LOCOMOTOR THERAPY TRIAL FOR SPINAL CORD INJURY

脊髓损伤的运动治疗试验

• 批准号: 8171112
• 负责人: BRUCE H DOBKIN
• 金额: $ 0.3万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8171112
• 关键词: Ankle; Area; Attention; Biological Assay; Body Weight; Cerebrum; Communities; Computer Retrieval of Information on Scientific Projects Database; Evolution; Functional Magnetic Resonance Imaging; Funding; Gait; Grant; Impairment; Institution; Learning; Leg; Measures; Neurologic; Outcome; Pattern; Physical therapy; Physiological; Research; Research Personnel; Resources; Source; Speed; Spinal; Spinal cord injury; Statistical Models; Stroke; Synapses; Testing; Time; Training; United States National Institutes of Health; Walking; disability; hemiparetic stroke; interest; longitudinal design; motor control; predictive modeling; rehabilitation strategy; theories; tool

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.

该子项目是利用该技术的众多研究子项目之一 资源由 NIH/NCRR 资助的中心拨款提供。子项目和 研究者 (PI) 可能已从 NIH 的另一个来源获得主要资金， 因此可以在其他 CRISP 条目中表示。列出的机构是 对于中心来说，它不一定是研究者的机构。 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增强与步行相关的结果，以及功能磁共振成像 (fMRI) 是否可以告知临床医生最佳治疗持续时间和强度。将为 32 名受试者提供一种称为体重支撑跑步机训练 (BWSTT) 和地面步行的标准化疗法，这些受试者在偏瘫中风后 6-18 个月时仍以低于社区行走所需的最低速度行走。受试者根据初始步行速度（<40 厘米/秒 vs 40-75 厘米/秒）进行分层，这与步行限制和神经损伤有关。该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增益相关的生理测量的变化。同时，使用麻痹腿被动和自愿踝关节背屈的标准化激活范例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，以及涉及注意力和学习的区域的活动，因为更好的运动控制是通过强化、渐进的康复策略而实现的。对于这种纵向设计，受试者继续以 12 个疗程为一组的训练，直到他们的步行速度达到稳定状态，并且在每个训练组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，踝背屈运动控制的进步将反映在步行网络的脊柱上成分的表征可塑性的可量化变化中。使用统计模型，我们将检查步行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。令人非常感兴趣的是，大脑活动的初始模式或早期训练引起的进化是否可以作为一种生理测定来预测幸存的网络受到更多治疗调节的持续能力。然后，我们将通过训练由 12 名受试者组成的新组来测试统计得出的预测模型。这项研究是朝着使用功能磁共振成像作为工具来开发基于理论和证据的实践以减少中风后残疾的方向迈出的一步。