Mental Practice Impact on Gait and Cortical Organization in SCI

描述(由申请人提供)：尽管脊髓损伤(SCI)后基本想要行走，但没有传统的康复方案可以安全和实用地改善步行能力。心理练习(MP)是一种补充/替代医学(CAM)心身技术，在这种技术中，身体技能可以以安全、重复的方式进行认知排练。此外，MP提高了运动技能的学习和表现，当精神上练习相同技能的动作时，同样的神经和肌肉结构被激活，就像在相同技能的物理练习中一样。我们的试验数据表明，包括使用MP在内的康复计划可以增加SCI患者的步速和腿部运动。作为一项更大规模试验的准备，我们期望这项早期的第二阶段研究将使用随机对照方法显示MP的参与产生了功能效应。基于我们的其他试验数据，我们还预计这项试验将验证一种基于生物学的测量MP神经作用机制的方法。我们的长期目标是改善中枢神经系统损伤后的运动结果和测量结果。这项研究将32名不完全性脊髓损伤患者随机分为两组：(A)30分钟的MP训练结合运动训练；或(B)单纯运动训练。这将解决这项申请的目标，即确定包括MP在内的训练方案对不完全脊髓损伤患者的功能影响。结果包括步态速度(主要终点)、步态运动学、主动腿部和脚踝运动以及功能磁共振成像。中心假设是，参与MP的患者将表现出更快的步速。我们将验证我们的中心假设，并通过追求以下具体目标来实现我们的目标：(1)确定MP参与对步态参数的影响；(2)确定MP参与对主动腿部运动的影响；(3)利用功能磁共振成像(FMRI)研究踝关节背屈作为行走恢复的神经生物标志物。这项研究符合NCCAM的优先事项，包括(1)改进有希望的CAM干预措施；以及(2)阐明CAM的作用机制。 公共卫生相关性：脊髓损伤是一种致残状态，会损害基本能力，如行走、呼吸和如厕。步态障碍是脊髓损伤后常见的、破坏性的损害。然而，尽管有步行的基本愿望，但没有任何传统疗法能够可靠地改善脊髓损伤后的步行能力，而且许多脊髓损伤患者没有可靠的交通工具，降低了社区融合度和获得包括康复在内的所需服务的机会。对可能预测不完全性脊髓损伤患者运动恢复的细微神经事件也知之甚少。这项研究将测试一种新的、安全的、易于实施的技术，该技术在改善不完全性脊髓损伤患者的步态方面显示出希望。我们预计这项研究将证实这项技术的有效性。这一结果有望产生一种治疗方法，改善社区居住的不完全脊髓损伤患者的预后和健康，并降低护理成本。

DESCRIPTION (provided by applicant): Despite the fundamental desire to walk after spinal cord injury (SCI), no conventional rehabilitation regimen improves ambulation safely and practicably. Mental practice (MP) is a complementary/alternative medicine (CAM) mind-body technique in which physical skills can be cognitively rehearsed in a safe, repetitive manner. Additionally, MP increases motor skill learning and performance, and the same neural and muscular structures are activated when movements are mentally practiced as during physical practice of the same skills. Our pilot data suggest that a rehabilitation program including MP use increases gait velocity and leg movement in SCI patients. As preparation for a larger trial, we expect this early Phase II study to show that MP participation renders a functional effect using randomized controlled methods. Based on our other pilot data, we also expect that this trial will validate a biologically-based method of measuring MP neural mechanisms of action. Our long- term goal is to improve motor outcomes and measurement after central nervous system injury. This study will randomize 32 incomplete SCI patients to either: (a) 30-minute MP sessions combined with locomotor training; or (b) locomotor training only. This will address the objective of this application, which is to determine the functional impact of a training regimen including MP in patients with incomplete SCI. Outcomes include gait velocity (primary endpoint), gait kinematics, active leg and ankle movement, and fMRI. The central hypothesis is that patients participating in MP will exhibit increased gait velocity. We will test our central hypothesis and accomplish our objective by pursuing the following specific aims: (1) Determine effects of MP participation on gait parameters; (2) Determine effect of MP participation on active leg movement; (3) Study ankle dorsiflexion as a neural biomarker of ambulation recovery using functional magnetic resonance imaging (fMRI). This study meets NCCAM priorities, including (1) refinement of promising CAM interventions; and (2) elucidation of CAM mechanisms of action. PUBLIC HEALTH RELEVANCE: Spinal cord injury is a disabling condition that impairs fundamental abilities, such as ambulation, respiration, and toileting. Compromised ambulation is a common, devastating impairment following SCI. Yet, despite the fundamental desire to walk, no conventional regimen reliably improves ambulation after SCI, and many SCI patients do not have reliable transportation access, decreasing community integration and access to needed services, including rehabilitation. Little is also known about the subtle neural events that may predict motor recovery in incomplete SCI patients. This study will test a novel, safe, easy to implement technique that has shown promise in improving gait in incomplete SCI patients. We expect that this study will confirm the efficacy of this technique. This outcome is expected to produce a therapy that improves outcomes and health, and reduces care costs, for community dwelling patients with incomplete SCI.