Development of sensory augmentation methods to improve post-stroke gait stability

中风后，独立活动能力的缺陷是生活质量下降的主要原因。许多 中风幸存者，包括每年经历中风的大约15,000名美国退伍军人， 被阻止恢复到以前的活动参与或参与社区的水平。一 活动性缺陷的主要原因是步态不稳定，这可能导致福尔斯风险增加或 害怕跌倒，这两种情况都会限制独立功能。虽然几种常见的康复方法 (e.g.运动训练，强化，平衡训练）可以改善某些方面的功能，它们具有 未能解决步态不稳，跌倒发生率缺乏改善就是证明。在某种程度上， 成功可能是由于目前的干预措施没有针对导致后 中风步态不稳 这项研究的一个长期目标是开发基于机制的干预措施， 步态稳定性，并在诊所或社区实施。作为实现这一目标的一步，该项目侧重于 中风后步态不稳的一个有希望的潜在机械原因。具体来说，中风后的缺陷， 将以步进宽度的机械上适当的逐步调整为目标。这个问题的核心假设是 工作是，增强的感觉反馈将增加步长的机械依赖性调制， 这是一个重要的步态稳定策略，在慢性卒中幸存者中经常被破坏。很有希望，非侵入性 感官刺激已被证明可以塑造一个人的感觉，他们的骨盆运动， 行走，从而影响他们一步一步的控制。本提案的目的是开发和测试一个 通过传递的振动刺激提供髋部本体感受反馈的实时增强的方法 在中风后行走时使用触觉器。这将通过三个具体目标来实现。 第一个具体目标是确定感官刺激有益作用的生理机制。 逐步增强步态稳定性。除了具有科学意义，研究结果还将提供 洞察机制，应针对未来的发展，便携式设备使用 在诊所或社区。第二个具体目标是确定是否个性化的感官 对个体参与者的增强方法对中风后步态稳定性产生更大的有益效果， 这将使我们能够解释病人对感官刺激的反应性的潜在变化。最后， 第三个具体目标是确定以康复干预为中心的安全性、可行性和有效性， 在步态期间反复暴露于感觉增强。结果将为未来的 大规模临床试验。总的来说，拟议工作的成果将构成发展的基础， 一种新的康复设备，可以帮助步态平衡以外的研究实验室设置。 该项目基于人体步态力学和运动学的综合理论框架 学习，并将量化使用新的感官刺激， 恢复中风幸存者的典型步态稳定策略。由此产生的知识有可能 为发展大规模康复模式作出重要贡献， 治疗干预针对患者的具体局限性。

Following a stroke, deficits in independent mobility are a primary contributor to decreased quality of life. Many stroke survivors, including the approximately 15,000 American veterans who experience a stroke each year, are prevented from returning to their prior levels of activity participation or involvement in the community. A major cause of mobility deficits is gait instability, which can result in an increased risk of falls or an increased fear of falling, either of which can limit independent function. While several common rehabilitation methods (e.g. locomotor training, strengthening, balance training) can improve some aspects of function, they have failed to address gait instability, as evidenced by a lack of improvement in fall incidence. In part, this lack of success is likely due to current interventions not being targeted toward the specific mechanisms causing post- stroke gait instability. A long-term goal of this research is to develop mechanism-based interventions that can improve post-stroke gait stability and be implemented in the clinic or community. As a step toward this goal, this project focuses on one promising potential mechanistic cause of post-stroke gait instability. Specifically, post-stroke deficits in the mechanically-appropriate step-by-step adjustments of step width will be targeted. The central hypothesis of this work is that augmented sensory feedback will increase the mechanics-dependent modulation of step width, an important gait stabilization strategy that is often disrupted in chronic stroke survivors. Promisingly, non-invasive sensory stimulation has been shown to shape an individual’s perception of the motion of their pelvis during walking, thus influencing their step-by-step control. The objective of this proposal is to develop and test a method of providing real-time augmentation of hip proprioceptive feedback through vibratory stimuli delivered using tactors during post-stroke walking. This will be accomplished through three Specific Aims. The first Specific Aim is to identify the physiological mechanism underlying the beneficial effects of sensory augmentation on step-by-step gait stabilization. Beyond being of scientific interest, the results will provide insight into the mechanism that should be targeted for the future development of a portable device to be used in the clinic or community. The second Specific Aim is to determine whether personalizing sensory augmentation methods to individual participants produces greater beneficial effects on post-stroke gait stability, which will allow us to account for potential variation in patient responsiveness to sensory stimulation. Finally, the third Specific Aim is to establish the safety, feasibility, and efficacy of a rehabilitation intervention centered on repeated exposure to sensory augmentation during gait. The results will provide justification for a future larger-scale clinical trial. Overall, the results of the proposed work will form the foundation for the development of a novel rehabilitation device that can assist gait balance outside of a research laboratory setting. The proposed project is based on the combined theoretical frameworks of human gait mechanics and motor learning, and will quantify the potential of a mechanism-based intervention using novel sensory stimulation to restore the typical gait stabilization strategy in stroke survivors. The resultant knowledge has the potential to make an important contribution to the development of a larger-scale rehabilitation paradigm in which therapeutic interventions are targeted to a patient’s specific limitations.