Below Injury Control Sources for Upper Extremity Neuroprosthetics in Spinal Cord

描述(申请人提供)：颈椎水平脊髓损伤(SCI)患者可以使用植入的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，通过扩大植入神经假体控制的替代方案，可以进一步显著提高功能结果。我们最近发现，大多数(如果不是全部)被归类为“运动性完全性”颈椎水平脊髓损伤的人实际上保留了对小腿肌肉的一些自愿控制。受试者没有意识到自己的能力，因为运动看不见或摸不到。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以自愿控制一块或多块腿部肌肉，这些肌肉可以用作神经假体系统的肌电控制源。我们将这些肌肉称为“损伤控制源以下”(BICS)。这一发现开启了本研究将追求的重大机遇。我们建议对50例完全性颈椎脊髓损伤患者进行队列筛查，以确定BICS的患病率。我们将制定有针对性的训练方法，以改善通过筛查过程发现的薄弱肌肉的控制。我们将训练被筛选的受试者的一个子集，以确定是否可以通过使用视觉和皮肤反馈的有针对性的训练来获得改善的性能。在这项研究的结论中，我们将评估BICS用于神经假体的潜在适用性，并将准备在未来的提案中利用BICS来改善神经假体功能。

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.