Targeted High-Definition tDCS to Improve Upper Limb Rehabilitation in SCI

只有不到1%的脊髓损伤（SCI）患者经历了完全的功能恢复 出院时。出院后，通过康复治疗与康复治疗相结合， 被称为非侵入性脑刺激的实验技术。非侵入性脑刺激是 据信，通过促进存活的神经基质的有利可塑性， 在大多数SCI中。具体来说，我们最近已经表明，一种非侵入性脑刺激，称为 经颅直流电刺激（tDCS），可以提高肌肉力量高达15%以上的康复 通过增加通往较弱肌肉的通路的兴奋性。 这项建议的理据是，优化tDCS的应用， 提高SCI患者的治疗效果。具体而言，我们的建议将建立在我们以前在SCI中的研究基础上 以确定是否使用更局灶形式的tDCS可以更好地改善瘫痪上肢的功能 与传统的tDCS相比。我们的设计是基于我们的初步数据，显示HD-tDCS显示了 与传统tDCS相比，在恢复上肢功能方面有40%的优势。因此，我们假设， 使用局灶性tDCS，我们将增加皮质脊髓兴奋性的途径，致力于薄弱的肌肉， 与传统tDCS相比，改善了它们对麻痹上肢运动控制的贡献。 为了验证我们的假设，我们将进行一项随机、评估者盲法临床可行性试验，其中24 C2-C6不完全SCI受试者将接受10次常规tDCS或焦点tDCS治疗， 一种名为高清tDCS（HD-tDCS）的新方法，与上肢康复相结合。我们的目标是：（1） 确定为我们的研究招募和保留受试者的可行性，（2）确定HD-tDCS如何影响 上肢功能和皮质脊髓兴奋性的途径致力于弱肌肉相比， 传统的tDCS将在治疗结束前、治疗结束后和治疗结束后四周收集两次结局指标。 治疗上肢功能将是主要结局，并将使用重新定义的分级标准进行测量。 强度、灵敏度和扩展性的评估。皮质脊髓兴奋性的特征将使用 经颅磁刺激 完成我们的研究将导致关于什么类型的tDCS应用程序的理解（局灶性vs. 非病灶性）在SCI康复中增强上肢功能将是最有效的。

Less than one percent of individuals with a spinal cord injury (SCI) experience complete functional recovery by hospital discharge. Functional deficits can be improved after discharge by combining rehabilitation with a promising experimental technique known as non-invasive brain stimulation. Non-invasive brain stimulation is believed to further improve recovery by promoting advantageous plasticity across neural substrates that survive in the majority of SCIs. Specifically, we have recently shown that a form of non-invasive brain stimulation, called transcranial direct current stimulation (tDCS), can improve muscle strength up to 15% more than rehabilitation alone by increasing the excitability of pathways to the weaker muscles. The rationale of this proposal is that optimizing the application of tDCS would lead to an even better enhancement of outcomes in those with SCI. Specifically, our proposal will build off our previous study in SCI to determine if using a more focal form of tDCS can better improve function of the paretic upper extremity compared to conventional tDCS. Our design is based on our preliminary data that shows HD-tDCS shows a 40% advantage over conventional tDCS in restoring upper limb function. Therefore, we hypothesize that by using focal tDCS, we would increase corticospinal excitability to pathways devoted to weak muscles and improve their contribution to movement control of the paretic upper extremity compared to conventional tDCS. To test our premise, we will perform a randomized, assessor-blinded clinical feasibility trial where 24 subjects with C2-C6 incomplete SCI will receive ten sessions of either conventional tDCS or focal tDCS, with a new approach called high-definition tDCS (HD-tDCS), paired with upper-limb rehabilitation. Our aims will: (1) determine the feasibility of recruiting and retaining subjects for our study, (2) identify how HD-tDCS affects upper extremity function and corticospinal excitability of pathways devoted to weak muscles compared to conventional tDCS. Outcome measures will be collected twice before, after and four weeks after the end of treatment. Upper limb function will be the primary outcome and will be measured using the graded redefined assessment of strength, sensibility and prehension. Corticospinal excitability will be characterized using transcranial magnetic stimulation. Completion of our study will result in an understanding concerning what type of tDCS application (focal vs. non-focal) will be most effective at enhancing upper limb function in SCI rehabilitation.