Functional and neurophysiological effects of a progressive robot assisted gait intervention early post stroke

项目摘要 促进脑卒中患者运动功能的恢复是一项重要的医学和经济目标。尽管取得了重大 尽管基于活动和技术的干预措施取得了进展，但该领域仍然未能实现同样的恢复水平 全组这种失败可能是由于延迟管理大规模实践训练，直到患者获得 显著的意志运动，这可能是中风后几周。适应不良的可塑性可能发生在这个过程中， 时间和挑战康复干预的治疗效果。外骨骼步行机器人（ER）可以 在行走训练期间提供帮助，并允许在中风后早期给予高剂量训练 该提案的主要假设是，越早开始大剂量步态治疗越好 是诱导可塑性和恢复的机会。在目标1中，研究人员建议比较 渐进式、长时间（10周内30小时）、ER按需辅助行走训练（ERASSIST）与 卒中急性期功能恢复期间给予的标准治疗（SOC）， 神经肌肉激活参与者将被随机分配到每组，研究人员将检查 每种干预对功能恢复和神经肌肉激活的调节的影响， 走路他们假设早期使用ER辅助进行强化步行训练可能导致 剂量的显著增加，以及行走功能和神经肌肉激活的重新正常化， 走路在目标2中，研究者将获得结构和静息状态功能MRI的纵向测量结果 4个时间点的连通性：卒中1个月内，ERASSIST或SOC干预10周前后， 以及中风后6个月。数据将用于模拟恢复过程并比较ERASSIST的效果 以及SOC干预对改善康复预后的作用。在目标3中，研究人员建议研究 脑卒中后和功能恢复过程中皮质-肌肉连接（CMC）的重组 并将其与性别和年龄匹配的健康对照组进行比较。静态CMC将使用经颅 磁刺激以记录同侧初级运动皮层兴奋性和募集曲线斜率。动态 CMC将使用移动的成像（EEG）和无线EMG技术进行探索，以测量皮质肌肉 行走时的连贯性比较中风和健康对照CMC数据的目的是了解 CMC的重组是对中风的适应或对健康的连接模式的重新正常化。 研究人员认为，高功能恢复的参与者将显示CMC重新正常化， 与年龄和性别匹配的健康对照组相似性更高。这项研究将对 “确定最佳组合和“剂量”的个别干预措施，以改善，并可能加快 通过检查可塑性、适应性和对损伤的反应的基础， 康复干预”。

Project Summary Promoting recovery of motor function in stroke is an essential medical and economic target. Despite significant advances in activity- and technology-based interventions, the field still fails to achieve the same level of recovery in all patients. This failure could be due to the delay in administering massed practice training until patients gain significant volitional movement, which can be weeks after stroke. Maladaptive plasticity could occur during this time and challenges the therapeutic effect of rehabilitation interventions. Exoskeleton Walking Robots (ERs) can provide assistance during walking training, and allow administering high dosage training early-on after stroke The primary hypothesis of this proposal is that the earlier the commence of high-dosage gait therapy, the better is the chance of inducing plasticity and recovery. In aim 1, investigators propose to compare the effect of progressive, long duration (30 hours over 10 weeks), ER assist-as-needed walking training (ERASSIST) versus standard of care (SOC) administered during the acute phase of a stroke on functional recovery and neuromuscular activation. Participants will be randomly assigned to each group, and investigators will examine the effect of each intervention on functional recovery and modulation of neuromuscular activations during walking. They hypothesize that early administration of intensive walking training using ER assistance can lead to significant increase in dosage, and a renormalization in walking function and neuromuscular activation during walking. In aim 2, investigators will acquire longitudinal measures of structural and resting-state functional MRI connectivity at 4 time-points: within 1 month of stroke, before and after 10 weeks of ERASSIST or SOC intervention, and at 6 months post stroke. Data will be used to model prognoses of recovery and compare the effect of ERASSIST and SOC interventions on improving the prognosis of recovery. In aim 3, investigators propose to study reorganization in cortico-muscular connectivity (CMC) post-stroke and over the course of functional recovery and compare it to gender- and age-matched healthy controls. Static CMC will be evaluated using transcranial magnetic stimulation to record ipsilesional primary motor cortex excitability and recruitment curve slope. Dynamic CMC will be explored using mobile imaging (EEG) and wireless EMG techniques to measure cortico-muscular coherence during walking. The objective of comparing stroke and healthy controls CMC data is to understand if the reorganization of CMC is an adaptation to stroke or a re-normalization to a healthy pattern of connectivity. Investigators assume that participants with high functional recovery will show a re-normalization of CMC toward more similarity with age- and gender-matched healthy controls. This research will have a significant impact on “determining optimal combination and “dosing” of individual interventions to improve, and possibly accelerate recovery following injury” by “examining the underpinnings of plasticity, adaptation, and response to injury and rehabilitation intervention.”