Neuromodulatory rehabilitation for respiratory motor function in individuals with chronic spinal cord injury

项目总结/摘要 呼吸运动控制缺陷是脊髓损伤患者发病和死亡的主要原因 损伤本研究的长期目标是制定一个呼吸康复策略， 脊髓损伤作为标准治疗。我们以前的研究结果表明，患者的呼吸功能 慢性脊髓损伤的患者可以通过使用我们原有的吸气-呼气压力阈值来改善 呼吸训练方案。然而，这种干预的有效性仅限于 在损伤的神经水平以下保留功能能力。我们为此获得的初步数据 提案证明了脊髓电刺激非侵入性地应用于靶向脊髓呼吸 回路结合呼吸训练可以激活和重组脊髓运动网络， 呼吸我们建议研究呼吸运动控制相关的反应，经皮脊髓 单独的脊髓刺激和与呼吸训练的组合。通过呼吸肌的表征 使用表面肌电图的激活模式与肺功能和相关 心血管测量，我们希望确定增加脊髓损伤所需的特定刺激参数。 兴奋性低于损伤水平，以增强对脊髓上中心输入的反应， 促进呼吸训练驱动的神经可塑性。这一假设将由以下人员进行检验： 追求两个具体目标：1）评价经皮脊髓刺激对 呼吸功能和运动控制特性;和2）评价经皮脊髓 脊髓刺激结合呼吸训练。

Project Summary/Abstract Respiratory motor control deficit is the leading cause of morbidity and mortality in patients with spinal cord injury. The long-term goal of this research is to develop a rehabilitation strategy for respiration in patients with spinal cord injury as a standard of care. Our previous findings demonstrate that respiratory function in patients with chronic spinal cord injury can be improved by using our original inspiratory-expiratory pressure threshold respiratory training protocol. However, the effectiveness of this intervention is limited to the amount of functional capacity preserved below the neurological level of injury. Our preliminary data obtained for this proposal demonstrate that electrical spinal cord stimulation applied non-invasively to target spinal respiratory circuits in combination with respiratory training can activate and re-organize spinal motor networks for respiration. We propose to investigate respiratory motor control-related responses to transcutaneous spinal cord stimulation alone and in combination with respiratory training. By characterization of respiratory muscle activation patterns using surface electromyography in association with pulmonary functional and related cardiovascular measures, we expect to determine specific stimulation parameters needed to increase spinal excitability below level of injury to enhance responses to the input from supraspinal centers that remain after injury and to promote the neural plasticity driven by the respiratory training. This hypothesis will be tested by pursuing two Specific Aims: 1) Evaluate the acute effects of transcutaneous spinal cord stimulation on respiratory functional and motor control properties; and 2) Evaluate the effectiveness of transcutaneous spinal cord stimulation combined with respiratory training.