Improving Hand and Arm Function in Individuals with SCI

描述（由申请人提供）：颈脊髓损伤患者通常将手部和手臂功能的丧失作为其损伤的最具破坏性的后果，然而很少有干预措施可以改善慢性四肢瘫痪患者的手部功能，这使得这一需求未得到满足。拟议的研究通过检查旨在改善慢性四肢瘫痪患者熟练的手/手臂使用的康复干预措施来满足这一需求。有证据表明，四肢瘫痪患者的手功能缺陷主要是由于下行皮质-脊髓连接受损，其次，习得性不使用和皮质兴奋性下降可能导致皮质对剩余脊髓连接的控制无效。这些继发性变化类似于中风后发生的变化，在某种程度上可能是可逆的。因此，有效改善中风后手/手臂功能的干预措施也可能对四肢瘫痪患者有益。在中风患者中，强化上肢技能训练（大量练习）与改善手部使用有关。另一种干预，体感刺激，已被证明可以增加非残疾个体的皮质兴奋性，并改善中风患者的力量。通过应用卒中康复的创新策略，我们的初步结果表明，大量练习和体感刺激可以改善慢性不完全性四肢瘫痪患者的手/手臂功能。这些改善可能伴随着皮质输出量的改善，也可能与生活质量的改善有关。建议的研究集中在这些结果上。在目标1中，我们将量化和比较熟练的手/手臂使用、握力和感觉功能的变化，这些变化与以下两种情况有关：大规模练习训练+体感刺激、单独体感刺激或对照干预（传统阻力训练）。在目标2中，我们将量化和比较与以下两种情况相关的皮质神经生理学变化：大规模练习+体感刺激、单独体感刺激或对照干预。在目标3中，我们将量化和比较与集体练习+体感刺激、单独体感刺激或对照干预相关的生活质量自我评估和社会参与的变化。我们相信这些研究的结果将对脊髓损伤导致的不完全性四肢瘫痪患者的功能和生活质量产生积极影响。

DESCRIPTION (provided by applicant): Individuals with cervical spinal cord injury often cite loss of hand and arm function as the most devastating consequence of their injury, yet there are few interventions available to improve hand function in individuals with chronic tetraplegia, making this an unmet need. The proposed studies target this need by examining rehabilitation interventions designed to improve skilled hand/arm use in individuals with chronic tetraplegia. Evidence suggests that while deficits of hand function in individuals with tetraplegia are primarily due to damage to descending corticospinal connections, secondarily, learned non-use and decreased cortical excitability likely contribute to ineffective cortical control of the remaining connections to the spinal cord. These secondary changes resemble those that occur after stroke and may be reversible to some extent. Consequently, interventions that are effective for improving hand/arm function after stroke may also be of benefit for individuals with tetraplegia. In individuals with stroke, intensive upper extremity skill training (massed practice) is associated with improved use of the hand. Another intervention, somatosensory stimulation, has been shown to increase cortical excitability in non-disabled individuals and to improve strength in individuals with stroke. By applying strategies that have been innovated for stroke rehabilitation, our preliminary results suggest that massed practice and somatosensory stimulation can improve hand/arm function in individuals with chronic incomplete tetraplegia. These improvements may be accompanied by improved cortical output and may also be associated with improvements in quality of life. The proposed studies focus on these outcomes. In Aim 1, we will quantify and compare changes in skilled hand/arm use, grip force and sensory function associated with either: massed practice training + somatosensory stimulation, somatosensory stimulation alone, or a control intervention (conventional resistance training). In Aim 2, we will quantify and compare changes in cortical neurophysiology associated with either: massed practice + somatosensory stimulation, somatosensory stimulation alone, or a control intervention. In Aim 3, we will quantify and compare changes in self-assessment of quality of life and societal participation associated with massed practice + somatosensory stimulation, somatosensory stimulation alone, or a control intervention. We believe the outcomes of the proposed studies will have a positive influence on function and quality of life for individuals with incomplete tetraplegia due to spinal cord injury.