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Studies of voluntary and involuntary control of human breathing


Within the central nervous system, we have identified three sites that can potentially cause respiratory issues; (1) the sensorimotor cortex, (2) the medullary respiratory centres, and (3) spinal reflex circuits. We are currently using a multi-faceted approach to investigate each of these three potential sites of failure of respiratory neural control, thus determining the central mechanisms of respiratory motor impairment.

Our team is uniquely qualified to apply a suite of specialised neurophysiological methods, many pioneered in our lab, to better understand voluntary activation of the diaphragm, cortical activation during breathing, and measure single motor unit activity.

A motor unit is made up of a motor neuron and the muscle it activates. We are the only group internationally who make motor unit recordings from human respiratory pump muscles. This is the only direct measure of neural drive.

Our current experiments are looking at voluntary and involuntary drive to the breathing muscles to try to answer this fundamental question about the neural control of breathing. In addition, we are looking at the potential cortical contributions to resting breathing in respiratory disorders.

Chronic Obstructive Pulmonary Disease

Respiratory impairment is a common and debilitating medical condition for older adults and people with chronic obstructive pulmonary disease (COPD). This condition is the third-highest ranking disease burden in Australia and New Zealand.

Respiratory illness limits daily activities and reduces health-related quality of life. These consequences and frequent hospitalisations are a public health burden that cost over $1 billion per year.

Spinal cord injury
After cervical spinal cord injury (SCI), the respiratory muscles are partly or completely paralysed. There are two major clinical consequences of this: the ability to get air into the lungs is diminished as is the ability to cough to remove secretions. This results in a lifetime of recurrent respiratory tract infections (2/year/person) that often proceed to pneumonia and frequent hospitalisations.

People with cervical SCI are 150 times more likely to die from respiratory complications than the general population. A recent longitudinal study of 283 people with cervical SCI showed that respiratory muscle weakness is linked to incidental pneumonia. There is an urgent need to identify a simple and effective treatment for weak respiratory muscles and the prevention of respiratory complications after SCI.

Obstructive Sleep Apnoea
OSA is a sleep disorder that affects more than 4 percent of the population and can lead to symptoms from daytime drowsiness to high blood pressure. People with sleep apnoea are often not breathing normally during sleep and may experience periods where the airway closes and they are unable to breathe. In severe sleep apnoea this can occur 50-60 times each hour. That is once each minute.

The closure of the upper airway is thought to be due to a number of factors, one of which is that the neural drive to the airway muscles is insufficient in people with sleep apnoea. In our lab, we have made the first extensive recordings from the major muscle of the upper airway, genioglossus.

We have shown that the neural drive to this muscle is very complex, more so than any limb muscle. At NeuRA, we have also pioneered new methods to image this muscle using fMRI and ultrasound. We are now planning to look at how changes in muscle architecture and mechanics relate to the neural drive to the muscle and whether that relationship is maintained in people with sleep apnoea.

See what’s going on at NeuRA


The RESTORE Trial: Immersive Virtual Reality Treatment for Restoring Touch Perception in People with Discomplete Paraplegia

Chief Investigators: Associate Professor Sylvia Gustin, Prof James Middleton, A/Prof Zina Trost, Prof Ashley Craig, Prof Jim Elliott, Dr Negin Hesam-Shariati, Corey Shum and James Stanley While recognition of surviving pathways in complete injuries has tremendous implications for SCI rehabilitation, currently no effective treatments exist to promote or restore touch perception among those with discomplete SCI. The proposed study will address this need by developing and testing a novel intervention that can provide touch restoration via the primary source of sensory perception: the brain.Complete spinal cord injury (SCI) is associated with a complete loss of function such as mobility or sensation. In a recent discovery we revealed that 50% of people with complete SCI still have surviving somatosensory nerve fibres at the level of the spine. For those with complete SCI this is hopeful news as it means -- contrary to previous belief that communication to the brain had been severed by injury -- that the brain is still receiving messages. This new SCI type is labelled “discomplete SCI” -- a SCI person who cannot feel touch, but touch information is still forwarded from the foot to the brain. The project will use virtual reality (VR) in a way it has never been used before. We will develop the first immersive VR interface that simultaneously enhances surviving spinal somatosensory nerve fibres and touch signals in the brain in an effort to restore touch perception in people with discomplete SCI. In other words, immersive VR is being used to re-train the brain to identify the distorted signals from toe to head as sensation (touch). For example, participants will receive touch simulation in the real world (e.g., their toe) while at the same time receiving corresponding multisensory touch stimuli in the virtual world (e.g., experiencing walking up to kick a ball). This project is the first effort worldwide to restore touch sensation in 50% of individuals with complete injuries. The outcomes to be achieved from the current study will represent a cultural and scientific paradigmatic shift in terms of what can be expected from life with a spinal cord injury. In addition, the project allows potential identification of brain mechanisms that may ultimately represent direct targets for acute discomplete SCI rehabilitation, including efforts to preserve rather than restore touch perception following SCI. RESTORE consolidates the expertise of scientists, clinicians, VR developers and stakeholders from NeuRA and UNSW School of Psychology (A/Prof Sylvia Gustin, Dr Negin Hesam-Shariati), John Walsh Centre for Rehabilitation Research, Kolling Institute and University of Sydney (Prof James Middleton, Prof Ashley Craig and Prof Jim Elliott), Virginia Commonwealth University (A/Prof Zina Trost), Immersive Experience Laboratories LLC (Director Corey Shum) and James Stanley. If you are interested in being contacted about the RESTORE trial, please email A/Prof Sylvia Gustin (s.gustin@unsw.edu.au) and include your name, phone number, address, type of SCI (e.g., complete or incomplete), level of injury (e.g., T12) and duration of SCI (e.g., 5 years).