Transformation of Paraplegic Paralysis to Overground Stepping in Humans

人类截瘫向地上行走的转变

• 批准号: 10241521
• 负责人: REGGIE EDGERTON
• 金额: $ 54.87万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10241521
• 关键词: Agonist; Ankle; Awareness; Body Weight; Buspirone; Chronic; Clinic; Communities; Cutaneous; Development; Devices; Diagnosis; Electrodes; Family Caregiver; Force of Gravity; Generations; Goals; Health; Health Care Costs; Hip region structure; Human; Individual; Injury; Intervention; Knee; Lead; Lesion; Locomotion; Lower Extremity; Mediating; Motion; Motor; Motor Activity; Movement; Mus; Musculoskeletal Equilibrium; Neurostimulation procedures of spinal cord tissue; Outcome; Painless; Paralysed; Paraplegia; Performance; Pharmacology; Probability; Property; Quality of life; Rattus; Recovery; Recovery of Function; Sensory; Series; Site; Speed; Spinal; Spinal Cord; Spinal Injuries; Spinal cord injury; Spinal cord injury patients; Step training; Technology; Training; Volition; Walkers; Weight-Bearing state; connectome; cost; effectiveness evaluation; exoskeleton; exoskeleton device; experience; experimental study; improved; insight; limb movement; motor control; motor function improvement; motor function recovery; neuroregulation; novel; relative effectiveness; robot assistance; robotic device; technology development; tool; treadmill

Project Summary It is becoming increasingly evident that the spinal circuitries below a paralyzing injury have a functional potential that far exceeds what has been thought to be possible. From recent studies in mice and rats with motor complete paralysis we know that the lumbosacral spinal cord can be neuromodulated electrically (eEmc) and pharmacologically (fEmc) to enable motor control, including full weight-bearing stepping. The main goal of the project is the development of noninvasive multiple neuromodulatory strategies to facilitate full weight bearing overground stepping in paralyzed subjects. Recently we demonstrated that four chronic, completely paralyzed individuals regained the ability to stand independently and the ability to voluntarily flex the hip, knee, and ankle when being stimulated epidurally. We propose to accomplish similar outcomes using a novel noninvasive multi-site spinal cord stimulation strategy in concert with pharmacological modulation with stand and step training to neuromodulate the lumbosacral circuitry so that completely paralyzed individuals can regain some locomotor function as well as voluntary movements. We propose to develop these strategies further by combining these interventions with an exoskeleton technology so that individuals with complete paralysis can regain significant levels of community mobility. We will determine the effectiveness of noninvasive spinal stimulation and administration of buspirone (a monoaminergic agonist) treatment for facilitating of locomotor activity in the gravity-neutral apparatus, body weight supported stepping on a treadmill, and stepping in the EKSO robotic device to achieve full weight bearing stepping in paralyzed subjects in rolling walker. It is anticipated that the early stages of development of this technology could be available within the clinic to improve motor function within a matter of a few years. These interventions have the potential to improve health, and can impact the quality of life and, in many cases, can likely to lead to reduced health costs and a lower burden not only to the paralyzed individuals, but also to their families and caregivers.

项目摘要 越来越明显的是，瘫痪损伤以下的脊柱电路具有功能潜力 这远远超出了被认为可能的可能性。从最新的研究中的小鼠和大鼠完成运动 瘫痪我们知道腰脊髓可以被电子神经调节（EEMC）和 在药理学上（FEMC）实现运动控制，包括全重重的步进。主要目标 项目是开发无创的多种神经调节策略，以促进全重重 地面阶梯瘫痪的受试者。最近我们证明了四个慢性，完全瘫痪了 个人恢复了独立站立的能力以及自愿弯曲臀部，膝盖和脚踝的能力 当被刺激时。我们建议使用新颖的无创，可以实现类似的结果 与支架和阶梯的药理学调制一起，多站点的脊髓刺激策略 训练以神经调节腰椎电路，以使完全瘫痪的个体可以恢复一些 运动功能以及自愿运动。我们建议通过 将这些干预措施与外骨骼技术相结合，以便完全麻痹的人 可以恢复重要水平的社区流动能力。我们将确定无创脊柱的有效性 胰蛋白酶（一种单胺能激动剂）的刺激和给药以促进运动 重力与中性设备的活动，体重支持踏上跑步机，然后踏上Ekso 机器人装置，可以在滚动步行者的瘫痪受试者中实现全重承重。预计 该技术开发的早期阶段可以在诊所内提供，以改善运动功能 在几年内。这些干预措施有可能改善健康，并可能影响 生活质量，在许多情况下，可能导致健康成本降低，不仅会给 瘫痪的人，也瘫痪了他们的家人和照顾者。