具体目标进行检验：1）确定 背屈肌 CST 和跖屈肌 SRC 兴奋性对踝关节意志控制的贡献 SCI； 2) 确定背屈肌 CST 和跖屈肌 SRC 兴奋性对踝关节的贡献 SCI 患者的痉挛状态。拟议的研究具有创新性，因为尚未有研究 研究同时针对 CST 和 SRC 的干预措施如何影响不同的群体 SCI 后痉挛步态的组成部分。了解痉挛步态的潜在机制具有重要意义 因为它为开发靶向非侵入性疗法以增加 受这种受损步态模式影响的人们的功能结果。总而言之，在这方面所获得的知识 该提案将为患有踝关节疾病的人提供更多关于脚踝控制和痉挛的潜在机制的见解。 SCI。