Closed loop control of vibration for muscle spasms after human spinal cord injury: efficacy and mechanism

摘要 无意识的肌肉活动（痉挛）是脊髓损伤（SCI）后痉挛状态中最令人衰弱的方面，因为 宫缩会影响日常工作，并限制康复。治疗并不总是有效的，降低健康- 相关的生活质量。我们的长期目标是使用肌腱振动的闭环控制来实现临床 有意义的肌肉痉挛管理，并了解负责痉挛产生的脊髓回路。 具体而言，我们的目标是建立在我们现有的能力和合作，以：1a）完善我们的住房设计， 通过使用面向消费者的输入将振动传递到跟腱的可穿戴设备; 在实验室中使用可穿戴设备减少SCI瘫痪的腿部肌肉痉挛的参数。沿 坐着或斜躺的位置，痉挛将使用肌电图（EMG）检测，然后跟腱将 以不同的频率、持续时间和振幅振动，以使用闭环控制实时抑制痉挛; 2） 检查肌腱振动在改变肌肉痉挛治疗痉挛，因为他们发生，个性化的疗效 最大化临床和用户影响的干预。将评估振动对痉挛的急性（慢性）影响 在24小时EMG记录期间，通过比较基线时的无条件痉挛与有条件痉挛，在振动期间， 干预和干预后。痉挛不同方面的前/后测量将提供对部位的洞察， 振动发生变化的幅度和时间过程;以及用户对治疗效果的看法。 将无创生理记录的功能与功能、临床和参与者报告的结局相结合 还将揭示神经和肌肉的可塑性，振动对痉挛的作用机制， 重要的是，改善SCI和其他神经系统疾病后痉挛管理的新方法的基本原理， 紊乱许多SCI患者可能会发现痉挛的非药物治疗很有吸引力，因为它可能导致 减少或消除痉挛药物。

ABSTRACT Involuntary muscle activity (spasms) is the most debilitating aspect of spasticity after spinal cord injury (SCI) because the contractions interfere with everyday tasks, and limit rehabilitation. Treatments are not always effective, lowering health- related quality of life. Our long-term Objective is to use closed-loop control of tendon vibration to implement clinically meaningful management of muscle spasms, and to understand the spinal circuits responsible for spasm generation. Specifically, we aim to build on our existing capabilities and collaborations to: 1a) Refine the design of the housing in our wearable device to deliver vibration to the Achilles tendon by using consumer-oriented input; 1b) Determine the vibration parameters that reduce spasms in leg muscles paralyzed by SCI in the laboratory using the wearable device. In either a seated or reclined position, spasms will be detected using electromyography (EMG), then the Achilles tendon will be vibrated at different frequencies, durations and amplitudes to dampen the spasms in real-time using closed-loop control; 2) Examine the efficacy of tendon vibration in altering muscle spasms by treating spasms as they occur, which personalizes the intervention for maximal clinical and user impact. The acute (chronic) effects of vibration on spasms will be evaluated during 24-hour EMG recordings by comparing unconditioned to conditioned spasms at baseline, during the vibration intervention, and post intervention. Pre/Post measures of different aspects of spasticity will provide insight into the site(s), magnitude, and time-course of changes that occur with vibration; and user perspective on the effects of the therapy. Combining the power of non-invasive physiological recordings with functional, clinical and participant reported outcomes will also reveal neural and muscular plasticity, the mechanisms underlying the action of vibration on spasms, and importantly, the rationale to improve this novel approach to spasm management after SCI and other neurological disorders. Many individuals with SCI may find non-pharmacological treatment for spasms attractive because it may lead to reductions or elimination of spasm medications.