Priming the Rehabilitation Engine: Aerobic Exercise as the Fuel to Spark Behavioral Improvements in Stroke

启动康复引擎：有氧运动作为改善中风行为的燃料

• 批准号: 10400049
• 负责人: Ryan Ross
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400049
• 关键词: Address; Adjuvant; Admission activity; Aerobic Exercise; Award; Behavioral; Biological Markers; Blood specimen; Brain; Brain-Derived Neurotrophic Factor; Cognition; Cognitive; Coupled; Data; Development; Ducks; Effectiveness; Environment; Exercise; Exposure to; Fostering; Foundations; Funding; Future; Goals; Health; Impairment; Individual; Infrastructure; Institution; Intervention; Long-Term Potentiation; Lower Extremity; Measures; Medical; Medical center; Mental Depression; Mentors; Motor; Movement; Neurobiology; Neurologic; Neuronal Plasticity; Outcome; Participant; Patient Self-Report; Physical Function; Physical Performance; Physical Rehabilitation; Physical assessment; Play; Positioning Attribute; Prevalence; Process; Psyche structure; Quality of life; Randomized; Rehabilitation therapy; Research; Research Personnel; Resources; Role; South Carolina; Stretching; Stroke; Synapses; Therapeutic Intervention; Training; Transcranial magnetic stimulation; Treatment Efficacy; United States; United States National Institutes of Health; Universities; Upper Extremity; Veterans; Work; arm function; base; cardiovascular health; chronic stroke; cognitive function; cohort; data acquisition; depressive symptoms; design; disability; effective intervention; executive function; experience; functional improvement; improved; improved functioning; innovation; insight; mental function; mortality; motor learning; motor rehabilitation; multidisciplinary; neurological rehabilitation; neuropsychiatry; post stroke; predicting response; psychologic; rehabilitation paradigm; rehabilitation research; rehabilitation strategy; rehabilitative care; response; skills; stroke outcome; stroke recovery; stroke rehabilitation; stroke survivor; tool; virtual reality

Stroke is a leading cause of disability in the United States and poses a significant burden to Veterans. The effectiveness of current intervention approaches is limited and many individuals following stroke live with persistent functional, cognitive and psychological impairments that significantly reduce long-term quality of life. The prevalence of post-stroke disability coupled with reduced stroke mortality rates reflects an increasing need to develop effective rehabilitation strategies aimed at reducing disability and improving quality of life for Veteran stroke survivors. Aerobic exercise (AEx) promotes numerous functional, cognitive, and psychological benefits. Additionally, AEx may enhance neuroplasticity through increases in circulating brain-derived neurotrophic factor (BDNF) and corticomotor excitability (CME). Emerging evidence also supports the use of AEx as a priming tool to enhance motor outcomes following targeted rehabilitation. Our conceptual framework involves priming with AEx prior to targeted motor rehabilitation to enhance the ‘neuroplastic environment” and make the brain more amenable to adaptation, thereby enhancing response to rehabilitation. Specifically, we propose to pair AEx with an upper extremity virtual reality rehabilitation game called Duck Duck Punch (DDP), developed by our team (Co-mentor: Woodbury) as the platform for examining the adjunctive potential of AEx. Therefore the primary aim of this proposal is to evaluate the priming effects of AEx on a motor rehabilitation intervention (i.e. DDP) for chronic stroke survivors. This will be accomplished by examining a cohort of stroke survivors who will be randomly assigned to receive 8 weeks (3 sessions/week) of DDP preceded by either 15 minutes of AEx (AEx+DDP) or a stretching control (CON+DDP). Assessment of physical function before and after the intervention will provide insight into the ability of AEx to enhance the response to motor rehabilitation. The secondary aim of this proposal is to gain insight into the mechanisms that underlie the priming effects of AEx through assessment of circulating BDNF and CME. Additionally, since stroke survivors often experience cognitive and psychological impairments we will also explore the influence of cognitive and psychological function on response to AEx+DDP. A potentially exciting possibility is that AEx facilitates an enhanced neuroplastic environment, which fosters improved function in a variety of aspects of stroke recovery including physical, cognitive, and psychological function. This proposal will be supported by the infrastructure and resources provided by the South Carolina Research Center for Recovery from Stroke (NIH P20 GM109040). Furthermore, the combination of the Ralph H. Johnson VA Medical Center and its affiliated academic institution, Medical University of South Carolina is uniquely positioned to fill the aforementioned gap in understanding for several reasons: 1) Charleston, South Carolina has one of the highest rates of stroke in the nation, and 2) in the last 5 years we have received over $23 million in research funds to support rehabilitation research in stroke recovery. During the award period, the applicant will capitalize on the opportunity to utilize these resources to develop the requisite skills and understanding of neurobiological data acquisition, analysis, and interpretation through direct hands-on training from local renowned experts. The overall goal of this CDA-2 application is to expose the candidate to a rich local environment for stroke recovery research, providing the foundation for his development into an independent VA researcher studying the effects of exercise- based interventions, alone or as adjuvants, for the treatment of Veterans. To accomplish this goal, the proposed training plan will enhance the candidate’s understanding of the neurobiological effects of AEx and the design and delivery of neurorehabilitation trials. The data generated will inform the development of additional AEx-based interventions aimed at improving function and quality of life for individuals following stroke and perhaps other neurological or neuropsychiatric conditions.

中风是美国残疾的主要原因，对退伍军人构成重大负担。的 目前的干预方法的有效性是有限的， 持续的功能、认知和心理障碍，显著降低长期生活质量。 卒中后残疾的流行率与卒中死亡率的降低反映了对 制定有效的康复战略，旨在减少残疾和提高退伍军人的生活质量 中风幸存者有氧运动（AEx）促进许多功能，认知和心理方面的益处。 此外，AEx可能通过增加循环脑源性神经营养因子来增强神经可塑性。 （BDNF）和皮质运动兴奋性（CME）。新出现的证据也支持使用AEx作为启动工具 以增强针对性康复后的运动效果。我们的概念框架涉及启动与 AEX之前，有针对性的运动康复，以加强"神经可塑性环境"，使大脑更 易于适应，从而加强对恢复的反应。具体来说，我们建议将AEx与 一款上肢虚拟现实康复游戏，名为Duck Duck Punch（DDP），由我们的团队开发 （共同导师：伍德伯里）作为检验AEx潜在竞争力的平台。因此，主要 本提案的目的是评估AEx对运动康复干预的启动效应（即， DDP）治疗慢性中风幸存者。这将通过检查一组中风幸存者来完成， 将被随机分配接受8周（3次/周）DDP治疗，之前接受15分钟AEx治疗 (AEx+ DDP）或拉伸对照（CON + DDP）。治疗前后的身体功能评估 干预将提供对AEx增强对运动康复反应的能力的深入了解。的 本研究的第二个目的是深入了解AEx启动效应的内在机制 通过评估循环BDNF和CME。此外，由于中风幸存者经常经历 认知和心理障碍，我们还将探讨认知和心理的影响， 对AEx + DDP的响应功能。一个潜在的令人兴奋的可能性是，AEx有助于增强 神经可塑性环境，促进改善中风恢复的各个方面的功能，包括 生理认知和心理功能这一建议将得到基础设施的支持， 由南卡罗来纳州中风恢复研究中心（NIH P20 GM 109040）提供的资源。 此外，Ralph H.约翰逊退伍军人医疗中心及其附属学术机构， 南卡罗来纳州医科大学具有独特的优势，可以填补上述理解的空白， 有几个原因：1）南卡罗来纳州的查尔斯顿是全国中风发病率最高的地区之一，2） 在过去的5年里，我们已经收到了超过2300万美元的研究基金，以支持中风康复研究 复苏在奖励期间，申请人将利用这些资源的机会， 培养必要的技能和神经生物学数据采集，分析和解释的理解 通过当地知名专家的直接实践培训。此CDA-2应用程序的总体目标是 使候选人接触到丰富的中风康复研究的当地环境， 为他发展成为一名独立的退伍军人管理局研究人员研究运动的影响奠定了基础- 基于干预措施，单独或作为佐剂，用于退伍军人的治疗。为了实现这一目标， 建议的培训计划将提高候选人对AEx的神经生物学效应的理解， 设计和交付神经康复试验。所产生的数据将为制定其他 旨在改善卒中后个体功能和生活质量的基于AEX的干预措施， 可能是其他神经或神经精神疾病。