Behavioral and Neurophysiologic Process of Locomotor Learning After Stroke

中风后运动学习的行为和神经生理过程

• 批准号: 10378119
• 负责人: DARCY S. REISMAN
• 金额: $ 48.31万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-22 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10378119
• 关键词: Address; Adult; Aerobic Exercise; Affect; Area; Attention; Awareness; Behavioral; Brain; Categories; Cerebellum; Chronic; Cognition; Cognitive; Cognitive deficits; Complex; Coupling; Cues; Data; Demographic Factors; Exercise; Funding; Goals; Impairment; Individual; Intervention; Learning; Left; Location; Movement; Neurologic; Patients; Pattern; Prefrontal Cortex; Process; Quality of life; Recovery; Rehabilitation therapy; Research; Research Personnel; Resources; Role; Short-Term Memory; Stroke; Techniques; Time; Training; Upper Extremity; Visuospatial; Walking; Work; chronic stroke; clinical practice; cognitive function; design; disability; exercise intensity; improved; motor learning; neurophysiology; novel; post stroke; stroke rehabilitation; stroke survivor; treadmill; verbal; visual feedback; walking rehabilitation

PROJECT SUMMARY / ABSTRACT Despite significant time and money spent on post-stroke rehabilitation, stroke survivors are left with reduced walking capacity and significant disability. Rehabilitation following stroke is required to make gains in walking beyond those achieved through spontaneous recovery during the first several months after stroke and this occurs through relearning movements that have been disrupted due to damage to the brain. Enhancing post- stroke motor learning is therefore critical to improving post-stroke rehabilitation. Most research examining the effects of stroke on locomotor learning has focused on a specific form of implicit locomotor learning (sensorimotor adaptation), which is relatively automatic. Post-stroke rehabilitation, however, is dominated by techniques, such as visual feedback and verbal cues, that are meant to encourage patients’ use of explicit learning (requiring attention, awareness). Considering that the effects of stroke on these two categories of learning (explicit and implicit) are likely quite different, since different brain areas are primarily involved in each type of learning, we must understand the effects of stroke on both types of learning. Moreover, factors such as cognitive deficits likely have differing effects, depending on the type of learning. Cognitive function is thought to be critical for more explicit forms of motor learning (specifically strategy-based learning), unlike implicit learning which is thought to place less demand on cognitive resources. Despite the numerous cognitive deficits present after stroke, the influence of cognitive function on motor learning (both implicit and explicit) after stroke has largely been ignored. Finally, differences in explicit and implicit learning may also influence the effects of exercise priming, (the coupling of a short bout of high intensity exercise with a learning task), that has been suggested as a mechanism to enhance motor learning in rehabilitation. In Aims 1 and 2 of this project, using both behavioral and computational data, we will determine the relationship between cognitive deficits (and other factors, such as stroke location) and locomotor learning in both explicit (strategy-based) and implicit (sensorimotor adaptation) locomotor learning tasks in those with chronic (>6 months) stroke. In Aim 3 we examine the effect of a short bout of high intensity exercise immediately following strategy-based locomotor learning on the retention of the newly learned walking pattern, along with its interaction with cognitive deficits, in those with chronic stroke. The results of this proposal have immediate implications for clinical practice because they will inform clinicians when to use certain techniques (e.g.-visual feedback with explicit cues, exercise priming) in patients with stroke with particular cognitive deficits, allowing for the design of personalized rehabilitation interventions.

项目总结/摘要 尽管在中风后康复上花费了大量的时间和金钱，但中风幸存者的生活质量却降低了。 行走能力和严重残疾。中风后需要康复以获得行走能力 超过中风后最初几个月通过自发恢复所达到的水平， 通过重新学习由于大脑损伤而中断的运动发生。加强后 因此，中风运动学习对于改善中风后康复至关重要。大多数研究 中风对运动学习的影响集中在一种特殊形式的内隐运动学习上 （感觉运动适应），这是相对自动的。然而，中风后康复主要是由 技术，如视觉反馈和口头暗示，旨在鼓励患者使用明确的 学习（需要注意，意识）。考虑到中风对这两种类型的 学习（外显和内隐）可能是完全不同的，因为不同的大脑区域主要涉及每一个 为了区分两种学习类型，我们必须了解中风对两种学习类型的影响。此外，诸如 认知缺陷可能有不同的影响，这取决于学习的类型。认知功能被认为是 与内隐学习不同，对于更明确的运动学习形式（特别是基于策略的学习）至关重要 这被认为对认知资源的需求较少。尽管存在许多认知缺陷 脑卒中后，认知功能对运动学习（内隐和外显）的影响， 基本上被忽略了。最后，外显和内隐学习的差异也可能影响 运动启动（将短时间的高强度运动与学习任务结合起来）， 建议作为一种机制，以加强运动学习康复。在本项目的目标1和2中，使用 行为和计算数据，我们将确定认知缺陷（和 其他因素，如中风的位置）和运动学习的显式（基于策略）和隐式 （感觉运动适应）运动学习任务的慢性（>6个月）中风。在目标3中， 检查在基于策略的运动之后立即进行一小段高强度运动的效果 学习保持新学习的行走模式，沿着其与认知缺陷的相互作用， 在慢性中风患者中。这一建议的结果对临床实践有直接的影响 因为它们将告知临床医生何时使用某些技术（例如，带有明确提示的视觉反馈， 运动启动）在具有特定认知缺陷的中风患者中，允许设计 个性化的康复治疗。