Neuromodulatory rehabilitation for respiratory motor function in individuals with chronic spinal cord injury

慢性脊髓损伤患者呼吸运动功能的神经调节康复

• 批准号: 10635519
• 负责人: Alexander Vladimirovich Ovechkin
• 金额: $ 37.14万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-10 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10635519
• 关键词: Activities of Daily Living; Acute; Blood Pressure; Breathing; COVID-19; Cardiovascular system; Chronic; Clinical; Complication; Cutaneous; Data; Development; Effectiveness of Interventions; Electromyography; Electrophysiology (science); Evaluation; Goals; Heart Rate; Human; Individual; Injury; Knowledge; Lesion; Lung; Measures; Methods; Modality; Morbidity - disease rate; Motor; Muscle; Neurologic; Neuronal Plasticity; Neurostimulation procedures of spinal cord tissue; Patients; Pattern; Physiological; Population; Property; Protocols documentation; Public Health; Pulmonary function tests; Randomized Controlled Clinical Trials; Rehabilitation therapy; Research; Respiration; Respiration Disorders; Respiratory Muscles; Respiratory physiology; Spinal; Spinal Cord; Spinal Cord Lesions; Spinal cord injury; Surface; Testing; Therapeutic Effect; Time; Training; Vertebral column; Work; comparative; design; disability; effectiveness evaluation; evidence base; fighting; follow-up; functional improvement; functional outcomes; improved; kinematics; mortality; motor control; neural network; neuroregulation; novel therapeutic intervention; preservation; pressure; rehabilitation strategy; respiratory; response; restoration; standard of care; transcutaneous stimulation; voltage

Project Summary/Abstract Respiratory motor control deficit is the leading cause of morbidity and mortality in patients with spinal cord injury. The long-term goal of this research is to develop a rehabilitation strategy for respiration in patients with spinal cord injury as a standard of care. Our previous findings demonstrate that respiratory function in patients with chronic spinal cord injury can be improved by using our original inspiratory-expiratory pressure threshold respiratory training protocol. However, the effectiveness of this intervention is limited to the amount of functional capacity preserved below the neurological level of injury. Our preliminary data obtained for this proposal demonstrate that electrical spinal cord stimulation applied non-invasively to target spinal respiratory circuits in combination with respiratory training can activate and re-organize spinal motor networks for respiration. We propose to investigate respiratory motor control-related responses to transcutaneous spinal cord stimulation alone and in combination with respiratory training. By characterization of respiratory muscle activation patterns using surface electromyography in association with pulmonary functional and related cardiovascular measures, we expect to determine specific stimulation parameters needed to increase spinal excitability below level of injury to enhance responses to the input from supraspinal centers that remain after injury and to promote the neural plasticity driven by the respiratory training. This hypothesis will be tested by pursuing two Specific Aims: 1) Evaluate the acute effects of transcutaneous spinal cord stimulation on respiratory functional and motor control properties; and 2) Evaluate the effectiveness of transcutaneous spinal cord stimulation combined with respiratory training.

项目摘要/摘要 呼吸运动控制缺陷是脊髓患者发病和死亡的主要原因 受伤。这项研究的长期目标是开发一种针对慢性阻塞性肺疾病患者的呼吸康复策略。 将脊髓损伤作为护理的标准。我们以前的发现表明，患者的呼吸功能 慢性脊髓损伤可以通过使用我们最初的吸气-呼气压力阈值来改善 呼吸训练规程。然而，这种干预的有效性仅限于 功能能力维持在神经损伤水平以下。我们为此获得的初步数据 建议证明脊髓电刺激非侵入性应用于脊髓呼吸靶点 回路与呼吸训练相结合可以激活和重组脊髓运动网络 呼吸。我们建议研究经皮脊髓对呼吸运动控制的相关反应。 单纯的脊髓刺激和结合呼吸训练。通过呼吸肌的特征 表面肌电信号的激活模式与肺功能及相关 心血管测量，我们希望确定增加脊髓所需的特定刺激参数 损伤水平以下的兴奋性，以增强对来自脊髓上中枢的输入的反应 促进呼吸训练所驱动的神经可塑性。这一假设将通过以下方式检验 追求两个具体目标：1)评估经皮脊髓刺激的急性效应 呼吸功能和运动控制特性；以及2)评估经皮脊柱手术的有效性 脊髓刺激结合呼吸训练。