Closed loop control of vibration for muscle spasms after human spinal cord injury: efficacy and mechanism

摘要 不自主肌肉活动(痉挛)是脊髓损伤(SCI)后痉挛最令人衰弱的方面，因为 宫缩干扰了日常工作，限制了康复。治疗并不总是有效的，会降低健康- 相关的生活质量。我们的长期目标是将肌腱振动的闭环控制应用于临床 对肌肉痉挛进行有意义的治疗，并了解导致痉挛产生的脊髓回路。 具体地说，我们的目标是在现有能力和合作的基础上：1A)完善我们的住房设计 可穿戴设备，通过面向消费者的输入将振动传递到跟腱；1b)确定振动 在实验室使用可穿戴设备减少因脊髓损伤瘫痪的腿部肌肉痉挛的参数。在任一 坐位或卧位时，肌电(EMG)检测到痉挛，然后对跟腱进行检查 以不同的频率、持续时间和幅度振动，通过闭环控制实时抑制痉挛；2) 检查肌腱振动在改变肌肉痉挛方面的有效性，方法是在痉挛发生时进行治疗，这是个性化的 最大限度地发挥临床和用户影响的干预措施。将评估振动对痉挛的急性(慢性)影响。 在24小时的肌电记录期间，通过比较基础状态下的无条件痉挛和条件痉挛，在振动期间 干预，和干预后。痉挛的不同方面的前后测量将提供对现场的洞察(S)， 与振动一起发生的变化的幅度和时间进程；以及用户对治疗效果的看法。 将无创生理记录的力量与功能、临床和参与者报告的结果结合起来 还将揭示神经和肌肉的可塑性，即振动对痉挛的作用机制，以及 重要的是，改进这种新方法治疗脊髓损伤和其他神经科疾病后痉挛的基本原理 精神错乱。许多脊髓损伤患者可能会发现非药物治疗痉挛很有吸引力，因为它可能会导致 减少或消除痉挛药物。

ABSTRACT Involuntary muscle activity (spasms) is the most debilitating aspect of spasticity after spinal cord injury (SCI) because the contractions interfere with everyday tasks, and limit rehabilitation. Treatments are not always effective, lowering health- related quality of life. Our long-term Objective is to use closed-loop control of tendon vibration to implement clinically meaningful management of muscle spasms, and to understand the spinal circuits responsible for spasm generation. Specifically, we aim to build on our existing capabilities and collaborations to: 1a) Refine the design of the housing in our wearable device to deliver vibration to the Achilles tendon by using consumer-oriented input; 1b) Determine the vibration parameters that reduce spasms in leg muscles paralyzed by SCI in the laboratory using the wearable device. In either a seated or reclined position, spasms will be detected using electromyography (EMG), then the Achilles tendon will be vibrated at different frequencies, durations and amplitudes to dampen the spasms in real-time using closed-loop control; 2) Examine the efficacy of tendon vibration in altering muscle spasms by treating spasms as they occur, which personalizes the intervention for maximal clinical and user impact. The acute (chronic) effects of vibration on spasms will be evaluated during 24-hour EMG recordings by comparing unconditioned to conditioned spasms at baseline, during the vibration intervention, and post intervention. Pre/Post measures of different aspects of spasticity will provide insight into the site(s), magnitude, and time-course of changes that occur with vibration; and user perspective on the effects of the therapy. Combining the power of non-invasive physiological recordings with functional, clinical and participant reported outcomes will also reveal neural and muscular plasticity, the mechanisms underlying the action of vibration on spasms, and importantly, the rationale to improve this novel approach to spasm management after SCI and other neurological disorders. Many individuals with SCI may find non-pharmacological treatment for spasms attractive because it may lead to reductions or elimination of spasm medications.