Epidural spinal cord stimulation and respiratory motor function after injury

Document text

Principal Investigator: Alexander Vladimirovich Ovechkin
Organization: UNIVERSITY OF LOUISVILLE
Fiscal Year: 2024
Award: $741,227
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 by the levels of functional
capacity preserved below the neurological level of injury. Our preliminary data obtained for this proposal
demonstrate that electrical spinal cord stimulation applied epidurally at the lumbar level in combination with
respiratory can activate and re-organize spinal motor networks for respiration. We propose to investigate
respiratory motor control-related responses to epidural 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 epidural spinal cord stimulation on respiratory functional and motor control
properties; and 2) Evaluate the effectiveness of epidural 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><Data><Development><Effectiveness of Interventions><Electromyography><Electrophysiology><Electrophysiology (science)><Evaluation><Goals><Heart Rate><Heart Vascular><Human><Individual><Injury><Knowledge><Lead><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><Pb element><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><heavy metal Pb><heavy metal lead><improve function><improved><improved functional outcomes><injuries><inspiration><kinematic model><kinematics><mortality><motor control><muscular><neural network><neural plasticity><neuroplastic><neuroplasticity><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><voltage>