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

项目摘要 促进卒中患者运动功能的恢复是一个重要的医学和经济目标。尽管意义重大 尽管在以活动和技术为基础的干预措施方面取得了进展，但该领域仍未能实现同样水平的复苏 在所有患者中。这一失败可能是由于在患者获得 明显的意志力运动，这可能是中风后的几周。在此过程中可能会发生不适应的可塑性 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 在步行训练中提供帮助，并允许在中风后早期进行大剂量训练 这项建议的基本假设是，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 循序渐进，持续时间长(10周30小时)，急诊室按需辅助步行训练(ERASSIST)与 卒中急性期应用标准护理(SOC)对功能恢复和 神经肌肉活动。参与者将被随机分配到每组，调查人员将检查 不同干预方式对慢性阻塞性肺疾病患者功能恢复及神经肌肉活动调节的影响 走路。他们假设，早期使用急诊室辅助进行强化步行训练可以导致 剂量显著增加，行走功能和神经肌肉活动在 走路。在目标2中，研究人员将获得结构和静息状态功能磁共振的纵向测量 4个时间点的连接性：卒中后1个月内，ERASSIST或SOC干预前后10周， 卒中后6个月。数据将被用来模拟复苏的预后，并比较ERASSIST的效果 以及SOC干预改善康复预后。在目标3中，调查人员提议研究 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TRANSCORIAL评估 磁刺激记录患侧初级运动皮质兴奋性和募集曲线斜率。动态 将使用移动成像(EEG)和无线肌电技术来探索CMC，以测量皮质肌肉 行走时的连贯性。比较中风和健康对照的CMC数据的目的是了解 CMC的重组是对中风的适应，或者是对健康的连接模式的重新正常化。 研究人员认为，功能恢复率较高的参与者将显示CMC重新正常化 与年龄和性别匹配的健康对照组更相似。这项研究将对 确定个别干预措施的最佳组合和“剂量”，以改善并可能加速 通过检查可塑性、适应性和对损伤的反应的基础，来研究损伤后的恢复。 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.”