LOCOMOTOR THERAPY TRIAL FOR SPINAL CORD INJURY

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 目的是确定功能性磁共振成像（fMRI）是否可以帮助预测任务导向的物理治疗是否可能增强与行走相关的结果，以及fMRI是否可以告知临床医生治疗的最佳持续时间和强度。将对32名在偏瘫卒中后6-18个月仍以低于社区步行所需的最低速度行走的受试者进行标准化治疗，称为体重支持跑步机训练（BWSTT）和地面行走。受试者按初始步行速度（<40 cm/sec vs 40-75 cm/sec）分层，这与步行限制和神经功能障碍有关。该研究连续量化了行走速度、耐力、步态模式和与运动控制增益相关的生理指标的治疗相关变化。同时，使用标准化的激活范式的被动和自愿踝关节背屈的麻痹腿进行系列功能磁共振成像研究。功能磁共振成像将量化初级和非初级大脑感觉运动区域内突触活动的变化，并反映皮质下和脊髓可塑性，以及参与注意力和学习的区域的活动，因为更好的运动控制是由密集的渐进式康复策略所巩固的。对于这种纵向设计，受试者继续在12个阶段的块中进行训练，直到他们的步行速度达到平台，并且在每个块结束时进行的fMRI没有发现进一步的重组。我们预计，随着训练时间的推移，踝关节背屈运动控制的增益将反映在行走网络的脊髓上成分中代表性可塑性的可量化变化中。使用统计建模，我们将研究步行相关的收益和治疗过程中诱导的功能磁共振成像模式之间的关系。非常感兴趣的是，大脑活动的初始模式或早期训练诱导的演变是否可以作为一种生理测定来预测备用网络的持续能力，以通过更多的治疗来调节。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。这项研究是使用功能磁共振成像作为一种工具，发展理论和证据为基础的做法，减少中风后残疾的一步。

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.