Quantitative EMG as a Predictor of Functional Recovery in SCI

描述（由申请人提供）： 项目概要/摘要。 由于脊髓损伤（SCI）导致的上肢和下肢运动和感觉丧失是毁灭性的，预测功能恢复对SCI退伍军人至关重要。即使是美国脊柱损伤协会（ASIA）评分的轻微改善也可能与大的功能增益相关。在目前的标准实践中，仅基于临床检查来预测功能恢复。该评估有些主观，未涉及基础病理生理学。提高我们预测功能恢复的能力可以帮助我们更好地定制康复计划，以最大限度地提高神经恢复。 本试验项目将评估定量肌电图预测SCI上肢功能恢复程度的实用性。我们已经开发了定量的肌电图分解方法，用于测量波形和发射模式的个别运动单位，以获得有关失神经支配和受损的运动控制的信息。定量肌电图可以提供一个客观的，定量评估特定的脊髓节段和周围神经束，不能单独显示临床检查。 因急性颈脊髓损伤而入住脊髓损伤中心的患者将在最初住院期间以及受伤后3个月和12个月接受体格检查和肌电图检查。测试将针对C4-C8肌节中的每一块肌肉。对于体格检查，将根据ASIA量表估计肌肉受累程度。对于EMG检查，将在每块肌肉的4个部位记录适度低水平自主收缩期间的10秒长信号。将使用EMG分解离线分析EMG信号，并将去神经支配和运动控制受损的指标（包括纤颤电位发生率、平均运动单位动作电位振幅、募集稳定性和放电频率变异性）制成表格。 将针对以下问题对数据进行分析：Q1：脊髓损伤后第一年内定量EMG参数如何变化？问题2：伤后3个月内测量的定量肌电图参数能否预测伤后12个月时测力计和功能评分所测得的功能恢复？ 这项研究将提供初步的数据，为随后的调查定量肌电图的能力，以确定患者谁将积极响应特定的康复方式，如电刺激。它还将提供有关SCI患者的运动单位放电模式和受损运动控制的信息，这是目前文献中缺乏的。 公共卫生相关性： 在目前的实践标准中，脊髓损伤的恢复是根据临床检查预测的。该项目将评估脊髓损伤后3个月的肌电图检查是否可以提高我们预测患者一年后恢复水平的能力。这方面的知识将是非常重要的定制康复计划，以个别患者，以促进恢复。这些信息将与VA SCI医疗保健使命密切相关，以最大限度地提高脊髓损伤患者的功能独立性和生活质量。预后准确性的进步，特别是在康复的急性期，可能转化为更有效和更有效的护理和更好的整体结果。

DESCRIPTION (provided by applicant): Project Summary/Abstract. Motor and sensory loss in upper and lower limbs due to spinal cord injury (SCI) is devastating, and predicting functional recovery is of utmost importance to veterans with SCI. Even a slight improvement in the American Spinal Injury Association (ASIA) scale can correlate with large functional gains. In current standard practice, functional recovery is predicted solely based on clinical examination. This assessment is somewhat subjective and does not address underlying pathophysiology. Improving our ability to predict functional gains can help us better tailor rehabilitation programs to maximize neurological return. This pilot project will evaluate the utility of quantitative EMG to predict the extent of functional recovery in the upper limb in SCI. We have developed quantitative EMG decomposition methods for measuring the waveforms and firing patterns of individual motor units to obtain information about denervation and impaired motor control. Quantitative EMG can provide an objective, quantitative assessment of specific spinal segments and peripheral nerve tracts that cannot be revealed by clinical exam alone. Patients admitted to the SCI Center with acute cervical SCI will receive a physical exam and an EMG exam during their initial stay and at 3 and 12 months post injury. The tests will target two muscles in each of the C4-C8 myotomes. For the physical exam, the extent of muscle involvement will be estimated according to the ASIA scale. For the EMG exam, 10-second-long signals will be recorded during moderately low levels of voluntary contraction at 4 sites in each muscle. The EMG signals will be analyzed off-line using EMG decomposition, and indices of denervation and impaired motor control, including incidence of fibrillation potentials, mean motor-unit-action-potential amplitude, recruitment stability, and firing-rate variability, will be tabulated. The data will be analyzed with respect to these questions: Q1: How do quantitative EMG parameters change during the first year after spinal cord injury? Q2: Can quantitative EMG parameters measured during the three months after injury predict functional recovery as measured in terms of dynamometry and functional scores at 12 months after injury? This study will provide preliminary data for a subsequent investigation of the ability of quantitative EMG to identify patients who will respond favorably to specific rehabilitation modalities, such as electrical stimulation. It will also provide information about motor unit firing patterns and impaired motor control in persons with SCI that is currently lacking from the literature. PUBLIC HEALTH RELEVANCE: Project Narrative In the current standard of practice, recovery from a spinal cord injury is predicted based on clinical examination. This project will assess whether an electromyography examination that assesses electrical activity in the muscle 3 months after a spinal cord injury can improve our ability to predict a patient's level of recovery after one year. This knowledge will be important for tailoring rehabilitation programs to individual patients in order to facilitate recovery. Such information would be of great relevance to the VA SCI healthcare mission to maximize functional independence and quality of life in persons with spinal cord injury. Advances in prognostic accuracy especially in the acute phase of rehabilitation may translate into more efficient and effective care and better overall outcomes.