LOCOMOTOR THERAPY TRIAL FOR SPINAL CORD INJURY

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 其目的是确定功能磁共振成像(FMRI)是否可以帮助预测以任务为导向的物理治疗是否可能改善与步行相关的结果，以及fMRI是否可以告知临床医生最佳治疗时间和强度。32名患者将接受一种名为体重支持跑步机训练(BWSTT)和地面步行的标准化治疗，这些患者在偏瘫后6-18个月仍以低于社区步行所需的最低速度行走。受试者根据初始步行速度(40厘米/秒与40-75厘米/秒)进行分层，这与步行限制和神经损伤有关。这项研究连续量化了与治疗相关的步行速度、耐力、步态模式以及与运动控制能力提高相关的生理指标的变化。同时，使用标准激活范例对瘫痪腿的被动和自愿踝关节背屈进行连续的功能磁共振研究。FMRI将量化主要和非主要大脑感觉运动区内突触活动的变化，并反映皮质下和脊髓的可塑性，以及参与注意力和学习的区域的活动，因为密集、渐进的康复策略奠定了更好的运动控制。在这种纵向设计中，受试者继续分12个阶段进行训练，直到他们的步行速度达到平台期，并且在每个阶段结束时进行的功能磁共振成像没有发现进一步的重组。我们预计，随着训练时间的推移，踝关节背屈的运动控制能力的提高将反映在行走网络的脊椎上成分中可量化的可塑性变化中。使用统计模型，我们将检查行走相关收益与治疗过程中诱发的功能磁共振成像模式之间的关系。人们非常感兴趣的是，最初的模式或早期训练诱导的脑活动演变是否可以作为一种生理测试来预测备用网络的持续能力，以便通过更多的治疗进行调节。然后，我们将通过训练一组新的12名受试者来测试统计推导的预测模型。这项研究是朝着将功能磁共振成像作为一种工具来开发基于理论和证据的实践，以减少中风后的残疾迈出的一步。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The aim is to determine if functional magnetic resonance imaging (fMRI) can help predict whether task-oriented physical therapy is likely to enhance outcomes related to walking and whether fMRI can inform clinicians about the optimal duration and intensity of treatment. A standardized therapy called body weight-supported treadmill training (BWSTT) and over ground walking will be given to 32 subjects who, at 6-18 months after hemiparetic stroke, still walk at less than the minimal velocity needed for community ambulation. Subjects are stratified by initial walking speed (<40 cm/sec vs 40-75 cm/sec), which relates to walking limitations and neurological impairment. The study serially quantifies therapy-related changes in walking speed, endurance, gait pattern, and physiological measures relevant to gains in motor control. In parallel, serial fMRI studies are performed using a standardized activation paradigm of passive and voluntary ankle dorsiflexion of the paretic leg. fMRI will quantify changes in synaptic activity within primary and nonprimary cerebral sensorimotor regions and reflect subcortical and spinal plasticity, as well as activity in areas engaged for attention and learning, as better motor control is engrained by the intensive, progressive rehabilitation strategy. For this longitudinal design, subjects continue training in blocks of 12 sessions, until their walking speed reaches a plateau and no further reorganization is found by fMRI performed at the end of each block. We anticipate that gains in motor control for ankle dorsiflexion will be reflected over time of training in quantifiable changes in representational plasticity within the supraspinal constituents of the network for walking. Using statistical modeling, we will examine relationships between walking related gains and the fMRI patterns induced over the course of therapy. Of great interest is whether the initial pattern or the early training-induced evolution of cerebral activity can serve as a physiological assay to predict the ongoing capacity of the spared network to be modulated by more therapy. We will then test a statistically derived predictive model by training a new group of 12 subjects. The study is a step toward using fMRI as a tool to develop theory- and evidencebased practices that lessen disabilities after stroke.