Contribution of the non-lesioned hemisphere to lower limb movement and walking function after stroke

未病变半球对中风后下肢运动和行走功能的贡献

• 批准号: 10393045
• 负责人: Brice Thomas Cleland
• 金额: $ 7.17万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10393045
• 关键词: Activities of Daily Living; Address; Adjuvant; Affect; Ankle; Bilateral; Characteristics; Clinical; Communities; Contralateral; Fellowship; Foundations; Future; Goals; Health; Health Status; Healthcare; Impaired health; Impairment; Individual; Intervention; Investigation; Ipsilateral; Isometric Contraction; Isometric Exercise; Knowledge; Leg; Lesion; Limb structure; Lower Extremity; Measurement; Measures; Motor; Motor Evoked Potentials; Motor Pathways; Movement; Muscle; Oranges; Outcome; Paresis; Participant; Physical activity; Physiologic pulse; Population; Quality of life; Rehabilitation therapy; Research; Research Personnel; Rest; Specificity; Stroke; Testing; Transcranial magnetic stimulation; Translating; Upper Extremity; Walking; Work; career; chronic stroke; community involvement; experience; improved; insight; kinematics; limb movement; mind control; motor control; motor impairment; motor rehabilitation; neurophysiology; neuroregulation; post stroke; recruit; rehabilitation strategy; response; spatiotemporal; stroke rehabilitation; stroke survivor; tibialis anterior muscle; walking rehabilitation; walking speed

Project Summary/Abstract Long-term walking impairments are common after stroke, reducing community involvement and physical activity and impairing health status and quality of life. Although improving walking is of high importance in this population, the impact of walking rehabilitation after stroke is limited. The ability to improve walking rehabilitation after stroke is hampered by a lack of knowledge about stroke-related changes in the cortical control of walking. In particular, previous work suggests that changes in the ipsilateral contribution of the contralesional (non-lesioned) hemisphere to motor control of the paretic limb and/or altered interhemispheric imbalance may contribute to walking impairment after stroke. However, more information about these phenomena, particularly during dynamic lower limb movement, is necessary to translate these neurophysiological measurements into improvements in stroke rehabilitation. The goal of this proposal is to evaluate the contribution of the contralesional hemisphere and interhemispheric interactions to dynamic, bilateral lower limb movements after stroke and determine if these constructs relate to walking function. We hypothesize that the ipsilateral contribution of the contralesional hemisphere to paretic limb movements will be greater than the ipsilateral contribution of the ipsilesional (lesioned) hemisphere to movements of the non- paretic limb. We also hypothesize that interhemispheric inhibition will be greater in the ipsilesional hemisphere than in the contralesional hemisphere. We expect both constructs to differ between isometric and dynamic tasks and be related to greater walking impairment. To test these hypotheses, we will provide transcranial magnetic stimulation during dynamic, bilateral ankle movement. In Aim 1, we will assess the contribution of each hemisphere to movements of the paretic and non-paretic limb, and in Aim 2, we will assess the degree of interhemispheric inhibition of each hemisphere by the opposite hemisphere. In Aim 3, we will evaluate walking speed and spatiotemporal characteristics and relate these measures to the ipsilateral contribution of the contralesional hemisphere to movement of the paretic limb and interhemispheric inhibition as measured during Aim 1 and 2. The proposed work is significant because it will further our understanding of functional corticomotor excitability after stroke and expand our knowledge about the motor control of dynamic, bilateral lower limb movements, such as walking. Information from these studies can then be used to optimize rehabilitation strategies, specifically informing the use of neuromodulatory adjuvants to walking rehabilitation. Ultimately, these improvements in post-stroke rehabilitation will lead to health improvements and reduced healthcare burden. Findings from these studies will establish my career as an independent investigator and help me achieve my long-term research objective of determining how motor rehabilitation and neuromodulatory interventions can be applied optimally to benefit walking after stroke.

项目总结/摘要 中风后长期行走障碍很常见，减少了社区参与和身体健康。 活动和损害健康状况和生活质量。虽然改善步行在这方面非常重要， 人群中，中风后步行康复的影响有限。改善行走的能力 脑卒中后的康复受到缺乏脑皮层卒中相关变化知识的阻碍， 控制行走。特别是，以前的工作表明，在同侧贡献的变化， 对侧（非病变）半球对麻痹肢体的运动控制和/或改变的半球间 不平衡可能导致中风后行走障碍。然而，更多关于这些 现象，特别是在动态下肢运动期间，需要将这些 神经生理学测量用于改善中风康复。本提案的目的是 评价对侧半球和半球间相互作用对动态， 中风后的双侧下肢运动，并确定这些结构是否与行走功能有关。我们 假设对侧半球对麻痹肢体运动的同侧贡献将是 大于同侧（病变）半球对非病变半球运动的同侧贡献， 瘫痪肢体我们还假设，在同侧半球，半球间抑制作用更强 而不是对侧半球。我们希望这两种结构在等距和动态之间有所不同 任务，并与更大的步行障碍有关。为了验证这些假设，我们将提供经颅 在动态，双侧踝关节运动期间进行磁刺激。在目标1中，我们将评估 在目标2中，我们将评估每个半球对麻痹和非麻痹肢体运动的影响程度， 对侧半球对侧半球的半球间抑制。在目标3中，我们将评估步行 速度和时空特性，并将这些措施与同侧贡献的 对侧半球对瘫痪肢体运动的抑制和半球间抑制， 目标1和2。所提出的工作是有意义的，因为它将进一步我们的理解功能 脑卒中后皮质运动兴奋性，并扩大我们对动态，双侧 下肢运动，如行走。这些研究的信息可以用来优化 康复策略，特别是告知使用神经调节辅助步行康复。 最终，中风后康复的这些改善将导致健康改善， 医疗负担。这些研究的结果将确立我作为独立调查员的职业生涯， 帮助我实现我的长期研究目标，确定运动康复和神经调节 可以最佳地应用干预措施以有益于中风后的行走。