Improving Hand and Arm Function in Individuals with SCI

描述(申请人提供)：建议的研究旨在加快与颈髓损伤(SCI)患者相关的干预措施的发现步伐，这些患者在日常活动中面临着巨大的挑战，需要使用手的功能。除了对脊髓的物理损伤外，大脑中的次级神经整形重组还会加剧功能丧失。在一些报告中，脊髓损伤后皮质运动兴奋性的变化与中风后的变化相似。通过增加对手的自愿驱动力，脊髓损伤后的功能可以得到改善。父母拨款中的研究适用于接受脊髓损伤干预的个人，这些干预类似于从最近的中风研究中收集到的。更新的证据表明，高频重复经颅磁刺激(RTMS)可能在改善中风后的手功能方面有效。建议的研究将使用rTMS，目标是增加皮质运动驱动力，以改善脊髓损伤患者的手功能。这些补充研究将在20名受试者中使用为期两周的单盲、假对照、交叉设计来评估rTMS的安全性、神经生理学效应和初步疗效。将实现以下目标：1)评估夹力的会话内变化，以量化rTMS对对侧手的力量产生的即时影响，与同侧手和假rTMS条件相比；2)评估为期3天的rTMS疗程的影响，以量化与同侧手功能和假rTMS相比，对侧手功能相关的短期影响、功能任务绩效和皮质运动神经生理学；以及3)通过量化rTMS对手功能和力量产生影响的持续性来评估影响的持久性。这些研究扩大了父母资助的目标，支持人员，并投资于技术设备。在两年的缩短资金期限内，该补充资料将最大限度地增加关于脊髓损伤患者的皮质脊髓驱动力和手功能之间关系的信息。 公共卫生相关性：在颈椎脊髓损伤患者中，手功能受损通过限制自我护理、工作和休闲任务的表现，严重限制了独立性和生活质量。这些研究旨在推进康复科学领域，通过改善脊髓损伤患者的手功能来减轻残疾负担。对于这些个体的功能、独立性和参与性而言，很少有比这更重要的目标了。

DESCRIPTION (provided by applicant): The studies proposed are intended to accelerate the pace of discovery related to interventions for individuals with cervical spinal cord injury (SCI) who face significant challenges in the performance of everyday activities that require functional use of the hands. Beyond the physical damage to the spinal cord, secondary neuroplastic reorganization in the brain exacerbates functional loss. In some reports, the changes in corticomotor excitability that occur after SCI are similar to those that occur following stroke. By increasing voluntary drive to the hands, function can be improved after SCI. The studies in the parent grant apply to individuals with SCI interventions similar to those gleaned from recent studies of stroke. Newer evidence indicates that high-frequency repetitive transcranial magnetic stimulation (rTMS) may be effective at improving hand function after stroke. The proposed studies will use rTMS with the goal of increasing corticomotor drive to improve hand function in individuals with SCI. These supplemental studies will assess the safety, neurophysiologic effects, and preliminary efficacy of rTMS using a two-week, single-blind, sham-controlled, crossover design in 20 subjects. The following aims will be accomplished: 1) Assess within-session changes in pinch force to quantify the immediate effects of rTMS on force production of the contralateral hand, compared to ipsilateral hand and to sham-rTMS condition, 2) Assess effects of a 3-day course of rTMS to quantify the short-term effects on force production, functional task performance, and cortimotor neurophysiology related to contralateral hand function, compared to ipsilateral hand function and to sham-rTMS, and 3) Assess endurance of effects by quantifying the persistence of effects of rTMS on hand function and force production. These studies expand the aims of the parent grant, support personnel, and invest in technological equipment. The supplement will maximize the information that can be learned about the relationship between corticospinal drive and hand function in individuals with SCI within the 2-year abbreviated funding period. PUBLIC HEALTH RELEVANCE: In individuals with cervical SCI, impairment of hand function severely restricts independence and quality of life by limiting performance of self care, work, and leisure tasks. These studies aim to advance the field of rehabilitation science and reduce the burden of disability by improving hand function in individuals with SCI. Few goals are more important for function, independence, and participation in these individuals.