Improving Hand and Arm Function in Individuals with SCI

描述（由申请人提供）：提出的研究旨在加快发现与颈脊髓损伤（SCI）患者相关的干预措施的步伐，这些患者在需要手部功能使用的日常活动中面临重大挑战。除了脊髓的物理损伤外，大脑中的继发性神经可塑性重组加剧了功能丧失。在一些报道中，脊髓损伤后皮质运动兴奋性的变化与中风后相似。通过增加手部的自主动力，可以改善脊髓损伤后的功能。父母资助的研究适用于接受脊髓损伤干预的个体，这些干预与最近中风研究中收集的研究相似。新的证据表明，高频重复经颅磁刺激（rTMS）可能有效改善中风后的手功能。拟议的研究将使用rTMS，目的是增加皮质运动驱动，以改善脊髓损伤患者的手部功能。这些补充研究将在20名受试者中采用为期两周的单盲、假对照、交叉设计来评估rTMS的安全性、神经生理效应和初步疗效。将实现以下目标：1)评估术中捏紧力的变化，以量化与同侧手和假性rTMS相比，rTMS对对侧手的力产生的直接影响。2)评估3天rTMS的效果，以量化与对侧手功能和假性rTMS相比，rTMS对对侧手的力产生、功能性任务表现和皮质运动神经生理学的短期影响。3)通过量化rTMS对手部功能和力量产生影响的持久性来评估效果的持久性。这些研究扩大了父母补助金的目标，支持人员，并投资于技术设备。在2年的短期资助期内，该补充将最大限度地了解脊髓损伤患者皮质脊髓驱动和手功能之间的关系。

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.