Evaluating cognitive impairment as a moderator of locomotor learning in older adults post-stroke

评估认知障碍作为中风后老年人运动学习的调节因素

• 批准号: 10281898
• 负责人: Kristan A. Leech
• 金额: $ 12.58万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10281898
• 关键词: Achievement; Adult; Affect; Aging; Bilateral; Biomechanics; Brain; Brain imaging; Cerebellum; Clinical; Cognition; Cognitive; Cognitive deficits; Cues; Dementia; Demographic Factors; Development; Elderly; Excision; Exhibits; Experimental Designs; Feedback; Foundations; Functional disorder; Gait; Goals; Imaging Techniques; Impaired cognition; Impairment; Individual; Intervention; K-Series Research Career Programs; Knowledge; Lead; Learning; Leeches; Length; Lesion; Location; Mediating; Motor; Movement; Neuropsychology; Outcome; Participant; Patients; Pattern; Performance; Prefrontal Cortex; Procedures; Process; Rehabilitation therapy; Reporting; Research; Research Personnel; Resources; Role; Severities; Speed; Stroke; Structure; System; Testing; Thick; Training; United States; Visual; Walking; Work; aging brain; base; career; chronic stroke; disability; effective therapy; gait rehabilitation; improved; insight; inter-individual variation; motor behavior; motor deficit; motor impairment; motor learning; neuroimaging; neuromechanism; post stroke; post stroke cognitive impairment; predictive modeling; programs; relating to nervous system; response; skills; statistics; treadmill; visual feedback

PROJECT SUMMARY Stroke is a leading cause of long-term disability around the world and disproportionately affects older adults. After a stroke, older adults commonly exhibit gait dysfunction (e.g., slow, unstable, asymmetric walking), which is the top patient-reported rehabilitation target. In addition to motor deficits, approximately 70% of people living with chronic stroke also have post-stroke cognitive impairment (PSCI). While post-stroke gait rehabilitation interventions effectively mitigate gait dysfunction in aging adults, there remains a significant degree of inter- individual variability in walking outcomes. We posit this is because current gait rehabilitation interventions are predominantly structured to leverage explicit versus implicit locomotor learning. Importantly, explicit motor learning is cognitively demanding. It occurs through intentional changes to a movement based on external feedback and relies primarily on the dorsolateral prefrontal cortex. Whereas, implicit motor learning is cerebellum-dependent and occurs more automatically in response to proprioceptive feedback. Despite evidence of shared neural resources between cognitive and motor processing, the impact of PSCI on the capacity for these forms of motor learning during walking remains largely unexplored. The overall goal of this proposal is to demonstrate that PSCI moderates explicit, but not implicit, locomotor learning in older adults with chronic stroke and identify the role of the dorsolateral prefrontal cortex in this relationship. Under this career development award, the PI (Leech) will develop skills in neuropsychology, structural neuroimaging, and advanced statistics. This training will promote the achievement of her long-term career goal: as an independent investigator, to develop effective, comprehensive, individualized interventions to reduce disability in older adults. This project has three research aims. Aim 1 will determine the impact of PSCI severity on explicit locomotor learning in older adults post-stroke. Aim 2 will test the impact of the PSCI severity the capacity for implicit locomotor learning in the same group of participants. Finally, Aim 3 will examine the role of dorsolateral prefrontal cortex structural integrity in explicit locomotor learning post-stroke. Older adults with chronic stroke who have a range of PSCI severity will complete the procedures necessary for all three aims over a total of 2 experimental sessions. We expect to show that PSCI severity limits an individual’s capacity to learn a more symmetric walking pattern through explicit, but not implicit, locomotor learning and that this relationship will be mediated by the structural integrity of the dorsolateral prefrontal cortex. This work will provide necessary scientific foundation for a program of research to develop an individualized gait rehabilitation intervention anchored to cognitive impairment and a comprehensive predictive model of locomotor learning in older adults post-stroke.

项目总结 中风是世界各地导致长期残疾的主要原因，对老年人的影响不成比例。 中风后，老年人通常表现出步态功能障碍(例如，缓慢、不稳定、不对称行走)，这 是患者报告的首要康复目标。除了运动障碍，大约70%的人生活在 慢性卒中患者还存在卒中后认知障碍(PSCI)。而中风后的步态康复 干预措施有效地缓解了老年人的步态功能障碍，但仍存在显著程度的相互影响 步行结果的个体差异性。我们推测这是因为目前的步态康复干预 主要的结构是利用外显和内隐的运动学习。重要的是，显式马达 学习对认知要求很高。它通过有意改变基于外部因素的运动而发生 反馈，主要依赖于背外侧前额叶皮质。然而，内隐运动学习是 依赖小脑，对本体感觉反馈的反应更自动。尽管有证据 认知和运动加工之间的共享神经资源，PSCI对认知和运动加工能力的影响 在行走过程中，这些运动学习的形式在很大程度上仍未被探索。这项提案的总体目标是 PSCI对老年慢性卒中患者运动学习的调节作用 并确定背外侧前额叶皮质在这种关系中的作用。在这种职业发展下 Pi(水蛭)将发展神经心理学、结构神经成像和高级统计学方面的技能。 这次培训将促进她实现长期的职业目标：作为一名独立调查员， 制定有效、全面、个性化的干预措施，以减少老年人的残疾。这个项目 有三个研究目标。目标1将确定PSCI严重程度对老年人外显运动学习的影响 成人中风后。目标2将测试PSCI严重程度对内隐运动学习能力的影响 同一组参与者。最后，目标3将检验背外侧前额叶皮质结构的作用。 中风后外显运动学习的完整性。有一系列PSCI的慢性中风老年患者 严重程度将在总共2个实验期内完成所有三个目标所需的程序。我们 希望能证明PSCI的严重性限制了个人学习更对称的行走模式的能力 通过外显但不是内隐的运动学习，这种关系将由结构性的 背外侧前额叶皮质的完整性。这项工作将为该计划提供必要的科学基础 研究开发以认知障碍为基础的个体化步态康复干预 老年人卒中后运动学习的综合预测模型。