SPINAL CORD STIMULATION TO RESTORE COUGH

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。颈髓和胸髓损伤的患者通常会有大部分呼气肌瘫痪，因此缺乏正常的咳嗽机制。因此，大多数患者清除呼吸道分泌物的能力明显下降，这是导致反复呼吸道感染的一个因素。由于大多数患者损伤平面以下的脊髓是完整的，所以支配呼气肌的脊髓运动神经元和周围神经肌肉系统也是完整的。因此，这些肌肉可以通过电刺激脊神经根来电激活，从而产生有效的功能性咳嗽。研究人员的假设是，下胸段脊髓刺激(SCS)会导致正常咳嗽的大正压和最大呼气流速的产生。因此，这种方法有可能在脊髓损伤患者中产生有效的咳嗽机制。18例脊髓损伤患者将纳入本研究。将进行完整的病史和体检、胸部X光和心电检查。患者的初步测试将包括测量自发潮气量、肺活量和呼吸肌力量，由最大吸气和呼气压力确定。然后将脊髓盘电极和射频接收器放置在手术室内。刺激参数最初将被设置得非常低，然后逐渐增加。脊髓刺激的有效性将通过测量呼吸道和胃压力、呼气量、呼气流速和腹部肌电记录来评估。训练的全部益处通常需要至少6-8周来优化其他呼吸肌的功能。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Patients with cervical and thoracic spinal cord injuries often have paralysis of a major portion of their expiratory muscles and therefore, lack a normal cough mechanism. Consequently, most of these patients suffer from a markedly reduced ability to clear airway secretions, a factor which contributes to the development of recurrent respiratory tract infections. Since the spinal cord below the level of injury is intact in most patients, the motor neurons of the spinal cord and peripheral neuromuscular system innervating the expiratory muscles are intact. These muscles, therefore, can be electrically activated by the electrical stimulation of the spinal roots to produce a functionally effective cough. It the hypothesis of the investigators that lower thoracic spinal cord stimulation (SCS) will result in the generation of large positive airway pressures and peak expiratory flow rates characteristic of a normal cough. This methodology, therefore, has the potential to produce an effective cough mechanism in spinal cord injured patients. Eighteen patients with spinal cord injury will be recruited into this study. A complete history and physical examination, chest x-ray and ECG will be performed. Patients initial testing will include measurement of spontaneous tidal volume, vital capacity and respiratory muscle strength as determined by maximum inspiratory and expiratory pressures. Spinal cord disc electrode and radiofrequency receiver will then be placed in the operating room. Stimulus parameters will be set very low initially and gradually increased. The effectiveness of spinal cord stimulation will be assessed by measurements of airway and gastric pressures, expired volume, expiratory flow rate, and abdominal EMG recordings. The full benefit of training usually requires a minimum of 6-8 weeks to optimize the function of other respiratory muscles.