Quantitative EMG as a Predictor of Functional Recovery in SCI

描述(由申请人提供)： 项目摘要/摘要。脊髓损伤(SCI)导致的上肢和下肢的运动和感觉丧失是毁灭性的，预测脊髓损伤退伍军人的功能恢复是至关重要的。即使是美国脊柱损伤协会(ASIA)评分的轻微改善也可能与巨大的功能进步相关。在目前的标准实践中，功能恢复完全是基于临床检查来预测的。这种评估有些主观，并不涉及潜在的病理生理学。提高我们预测功能恢复的能力可以帮助我们更好地定制康复计划，以最大限度地提高神经功能恢复。这个试点项目将评估定量肌电在预测脊髓损伤患者上肢功能恢复程度方面的应用。我们开发了定量的肌电分解方法，用于测量单个运动单位的波形和放电模式，以获得有关失神经和运动控制受损的信息。定量肌电图可以为特定的脊柱节段和周围神经束提供客观、定量的评估，而这是仅靠临床检查不能揭示的。住进脊髓损伤中心的急性颈髓损伤患者在首次住院期间以及受伤后3个月和12个月将接受体检和肌电检查。测试的目标是每个C4-C8肌节的两块肌肉。对于体检，肌肉受累的程度将根据亚洲评分进行估计。对于肌电检查，在每块肌肉的4个部位进行中等低水平的自愿收缩时，将记录10秒长的信号。肌电信号将使用肌电分解进行离线分析，失神经和运动控制受损的指标将被列表，包括纤颤电位的发生率、平均运动单位动作电位幅度、募集稳定性和放电频率变异性。数据将针对以下问题进行分析：问题1：脊髓损伤后第一年定量肌电参数是如何变化的？问2：在损伤后三个月内测量的定量肌电参数是否可以预测损伤后12个月的测功和功能评分的功能恢复？这项研究将为后续定量肌电图识别对特定康复方式(如电刺激)反应良好的患者的能力提供初步数据。它还将提供有关脊髓损伤患者运动单位放电模式和运动控制受损的信息，这是目前文献中所缺乏的。

DESCRIPTION (provided by applicant): Project Summary/Abstract. Motor and sensory loss in upper and lower limbs due to spinal cord injury (SCI) is devastating, and predicting functional recovery is of utmost importance to veterans with SCI. Even a slight improvement in the American Spinal Injury Association (ASIA) scale can correlate with large functional gains. In current standard practice, functional recovery is predicted solely based on clinical examination. This assessment is somewhat subjective and does not address underlying pathophysiology. Improving our ability to predict functional gains can help us better tailor rehabilitation programs to maximize neurological return. This pilot project will evaluate the utility of quantitative EMG to predict the extent of functional recovery in the upper limb in SCI. We have developed quantitative EMG decomposition methods for measuring the waveforms and firing patterns of individual motor units to obtain information about denervation and impaired motor control. Quantitative EMG can provide an objective, quantitative assessment of specific spinal segments and peripheral nerve tracts that cannot be revealed by clinical exam alone. Patients admitted to the SCI Center with acute cervical SCI will receive a physical exam and an EMG exam during their initial stay and at 3 and 12 months post injury. The tests will target two muscles in each of the C4-C8 myotomes. For the physical exam, the extent of muscle involvement will be estimated according to the ASIA scale. For the EMG exam, 10-second-long signals will be recorded during moderately low levels of voluntary contraction at 4 sites in each muscle. The EMG signals will be analyzed off-line using EMG decomposition, and indices of denervation and impaired motor control, including incidence of fibrillation potentials, mean motor-unit-action-potential amplitude, recruitment stability, and firing-rate variability, will be tabulated. The data will be analyzed with respect to these questions: Q1: How do quantitative EMG parameters change during the first year after spinal cord injury? Q2: Can quantitative EMG parameters measured during the three months after injury predict functional recovery as measured in terms of dynamometry and functional scores at 12 months after injury? This study will provide preliminary data for a subsequent investigation of the ability of quantitative EMG to identify patients who will respond favorably to specific rehabilitation modalities, such as electrical stimulation. It will also provide information about motor unit firing patterns and impaired motor control in persons with SCI that is currently lacking from the literature.