REHABILITATION OF THE PARALYZED LARYNX

喉部麻痹使人虚弱，有时甚至危及生命。 临床问题。拟议研究的目标是：1)评估 单侧和双侧瘫痪治疗效果的测量 患者的嗓音、呼吸道保护和呼吸功能的变化 在治疗之后，以及2)开发新的动态方法 使用功能性电刺激(FES)和 动物模型中的神经再支配策略。单侧的治疗方法 麻痹(如特氟隆注射、甲状腺成形术)试图改善嗓音 通过调节声带来提高音质。双侧瘫痪的治疗 (例如，激光环状软骨切除术)的目的是通过偏侧 声带或形成声门下巴。这些方法比 理想，因为它们改善了一种喉部功能，但代价是 又一个。它们还代表静态的、不可逆的过程，忽略 声带萎缩对声带质量和位置的长期影响。功能性 电刺激提供了一种更具生理学意义的治疗方法。在……里面 双侧瘫痪1例，瘫痪的环鳗后肌 可以用吸气信号刺激来外展声带 来源于隔膜、膈神经或胸膜腔(外展肌 定步)。在非吸气阶段，声带被动地 向中线放松，允许不打折扣的声音制作和 呼吸道保护。在单侧瘫痪的情况下，瘫痪的内收肌或 可以刺激外展肌来恢复这两条声带中的任何一条 功能。对肌肉的刺激将由衍生的信号触发 从对侧的未瘫痪的伙伴那里。的能力 将探索电刺激以使瘫痪的喉部恢复活力 在犬类的慢性实验中，植入了微型 刺激/传感器设备。还将进行研究，以确定是否 电刺激可以对丧失神经的人产生其他有益的影响 喉肌及其神经再支配的可能过程。慢性 电刺激可以防止或逆转失神经萎缩，以及 将肌肉力量维持或恢复到正常范围内。它可能会使一个 不能被外来神经再支配的肌肉和鼓励性 由其自身的内在神经重新支配。最后，电刺激 在华盛顿特区的面前。磁场可能会吸引再生神经纤维 以前支配肌肉，提供了一种选择性的手段 神经再支配。继#年成功开发FES方法之后 动物，实验研究将开始在患者身上比较 常规方法治疗效果观察。

Laryngeal paralysis is a debilitating and sometimes life-threatening clinical problem. The goals of the proposed research are to: 1) assess the treatment effacies for unilateral and bilateral paralysis by measuring changes in voice, airway protection, and respiratory functions in patients following treatment, and 2) develop new dynamic approaches to rehabilitation using functional electrical stimulation (FES) and reinnervation strategies in animal models. Treatments for unilateral paralysis (e.g. teflon injection, thyroplasty) attempt to improve voice quality by medializing the vocal cord. Treatments for bilateral paralysis (e.g. laser arytenoidectomy) aim to enlarge the airway by lateralizing the vocal cord or creating a glottal chink. These approaches are less than ideal, since they improve upon one laryngeal function at the expense of another. They also represent static, irreversible processes that ignore the long term effects of atrophy on vocal cord mass and position. Functional electrical stimulation offers a more physiologic approach to treatment. In case of bilateral paralysis, the paralyzed posterior cricoarytenoid muscles could be stimulated to abduct the vocal cords using inspiratory signals derived from the diaphragm, phrenic nerve, or intrapleural space (abductor pacing). During noninspiratory phases, the vocal cords would passively relax towards the midline, allowing uncompromised voice production and airway protection. In case of unilateral paralysis, a paralyzed adductor or abductor muscle could be stimulated to restore either of these vocal cord functions. Stimulation of a muscle would be triggered by signals derived from its unparalyzed partner on the contralateral side. The ability of electrical stimulation to reanimate the paralyzed larynx will be explored in chronic experiments on canines, implanted with miniaturized stimulation/sensor devices. Studies will also be performed to determine if electrical stimulation can produce other beneficial effects on a denervated laryngeal muscle and the possible course of its reinnervation. Chronic electrical stimulation may prevent or reverse denervation atrophy, and maintain or restore muscle strength to within normal limits. It may make a muscle refractory to reinnervation by a foreign nerve and encourage reinnervation by its own intrinsic nerve. Finally, electrical stimulation in the presence of a d.c. field may attract regenerating nerve fibers that previously innervated the muscle, providing a means for selective reinnervation. Following successful development of an FES approach in animals, experimental studies will begin in patients to compare the treatment efficacy with conventional methods.