Evaluating Neural Adaptation after Tendon Transfer and Task-based Training in SCI

 描述(由申请人提供)： 恢复C5/6四肢瘫痪患者侧方握力的常见方法是将臂尺肌远端肌腱转移到瘫痪拇长屈肌的肌腱(BR-FPL)上。传统的术后护理没有明确的定义，由于住院时间的限制，一些人在接受定向治疗计划之前就出院了。手术后，转移的BR不是完全激活的，不能执行夹紧任务。毫无疑问，这是导致一系列功能结果的一个因素，尽管手术成功，但可以通过有针对性的再培训计划来解决这些问题。成功地将被转移的肌肉重新训练以执行新任务的机制(S)尚不清楚，可能涉及运动和神经适应。最近的证据表明，基于任务的治疗可以通过加强现有的神经连接和/或形成新的神经连接来改善上肢功能。这项拟议的研究将评估BR到FPL肌腱移植受者基于任务的肌肉再教育计划的神经反应。这一拟议的试点项目是朝着更广泛的目标迈出的关键一步 四肢瘫痪肌腱移位术的功能结果。该研究的目的是获得由功能磁共振成像(FMRI)和功能表现测量组成的先导数据，以评估肌腱转移后成功进行肌肉再教育的神经预测因素和相关性。参与者将患有慢性颈脊髓损伤，并已接受肌腱移植或符合移植手术的手术标准。从BR到FPL转移接受者的神经活动模式将被评估(I)结果较差和良好的患者，以及(Ii)参与旨在改善功能握手任务中被转移BR的自愿激活的任务型治疗计划前后的神经活动模式。功能表现测量包括对转移的BR的自愿激活的定量肌电(EMG)测量，选定功能任务中的最大努力夹紧力，以及自我报告的表现测量。具体目标是：评估BR到FPL移植后的肌肉再教育效果好和差的个体，并确定训练计划后的神经活动模式是否与那些夹紧力测量较高的个体相媲美。基于任务的训练计划是一项正在进行的改善BR到FPL手术结果的研究的一部分，初步结果表明，在功能任务期间，夹紧力的产生和转移的BR与近端肌肉的协调激活发生了积极的变化。神经成像技术，如功能磁共振成像(FMRI)，已经成为了解神经肌肉系统可塑性和评估神经变化对新干预的重要工具。我们提出，在BR到FPL转移后，一个定向的基于任务的训练计划将驱动神经变化，从而影响功能(PINCH)能力。建立这种关系将有助于加深对患者成功干预机制的理解，并将提出基于大脑的动力学，这可能是未来治疗的重点，如生物反馈或脑刺激。更有效的术后康复计划将改善急慢性脊髓损伤患者肌腱移植后的长期功能结果。这些数据将被用于更广泛的研究设计，以对重点康复干预的效果进行前瞻性调查。从拟议的试点中获得的信息 这项研究将被用来开发假设和统计能力，以指导一项全面的研究，以评估通过基于任务的培训改善手术结果的能力。

 DESCRIPTION (provided by applicant): A common procedure to restore lateral pinch strength to persons with C5/6 tetraplegia is to transfer the distal tendon of the brachioradialis muscle to the tendon of the paralyzed flexor pollicis longus muscle (Br to FPL). Conventional post-surgical care is not well defined and some individuals are discharged before receiving a directed therapy program due to limitations in hospital stay. After surgery, the transferred Br is not fully activated to perform pinch tasks. Undoubtedly, this is one factor that leads to a range of functional outcomes, despite a successful surgery, that may be addressed by a focused re-training program. The mechanism(s) underlying successful re-training of the transferred muscle to perform a new task are unknown and may involve both motor and neural adaptation. Recent evidence suggests that task-based therapy can result in improved upper limb function by strengthening the existing neural connections and/or forming new ones. The proposed study will assess the neural response to a task-based therapy program for muscle re-education for Br to FPL tendon transfer recipients. This proposed pilot project is a critical step towards the broader objective to improve functional outcomes of tendon transfer procedures in tetraplegia. The purpose of the study is to obtain pilot data consisting of functional magnetic resonance imaging (fMRI) and functional performance measures to evaluate neural predictors and correlates of successful muscle re- education after tendon transfer. The participants will have chronic cervical SCI and have received a tendon transfer or meet the surgical criteria for transfer surgery. Patterns of neural activity from Br to FPL transfer recipients will be assessed (i) in those with poor versus good outcomes and (ii) before and after participating in the task-based therapy program designed to improve voluntary activation of the transferred Br in functional pinch tasks. Functional performance measures include quantitative electromyographic (EMG) measures of voluntary activation of the transferred Br, maximum effort pinch force in selected functional tasks, and a self- reported performance measure. The specific objectives are to: evaluate muscle re-education after Br to FPL transfer in individuals with good and poor outcomes, and to determine if the pattern of neural activity after the training program is comparable to those individuals wit higher pinch force measurements. The task-based training program is part of an ongoing study to improve Br to FPL surgical outcomes and preliminary results indicate positive changes in pinch force production and activation of the transferred Br in coordination with proximal muscles during functional tasks. Neuroimaging techniques, such as functional magnetic resonance imaging (fMRI) have become important tools for understanding plasticity in the neuromuscular system and for assessing the neural changes in response to novel interventions. We propose that a directed task-based training program after Br to FPL transfer will drive neural changes that impact functional (pinch) ability. Establishing this relationship will allow for increased understanding of the mechanisms of successful interventions in patients and will suggest brain based dynamics that could be the focus of future treatments, such as biofeedback or brain stimulation. A more effective post-surgical rehabilitation program will lead to improved long-term functional outcomes following tendon-transfer in patients with both acute and chronic spinal cord injuries. These data will be used towards a broader study design for a prospective investigation of the effects of a focused rehabilitation intervention. Information gained from the proposed pilot study will be used to develop hypotheses and statistical power to guide a full-scale study to evaluate the capacity for improving surgical outcomes through task-based training.