Grasping Function after Spinal Cord Injury

抓握行为是日常生活功能所必需的，在患有以下疾病的人中，这种行为严重受损 颈髓损伤(SCI)。尽管康复干预在提高能力方面取得了成功 要掌握受伤后的情况，它们的整体效果仍然有限。这项提案的目标是研究 生理通路在颈髓损伤后握力行为控制中的作用 通过使用量身定制的非侵入性刺激方案结合运动训练来恢复抓握能力。我们建议 学习两种基本的抓握行为：精准抓握和强力抓握。这些行为至关重要，因为它们 为许多人类抓握操作提供基础，也是进食、写作、 穿衣，还有许多其他功能。因此，我们的结果可能会直接影响退伍军人的生活质量 以及他们的照顾者，通过提高他们的独立性和护理水平。 在目标1中，我们将研究皮质脊髓和脑干通路在控制脑出血中的作用。 手部肌肉参与颈椎损伤后的精准握力和力量握力。经颅磁刺激(TMS) 将被用来检查皮质脊髓和皮质内通路的传递，这些通路针对手指肌肉和 有或没有TMS的声学惊吓刺激将被用来研究脑干通路的贡献。 功能磁共振成像(FMRI)将被用来进一步评估在 这些手部运动任务。在目标2中，我们建议通过使用新的量身定做来提高抓取的恢复 无创重复TMS靶向晚期间接(I)下行抽动(ITMS)和声学检查 惊吓刺激。ITMS和STARTLE将在任务依赖的精确度和力量握力动作中使用 以诱导皮质和皮质下可塑性和增强手部肌肉的自愿输出的方式(目标2a)。 稍后，ITMS和STARTLE将以任务依赖的方式在运动训练任务中应用，包括 精确度和力量抓地力(目标2b)。这些独特的方法旨在促进神经可塑性在功能 相关的抓取动作以前从未被使用过。 拟议的实验将提供关于抓取功能的机制的新知识，这将 用于指导与功能相关的可塑性诱导方案，以促进手功能的恢复。这个 颈椎脊髓损伤退伍军人的抓握运动障碍缺乏公认的治疗方法 目前干预措施的有限行为收益强调了这些调查的重要性。

Grasping behaviors, which are essential for daily-life functions, are largely impaired in individuals with cervical spinal cord injury (SCI). Although rehabilitative interventions have shown success in improving the ability to grasp following injury their overall effects remain limited. The goals of this proposal are to examine the contribution of physiological pathways to the control of grasping behaviors after cervical SCI, and to maximize the recovery of grasping by using tailored non-invasive stimulation protocols with motor training. We propose to study two basic grasping behaviors: a precision grip and a power grip. These behaviors are crucial because they provide the basis for a number human prehensile manipulations and are also necessary skills for eating, writing, dressing, and many other functions. Thus, our results may have a direct impact on the quality of life for veterans and their caregivers by enhancing their independence and level of care. In Aim 1, we will investigate the contribution of corticospinal and brainstem pathways to the control of hand muscles involved in precision and power grip after cervical SCI. Transcranial magnetic stimulation (TMS) will be used to examine transmission in corticospinal and intracortical pathways targeting finger muscles and an acoustic startle stimulus with and without TMS will be used to examine the contribution from brainstem pathways. Functional magnetic resonance imaging (fMRI) will be used to further assess changes in brain activity during these hand motor tasks. In Aim 2, we propose to enhance the recovery of grasping by using novel tailored protocols of non-invasive repetitive TMS targeting late indirect (I) descending volleys (iTMS) and an acoustic startle stimuli. iTMS and startle will be used during precision and power grip movements in a task-dependent manner to induce cortical and subcortical plasticity and enhance voluntary output of hand muscles (Aim 2a). Later, iTMS and startle will be applied in a task-dependent manner during a motor training task that involves precision and power grip (Aim 2b). These unique approaches aim at promoting neuroplasticity during functionally relevant grasping movements has not been used before. The proposed experiments will provide new knowledge on mechanisms of grasping functions which will be used to guide functionally-relevant plasticity-inducing protocols to enhance recovery of hand function. The absence of well-accepted treatments for grasping motor impairments for veterans with cervical SCI and the limited behavioral gains of present interventions underline the importance of these investigations.