A novel, comprehensive approach to post-stroke gait rehabilitation

一种新颖、综合的中风后步态康复方法

• 批准号: 10488408
• 负责人: Kristan A. Leech
• 金额: $ 10.04万
• 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: 2021-05-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10488408
• 关键词: Address; Aerobic; Aerobic Exercise; Applications Grants; Award; Back; Biofeedback; Brain; Classification; Crossover Design; Development; Educational Intervention; Experimental Designs; Foundations; Functional disorder; Gait; Goals; Gold; Health; Heart Rate; Impairment; Individual; International; Intervention; Lead; Learning; Length; Limb structure; Link; Lower Extremity; Methods; Motor; Movement; Neurologic; Neuronal Plasticity; Outcome; Outcome Measure; Paresis; Participant; Pattern; Performance; Persons; Physiological; Prefrontal Cortex; Process; Protocols documentation; Randomized; Research; Research Personnel; Structure; Testing; Time; Training; United States National Institutes of Health; Walking; Work; base; biomechanical test; cardiovascular fitness; career; chronic stroke; cohort; disability; exercise intensity; feeding; gait rehabilitation; improved; innovation; kinematics; motor learning; neurotrophic factor; novel; novel strategies; patient population; post stroke; primary outcome; standard of care; stroke survivor; walking speed

Information from PI-Prime Award PROJECT SUMMARY The goal of this project is to determine the feasibility and optimal parameters of a novel, comprehensive approach to gait training in individuals with chronic stroke. Current post-stroke gait training interventions follow into two distinct approaches that target different domains of gait dysfunction (as defined by the International Classification of Functioning, Health, and Disability). Biofeedback-based training is typically employed to treat walking pattern impairments (e.g., kinematic deviations relative to able-bodied controls). Whereas, aerobic exercise intensity-based training is the current gold-standard to treat walking activity limitations (e.g., slow walking speeds). Here, we propose to test the impact of combining these approaches into a single intervention to work toward the development of a more effective, comprehensive, carefully crafted approach to gait rehabilitation or persons post-stroke. The central hypothesis is that individuals with chronic stroke have the capacity to use biofeedback to reduce kinematic gait deviations while walking at a range of recommended aerobic intensity levels. Aim 1 will identify the gait biofeedback variable that elicits the largest reduction in interlimb asymmetry in persons post-stroke. Aim 2 will determine the capacity for persons post-stroke to reduce their interlimb asymmetry while walking at three different levels of aerobic intensity. Participants with chronic stroke in Aims 1 will each complete in three experimental sessions and participants in Aim 2 will complete 1 experimental session. Biomechanical analyses and physiologic assessments will be used across both aims to test our working hypotheses. We expect to show that biofeedback of paretic propulsion leads to the greatest reduction in interlimb asymmetry post-stroke and that participants have the capacity to make biofeedback-driven interlimb asymmetry reductions in all three aerobic intensities, but the magnitude of reduction will be the largest at a moderate aerobic walking intensity. The proposed work is innovative because it will be the first to test the relative effects of providing biofeedback of different gait variables on whole lower extremity kinematics in persons post-stroke and test a novel combination of two well-established gait training methods (biofeedback- and intensity-based training) for neurologic patient populations. This is a critical next step in moving the post-stroke gait rehabilitation field forward. The results are expected to have a high impact because it will provide foundational evidence to support a subsequent R01 proposal aimed to assess the long- term learning effects and potential mechanisms of action of a combinatory post-stroke gait rehabilitation approach. If successful, this line of work stands to significantly improve the current standard of care in gait rehabilitation post-stroke.

关于PI-Prime Award 项目摘要 该项目的目标是确定一种新颖的、全面的、 慢性中风患者步态训练的方法。目前的中风后步态训练干预措施如下 分为两种不同的方法，针对不同领域的步态功能障碍（定义由国际 功能、健康和残疾分类）。基于生物反馈的训练通常用于治疗 行走模式损伤（例如，相对于健全人控制的运动学偏差）。然而，有氧 基于锻炼强度的训练是目前治疗步行活动限制的黄金标准（例如，慢 步行速度）。在这里，我们建议测试将这些方法组合成单一干预措施的影响 致力于发展一种更有效、全面、精心设计的步态治疗方法， 康复或中风后的人。中心假设是慢性中风患者有 能够使用生物反馈减少运动步态偏差，同时在建议的范围内行走 有氧强度水平。目标1将确定步态生物反馈变量，electively最大的减少， 中风后肢体不对称。目标2将确定中风后患者的能力， 在三种不同的有氧强度下行走时，减少他们的肢体间不对称。参与者 目标1中的慢性卒中将在三个实验阶段中完成，目标2中的参与者将 完成1次实验。生物力学分析和生理评估将用于 都是为了验证我们的工作假设。我们希望表明，麻痹性推进的生物反馈导致 中风后肢体间不对称的最大减少，参与者有能力 生物反馈驱动的肢体间不对称减少在所有三个有氧强度，但幅度 在中等有氧步行强度下，减少量将最大。这项工作具有创新性，因为 这将是第一次测试提供不同步态变量的生物反馈对整个下肢的相对影响。 肢体运动学在中风后的人，并测试两个完善的步态训练的新组合 方法（生物反馈和强度为基础的培训）为神经系统患者群体。这是一个关键的下一个 这是推动中风后步态康复领域向前发展的一步。预计结果将产生很高的影响 因为它将提供基础证据，支持随后的R 01提案，旨在评估长期的 脑卒中后步态康复联合治疗的远期学习效果和潜在作用机制 approach.如果成功的话，这一系列的工作将显著改善目前的步态护理标准。 中风后的康复

项目成果

Younger and Late Middle-Aged Adults Exhibit Different Patterns of Cognitive-Motor Interference During Locomotor Adaptation, With No Disruption of Savings.

• DOI: 10.3389/fnagi.2021.729284
• 发表时间: 2021
• 期刊: Frontiers in aging neuroscience
• 影响因子: 4.8
• 作者: Rossi C;Roemmich RT;Schweighofer N;Bastian AJ;Leech KA
• 通讯作者: Leech KA

Author Response to Macpherson et al.

作者对麦克弗森等人的回应

• DOI: 10.1093/ptj/pzac084
• 发表时间: 2022
• 期刊: Physical therapy
• 影响因子: 3.2
• 作者: Leech,KristanA;Roemmich,RyanT;Gordon,James;Reisman,DarcyS;Cherry-Allen,KendraM
• 通讯作者: Cherry-Allen,KendraM

Gait speed and individual characteristics are related to specific gait metrics in neurotypical adults.

• DOI: 10.1038/s41598-023-35317-y
• 发表时间: 2023-05-18
• 期刊: Scientific reports
• 影响因子: 4.6

Speed-dependent biomechanical changes vary across individual gait metrics post-stroke relative to neurotypical adults.

相对于神经型成年人，速度依赖性的生物力学变化在中风后各个步态指标都有所不同。

• DOI: 10.1186/s12984-023-01139-2
• 发表时间: 2023-01-27
• 期刊: JOURNAL OF NEUROENGINEERING AND REHABILITATION
• 影响因子: 5.1
• 作者: Kettlety, Sarah A. A.;Finley, James M. M.;Reisman, Darcy S. S.;Schweighofer, Nicolas;Leech, Kristan A. A.
• 通讯作者: Leech, Kristan A. A.