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

有针对性的高清 tDCS 改善 SCI 上肢康复

• 批准号: 9903945
• 负责人: Kelsey Potter-Baker
• 金额: $ 14.53万
• 依托单位: UNIVERSITY OF TEXAS RIO GRANDE VALLEY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-07 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903945
• 关键词: Activities of Daily Living; Affect; Area; Blinded; Brachial Paresis; Brain; Cervical spinal cord injury; Clinic; Clinical; Clinical Trials; Computer Models; Cross-Over Studies; Data; Diffuse; Effectiveness; Electrodes; Future; Goals; Hand Strength; Hospitals; Hour; Individual; Injury; Intervention; Lead; Measures; Mission; Motor; Movement; Muscle; Neurologic; Outcome; Outcome Measure; Paresis; Pathway interactions; Patients; Phase; Population; Quality of life; Randomized; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Site; Specificity; Spinal cord injury; Techniques; Testing; Training; Transcranial magnetic stimulation; Translating; Triceps Brachii Muscle; Upper Extremity; Work; arm; base; clinically significant; design; disability; electric field; experience; feasibility trial; functional gain; functional independence; hand rehabilitation; improved; improved functioning; muscle strength; novel strategies; primary outcome; recruit; relating to nervous system; retention rate

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.

只有不到百分之一的脊髓损伤患者能完全恢复功能。 由医院出院。康复与康复相结合可改善出院后的功能障碍 被称为非侵入性脑刺激的有前途的实验技术。无创脑刺激是 据信通过促进存活的神经基质的有利可塑性进一步改善康复 在大多数SCI中。具体地说，我们最近证明了一种非侵入性的大脑刺激形式，称为 经颅直流电刺激(Tdcs)，可提高肌肉力量高达15%以上的康复。 仅通过增加通向较弱肌肉的通路的兴奋性来实现。 这项建议的理由是，优化tdcs的应用将导致更好的 改善脊髓损伤患者的预后。具体地说，我们的建议将建立在我们先前在SCI中的研究基础上 为了确定是否使用更有针对性的tdcs可以更好地改善偏瘫患者的上肢功能。 与传统的tdcs进行了比较。我们的设计基于我们的初步数据，该数据显示HD-tDCS显示 在恢复上肢功能方面比传统的tdcs高40%。因此，我们假设，通过 使用局灶性TDCs，我们将增加皮质脊髓对专用于弱肌肉和 与传统的tdcs相比，其对偏瘫患者上肢运动控制的贡献更大。 为了测试我们的假设，我们将进行一项随机的、评估者盲的临床可行性试验，其中24 患有C2-C6不完全性脊髓损伤的受试者将接受10次常规tdcs或局部tdcs的治疗， 新的方法被称为高清晰度tdcs(HD-tdcs)，与上肢康复相结合。我们的目标是：(1) 确定招募和保留我们研究对象的可行性，(2)确定HD-TDC如何影响 弱肌肉通路的上肢功能和皮质脊髓兴奋性的比较 传统的tdcs。将在结束前、结束后和结束后四周收集两次结果衡量标准 治疗。上肢功能将是主要结果，并将使用分级重新定义的 对力量、敏感度和感受力的评估。皮质脊髓兴奋性的特征将使用 经颅磁刺激。 我们研究的完成将导致对哪种类型的tdcs应用程序(焦点与 非局灶性)在脊髓损伤康复中将是提高上肢功能最有效的方法。