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

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Principal Investigator: Alexander Vladimirovich Ovechkin
Organization: UNIVERSITY OF LOUISVILLE
Fiscal Year: 2024
Award: $368,666
Funding agency: National Heart Lung and Blood Institute

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.

Terms: <Active Follow-up><Activities of Daily Living><Activities of everyday life><Acute><Blood Pressure><Breathing><CNS plasticity><COVID-19><CV-19><Cardiac Chronotropism><Cardiovascular><Cardiovascular Body System><Cardiovascular Organ System><Cardiovascular system><Chronic><Clinical><Complication><Coronavirus Infectious Disease 2019><Cutaneous><Data><Development><Effectiveness of Interventions><Electromyography><Electrophysiology><Electrophysiology (science)><Evaluation><Goals><Heart Rate><Heart Vascular><Human><Individual><Injury><Knowledge><Lesion><Lung><Lung Function Tests><Lung Respiratory System><Measures><Medical Rehabilitation><Medulla Spinalis><Methods><Modality><Modern Man><Morbidity><Morbidity - disease rate><Motor><Muscle><Muscle Tissue><Neurologic><Neurological><Neuronal Plasticity><Neurophysiology / Electrophysiology><Neurostimulation procedures of spinal cord tissue><Patients><Pattern><Physiologic><Physiological><Population><Property><Protocol><Protocols documentation><Public Health><Pulmonary function tests><Randomized Controlled Clinical Trials><Rehabilitation><Rehabilitation therapy><Research><Respiration><Respiration Disorders><Respiratory Aspiration><Respiratory Disorder><Respiratory Inspiration><Respiratory Muscles><Respiratory physiology><Spinal><Spinal Cord><Spinal Cord Lesions><Spinal Cord Stimulation><Spinal Cord Trauma><Spinal Trauma><Spinal cord injured><Spinal cord injury><Surface><Testing><Therapeutic Effect><Time><Training><Traumatic Myelopathy><Ventilatory Muscles><Work><active followup><assess effectiveness><breathing disorder><central nervous system plasticity><circulatory system><comparative><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><daily living function><daily living functionality><design><designing><determine effectiveness><developmental><disability><effectiveness assessment><effectiveness evaluation><electrophysiological><evaluate effectiveness><evidence base><examine effectiveness><fighting><follow up><follow-up><followed up><followup><functional ability><functional capacity><functional improvement><functional outcomes><improve function><improved><improved functional outcomes><injuries><inspiration><kinematic model><kinematics><mortality><motor control><muscular><neural control><neural network><neural plasticity><neural regulation><neuromodulation><neuromodulatory><neuroplastic><neuroplasticity><neuroregulation><new therapeutic approach><new therapeutic intervention><new therapeutic strategies><new therapy approaches><new treatment approach><new treatment strategy><novel therapeutic approach><novel therapeutic intervention><novel therapeutic strategies><novel therapy approach><preservation><pressure><pulmonary><randomized control clinical trial><rehab strategy><rehab therapy><rehabilitation strategy><rehabilitative><rehabilitative therapy><respiratory><respiratory dysfunction><respiratory function><respiratory mechanism><response><restoration><standard of care><transcutaneous stimulation><transdermal stimulation><voltage>