Below Injury Control Sources for Upper Extremity Neuroprosthetics in Spinal Cord

描述（由申请人提供）：颈椎水平脊髓损伤（SCI）的个体可以通过植入上肢神经假体获得显著的功能收益，包括在日常生活活动中更加独立的能力，如饮食、个人卫生和办公室任务。我们假设，通过扩大控制植入神经义肢的选择，可以进一步显著增加功能结果。我们最近发现，大多数（如果不是全部的话）被归类为“运动完全性”颈椎水平脊髓损伤的人，实际上对小腿肌肉仍有一定的自主控制能力。实验对象没有意识到他们的能力，因为这些动作是看不见的，也摸不到的。这项研究的一个重要的实际意义是，被认为是完整的受试者可能具有对一个或多个下肢肌肉的自主控制，这些肌肉可以用作神经假肢系统的肌电控制源。我们将这些肌肉称为“损伤控制源以下”（BICS）。这一发现为本研究提供了重要的机会。我们建议筛选50名运动完全性颈椎脊髓损伤受试者，以确定BICS的患病率。我们将制定针对性的训练方法，以改善通过筛选过程确定的无力肌肉的控制。我们将训练筛选受试者的一个子集，以确定是否可以通过视觉和皮肤电反馈的有针对性的训练获得改善的表现。在本研究结束时，我们将评估BICS用于神经假体的潜在适用性，并准备在未来的提案中利用BICS来改善神经假体的功能。

DESCRIPTION (provided by applicant): Individuals with cervical level spinal cord injury (SCI) can achieve significant functional gains using an implanted upper extremity neuroprosthesis, including the ability to be more independent in activities of daily living, such as eating, personal hygiene and office tasks. We hypothesize that further significant increases in functional outcomes can be obtained by expanding the alternatives for control of implanted neuroprosthetics. We have recently discovered that most, if not all, individuals who have been classified as having a "motor complete" cervical level spinal cord injury actually retain some voluntary control over lower leg muscles. Subjects were not aware of their ability because the movements were not visible or palpable. One of the important practical implications of this research is that subjects who are considered complete may have voluntary control over one or more lower extremity muscles that could be utilized as myoelectric control sources for a neuroprosthetic system. We refer to these muscles as "below injury control sources" (BICS). This discovery opens up significant opportunities that will be pursued in this study. We propose to screen a cohort of 50 motor complete cervical level SCI subjects to identify the prevalence of BICS. We will develop training methods targeted at improving the control of the weak muscles identified through the screening process. We will train a subset of the screened subject to determine whether improved performance can be obtained with targeted training using visual and electrocutaneous feedback. At the conclusion of this study we will have evaluated the potential suitability of BICS for neuroprosthetic use and will be prepared to utilize BICS to improve neuroprosthetic function in a future proposal. PUBLIC HEALTH RELEVANCE: Cervical spinal cord injury can result complete paralysis, particularly loss of hand and arm function. Some function can be restored through the use of electrical stimulation of the paralyzed muscles. Individuals control these systems through activation of muscles above the level of injury. In this project, we are exploring the recent discovery that many paralyzed individuals have very weak control over many muscles below their injury that were previously considered completely paralyzed. Although these muscles are far too weak to provide movement on their own, they might be able to be used to control stimulated muscle function.