Functional Electrical Stimulation-Assisted Exercise and Bone Health after Spinal Cord Injury

功能性电刺激辅助运动与脊髓损伤后的骨骼健康

• 批准号: 9084929
• 负责人: Rebecca Lambach
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9084929
• 关键词: Address; Affect; Ankle; Bone Density; Clinical; Collaborations; Collection; Computer Simulation; Consensus; Data; Development; Devices; Dose; Effectiveness; Electric Stimulation; Equipment; Exercise; Femur; Fracture; Future; Generations; Goals; Health; Incidence; Individual; Intervention Studies; Joints; Kinetics; Knowledge; Leg; Lower Extremity; Maintenance; Measures; Mechanics; Modeling; Modification; Motion; Muscle; Musculoskeletal; Paralysed; Patients; Physicians; Positioning Attribute; Posture; Primary Health Care; Protocols documentation; Quality of life; Reaction; Rehabilitation therapy; Research; Research Training; Resistance; Resources; Risk; Safety; Spinal cord injury; Spinal cord injury patients; Stimulus; Surface; Techniques; Therapeutic; Training; Training Programs; Translational Research; Veterans; Weight; Weight-Bearing state; Wheelchairs; Work; base; bone; bone health; bone loss; career development; clinical application; clinical practice; cost; design; exercise intensity; exercise intervention; exercise rehabilitation; experience; foot; high risk; improved; individual patient; kinematics; medical complication; models and simulation; prevent; protocol development; public health relevance; rehabilitation strategy; research study; simulation; skeletal; three-dimensional modeling; tibia; tool

 DESCRIPTION: Fragility fractures that occur during everyday activities negatively impact the health and quality of life of many individuals who have a spinal cord injury (SCI). In order to decrease the incidence of fragility fractures in individuals with SCI, there is a need for the development of better rehabilitation strategies targeted at maintaining bone health. Therapeutic exercises that load the lower limbs have shown potential to modulate bone loss after SCI, but consistently beneficial results have not been demonstrated. Bone mechanobiology research indicates that the magnitude of skeletal force and the number of loading repetitions during exercising are key parameters affecting skeletal health. Yet, the mechanical stimulus imposed on the lower limbs during different types and intensities of rehabilitation exercises have not been well characterized or compared, making it difficult to assess their relative potential to modulate bone loss after SCI The key goals of the proposed research are to evaluate skeletal loading during four different SCI rehabilitation activities and to assess their relative potential to benefit skeletal health. Th results of this study have the potential to influence clinical practice by informing clinicians in he design of exercise protocols that will supply the lower limbs with sufficient mechanical stimulus to benefit skeletal health. The key goals will be addressed by collecting three-dimensional motion and force data while individuals with SCI perform four different rehabilitation exercises which load the lower limbs: 1) static weight bearing using a standing frame; 2) standing frame therapy with functional electrical stimulation (FES); 3) FES cycling; and 4) FES rowing. Two types of subject-specific musculoskeletal models (2D analytical models and 3D computational models) will be developed to estimate skeletal loading. Musculoskeletal models and simulations will be used to calculate the FES-activated muscle forces and the skeletal forces applied to the femur and tibia during each rehabilitation exercise. Exercises will be ranked according to the magnitude of skeletal force. The bone mechanical stimulus imposed on the lower limbs during each rehabilitation exercise will be estimated using the number of loading cycles during a typical exercise session and the average peak skeletal forces from each rehabilitation activity. The relative potential of each exercise to preserve bone density will be estimated based on the mechanical stimulus. The exercise dose that would be required for each rehabilitation exercise to produce an equivalent potential for bone health will also be calculated. These results will produce a valuable clinical resource for selecting rehabilitation exercises and activity doses which have the greatest potential to benefit skeletal health after SCI. This research study and training program will also serve to advance the applicant's career development through increased clinical exposure, advanced technical knowledge in musculoskeletal modeling, further development of clinical collaborations, and experience in the translation of research results into clinically meaningful applications. The data generated by this project will be used to design a future exercise intervention study to evaluate the effect of current and newly developed rehabilitation protocols on bone health after SCI. Additionally, the models and simulations developed for this study can be used to answer key questions about the setup and use of new or existing rehabilitation equipment or exercise techniques that could enhance the effectiveness of exercises. Results from predictive simulations that apply these models can inform physicians and therapists of modifications (e.g. cycle or rower seat position, adding weights or resistance, etc.) that could increase or decrease skeletal forces in a way that would be appropriate for each individual patient given their current skeletal status. This project represents an early step towar the ultimate goal of reducing the incidence of fragility fracture by developing better rehabilitatin protocols that can maintain bone health after SCI.

 产品说明： 在日常活动中发生的脆性骨折对许多脊髓损伤（SCI）患者的健康和生活质量产生负面影响。为了降低SCI患者脆性骨折的发生率，有必要制定更好的康复策略，以保持骨骼健康。下肢负重的治疗性运动已显示出调节SCI后骨丢失的潜力，但尚未证实持续有益的结果。骨力学生物学研究表明，运动过程中骨骼力的大小和重复负荷的次数是影响骨骼健康的关键参数。然而，在不同类型和强度的康复训练中施加在下肢上的机械刺激尚未得到很好的表征 或进行比较，使得难以评估它们调节SCI后骨丢失的相对潜力。拟议研究的主要目标是评估四种不同SCI康复活动期间的骨骼负荷，并评估它们有益于骨骼健康的相对潜力。这项研究的结果有可能影响临床实践，通知临床医生在他的运动方案的设计，将提供足够的机械刺激下肢骨骼健康受益。关键目标将通过收集三维运动和力数据来解决，同时SCI患者进行四种不同的下肢负荷康复锻炼：1）使用站立架的静态负重; 2）功能性电刺激（FES）站立架治疗; 3）FES骑自行车; 4）FES划船。将开发两种类型的受试者特定肌肉骨骼模型（2D分析模型和3D计算模型）以估计骨骼负荷。肌肉骨骼模型和模拟将用于计算每次康复运动期间FES激活的肌肉力和施加于股骨和胫骨的骨骼力。练习将根据骨骼力量的大小进行排名。将使用典型锻炼期间的负荷循环次数和每次康复活动的平均峰值骨骼力来估计每次康复锻炼期间施加在下肢上的骨机械刺激。将根据机械刺激估计每次运动保持骨密度的相对潜力。还将计算每次康复运动产生同等骨骼健康潜力所需的运动剂量。这些结果将产生一个有价值的临床资源，选择康复锻炼和活动剂量，有最大的潜力，有利于脊髓损伤后骨骼健康。这项研究和培训计划还将通过增加临床接触，肌肉骨骼建模的先进技术知识，临床合作的进一步发展以及将研究成果转化为临床有意义的应用的经验来促进申请人的职业发展。该项目产生的数据将用于设计未来的运动干预研究，以评估当前和新开发的康复方案对SCI后骨骼健康的影响。此外，为这项研究开发的模型和模拟可用于回答有关设置和使用新的或现有的康复设备或锻炼技术，可以提高锻炼的有效性的关键问题。应用这些模型的预测模拟结果可以通知医生和治疗师修改（例如，自行车或划船者座椅位置，增加重量或阻力等）。这可以增加或减少骨骼力量的方式，将是适合每个病人目前的骨骼状态。该项目代表了通过制定更好的康复方案来维持SCI后骨骼健康，从而降低脆性骨折发生率这一最终目标的早期步骤。