Improving mechanistic understanding of responsiveness to spinal cord stimulation after spinal cord injury

提高对脊髓损伤后脊髓刺激反应机制的理解

• 批准号: 10672452
• 负责人: Andrew Craig Smith
• 金额: $ 12.72万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672452
• 关键词: Address; Axon; Bilateral; Biological Markers; Case Study; Classification; Clinical Management; Electromyography; Event; Foundations; Funding; Generations; Goals; Handedness; Health; Human; Implant; Individual; Injury; Institution; Intervention; Investigation; Ipsilateral; Knowledge; Leg; Life Expectancy; Light; Lower Extremity; Magnetic Resonance Imaging; Manuscripts; Measures; Motor; Movement; Muscle; National Institute of Child Health and Human Development; Neuronal Plasticity; Neurostimulation procedures of spinal cord tissue; Operative Surgical Procedures; Participant; Pattern; Persons; Physical Function; Pilot Projects; Productivity; Prognosis; Quality of life; Recovery; Reporting; Research; Research Personnel; Residual state; Resolution; Sensory; Side; Signal Transduction; Spinal Cord; Spinal cord damage; Spinal cord injury; Supine Position; Time; Tissues; Touch sensation; Training; Travel; United States National Institutes of Health; Walking; Work; biomarker identification; clinical examination; cohort; cost; design; electric field; implantation; improved; improved outcome; magnetic resonance imaging biomarker; man; neural network; neuroimaging; neuroimaging marker; neuroregulation; personalized approach; physically handicapped; prospective; rehabilitation research; sound; theories; tool; treatment strategy; trend

PROJECT SUMMARY / ABSTRACT Spinal cord injury (SCI) is a devastating event in terms of a person’s health, physical function, costs (direct and indirect), and life expectancy. It has been conventionally thought that individuals with severe SCIs, with no motor function below the level of injury, will not recover the ability to functionally move their lower extremities or voluntarily walk. However, spinal cord stimulation (SCS) has emerged as a promising intervention challenging this long-held assumption. While spinal cord stimulation allows for restored voluntary movement after severe SCI, there is a lack of mechanistic understanding regarding how it works and why some individuals respond better than others. Thus, the overall objective of this proposal is to apply neuroimaging biomarkers to generate fundamental knowledge regarding responsiveness to spinal cord stimulation (SCS). Aim 1: Use neuroimaging biomarkers to understand responsiveness to epidural SCS in participants with severe SCI, during volitional movement and standing tasks. Using high-resolution MRI in a prospective design, the applicant hypothesizes that the laterality of cord damage, detected prior to surgical implantation, will predict ipsilateral lower extremity muscle responsiveness to epidural SCS prior to any training. Aim 2: Use neuroimaging biomarkers to understand responsiveness to transcutaneous SCS in participants with severe SCI, during volitional movement tasks and sensory examination. Using high- resolution MRI in a prospective design, the applicant hypothesizes that total spinal cord spared tissue will predict bilateral lower extremity muscle responsiveness to transcutaneous SCS prior to any training, and that posterior cord spared tissue will predict light touch sensory recovery prior to any training. Significance: Successful completion of these Aims will advance the NIH/NICHD NCMRR aim: “to enhance the health, productivity, independence, and quality of life of people with physical disabilities.” One important problem in the field of SCS is a lack of foundational knowledge on why the intervention works. Neuroimaging holds pronounced potential to address this problem. Neuroimaging biomarkers will not only improve the understanding of responsiveness to this intervention after SCI, but will also help drive individualized approaches for using SCS, selection of epidural versus transcutaneous SCS, prognosis for improvement using SCS, and the identification of who is likely to optimally respond before activity-based recovery training. Completion of the proposed aims will lead to the high likelihood of sustained, powerful influence on the SCS field, laying a vital foundation for using MRI biomarkers to guide SCS intervention, ultimately improving the clinical management of persons with SCI.

项目总结/摘要 脊髓损伤（SCI）是一个人的健康，身体功能，成本（直接和间接）方面的破坏性事件。 间接）和预期寿命。传统上认为，患有严重SCI的人，没有运动 功能低于损伤水平，将无法恢复功能性移动下肢的能力，或 自愿步行。然而，脊髓刺激（SCS）已成为一种有前途的干预措施， 这个长期的假设。虽然脊髓刺激可以在严重的脊髓损伤后恢复自主运动， SCI，缺乏对它如何工作以及为什么有些人会做出反应的机械理解 比其他人更好因此，该提议的总体目标是应用神经成像生物标志物来生成 关于脊髓刺激（SCS）反应性的基本知识。 目的1：使用神经影像学生物标志物了解参与者对硬膜外SCS的反应性， 严重SCI，在意志运动和站立任务期间。在前瞻性研究中使用高分辨率MRI 设计，申请人假设在手术植入前检测到的脊髓损伤的偏侧性， 在任何训练之前预测同侧下肢肌肉对硬膜外SCS的反应性。 目的2：使用神经影像学生物标志物了解经皮SCS的反应性， 严重SCI的参与者，在意志运动任务和感觉检查。使用高- 在一项前瞻性设计中，申请人假设脊髓备用组织总数将预测 在任何训练之前，双侧下肢肌肉对经皮SCS的反应性，以及 在任何训练之前，脊髓备用组织将预测轻触感觉恢复。 意义：这些目标的成功完成将推进NIH/NICHD NCMRR的目标：“加强 身体残疾者的健康、生产力、独立性和生活质量。”一个重要问题 在SCS领域中，缺乏关于为什么干预有效的基础知识。神经影像学检查 解决这一问题的潜力。神经影像学生物标记物不仅能提高对 SCI后对这种干预的反应性，但也将有助于推动使用SCS的个性化方法， 硬膜外与经皮SCS的选择、使用SCS改善的预后以及识别 的人可能在基于活动的恢复训练之前做出最佳反应。完成拟议目标 将导致对SCS场产生持续、强大影响的可能性很高，为使用 MRI生物标志物指导SCS干预，最终改善SCI患者的临床管理。

项目成果

The presence or absence of midsagittal tissue bridges and walking: a retrospective cohort study in spinal cord injury.

中矢状组织桥的存在或不存在和行走：脊髓损伤的回顾性队列研究。

• DOI: 10.1038/s41393-023-00890-6
• 发表时间: 2023
• 期刊: Spinal cord
• 影响因子: 2.2
• 作者: Thornton,WA;Marzloff,G;Ryder,S;Best,A;Rasheed,K;Coons,D;Smith,AC
• 通讯作者: Smith,AC

Needs of an uninsured equity-deserving minority patient cohort with physical disabilities during the first wave of the COVID-19 pandemic.

• DOI: 10.3389/fresc.2023.1000838
• 发表时间: 2023
• 期刊: FRONTIERS IN REHABILITATION SCIENCES
• 作者: Claus, D.;Draganich, C.;Berliner, J.;Niehaus, W.;Berliner, J.;Magnusson, D.;Smith, A. C.
• 通讯作者: Smith, A. C.

Muscle adaptations in acute SCI following overground exoskeleton + FES training: A pilot study.

• DOI: 10.3389/fresc.2022.963771
• 发表时间: 2022
• 期刊: FRONTIERS IN REHABILITATION SCIENCES
• 作者: Hohl, Kristen;Smith, Andrew C.;Macaluso, Rebecca;Giffhorn, Matthew;Prokup, Sara;O'Dell, Denise R.;Kleinschmidt, Lina;Elliott, Jim M.;Jayaraman, Arun
• 通讯作者: Jayaraman, Arun