Augmentation of Locomotor Adaptation Post-Stroke

中风后运动适应的增强

• 批准号: 8984307
• 负责人: Mark G. Bowden
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8984307
• 关键词: Acceleration; Address; Ankle; Award; Biological Assay; Biomechanics; Brain; Clinical Trials; Complex; Development; Electric Stimulation; Electrical Stimulation of the Brain; Electrodes; Elements; Enrollment; Foundations; Functional disorder; Goals; Human; Impairment; Individual; Intervention; Investigation; Knowledge; Laboratory Research; Learning; Literature; Locomotion; Locomotor Recovery; Locomotor adaptation; Lower Extremity; Medical center; Mentors; Mentorship; Methods; Modification; Motor; Motor Activity; Motor output; Movement; Muscle; Neurologic; Neuromechanics; Outcome; Paresis; Pattern; Performance; Persons; Physicians; Positioning Attribute; Productivity; Recovery; Recruitment Activity; Rehabilitation Outcome; Rehabilitation therapy; Research; Research Personnel; Resources; Risk; Selection for Treatments; Stroke; Techniques; Training; Translational Research; Upper Extremity; Walking; Work; base; brain tissue; career; career development; chronic stroke; clinical decision-making; cost; experience; hemiparesis; improved; interest; locomotor tasks; meetings; motor control; motor disorder; motor learning; multidisciplinary; neural circuit; novel; post stroke; programs; relating to nervous system; research study; response; skills; stroke hemiparesis; theories; therapy development; tool; treatment program

DESCRIPTION My ultimate goal is to develop therapies based on an understanding of the mechanisms of human movement and how that understanding can be utilized to re-train walking in the most effective manner possible. A fundamental understanding of the specific mechanisms underlying locomotor dysfunction is required for developing individualized rehabilitation programs targeting improved walking performance. Therapists will improve clinical decision-making if detailed knowledge of the relationship between these mechanistic underpinnings and response to rehabilitation allows them to target specific neuromechanical contributors to motor dysfunction. Furthermore, knowledge of how individuals with neurological impairments adapt to training tasks will assist in the optimization of treatment programs, which essentially aim to promote long-term learning. This application reflects the goal of indivually-based, theory-driven interventions by targeting specific biomechanical elements of walking, assaying motor learning, and applying adjunctive non-invasive electrical stimulation to decrease neural activation impairments. The proposed work will continue my training in motor control and learning under my current CDA-1 mentor Dr. Steven Kautz. An exciting new element that will be incorporated into the proposed work is electrical stimulation of the brain as an intervention to potentially improve motor adaptations and motor learning potential. I will attain this new skill under the direction of mentor Dr. Mark George, a world leader in brain stimulation and a physician investigator at the Ralph H. Johnson VA Medical Center. The proposed project seeks to identify effective strategies for training a specific locomotor adaptation, to establish the optimal configuration of electrodes to activate neural circuits involved in post-stroke locomotion, and to improve adaptations via adjunctive non- invasive brain stimulation. Over the next five years, we propose to focus on three specific goals: 1) develop skills associated with applying transcranial direct current stimulation (tDCS) for locomotor recovery post-stroke; 2) progress motor adaptation assessment skills; and 3) perform a foundational research study that prepares investigator for subsequent Merit Award. For Goal 1, we will recruit 40 individuals with chronic stroke (greater than six months post-stroke) in order to determine the optimal configuration of tDCS to elicit immediate lower extremity muscle activation in those with post-stroke hemiparesis. Recent investigations of tDCS in the upper extremity post-stroke indicate that ipsilesional excitation and contralesional inhibition are both effective at increasing motor control, but we hypothesize that a combination of the two placements will produce the largest improvements in lower extremity motor activation and interlimb coordination required for a locomotor task. For Goal 2, we will recruit 40 individuals with chronic stroke to distinguish between two approaches (treadmill incline walking and COM-assisted walking) for retraining the center of mass acceleration (COMa) in those post-stroke presenting with propulsion deficits. For this goal, we hypothesize that treadmill incline walking will demonstrate normalization of the COMa curve, increased paretic propulsion, and improved smoothness of the COMa curve (harmonic ratio) > COM-assisted walking > than walking on a treadmill alone. Lastly, for Goal 3 we will enroll the same 40 individuals from Goal 2 to determine the effect of combining tDCS with COMa training. We hypothesize that training with the optimal electrode configuration (determined in Aim 1) and the optimal method for training COMa (determined from individual assessments in Aim 2) will be superior to training COMa with sham stimulation. Furthermore, we hypothesize that multiple days of training will increase cortical excitability and demonstrate improved modification of the COMa. This work will not only yield important contributions to the literature regarding motor learning specific to locomotion, but also will provide the necessary information to propose a Merit Award at the end of the Career Development period.

描述 我的最终目标是基于对人类运动机制的理解以及如何利用这种理解以最有效的方式重新训练行走来开发治疗方法。制定旨在改善步行表现的个性化康复计划需要对运动功能障碍的具体机制有基本的了解。 如果治疗师详细了解这些机械基础与康复反应之间的关系，使他们能够针对运动功能障碍的特定神经机械因素，他们将改善临床决策。此外，了解神经损伤患者如何适应训练任务将有助于优化治疗方案，其主要目的是促进长期学习。该应用反映了基于个体、理论驱动的干预措施的目标，通过针对步行的特定生物力学要素、分析运动学习以及应用辅助非侵入性电刺激来减少神经激活损伤。拟议的工作将在我当前的 CDA-1 导师 Steven Kautz 博士的指导下继续进行运动控制和学习方面的培训。将纳入拟议工作的一个令人兴奋的新元素是大脑的电刺激，作为潜在改善运动适应和运动学习潜力的干预措施。我将在导师马克·乔治 (Mark George) 博士的指导下获得这项新技能，他是脑刺激领域的世界领先者，也是拉尔夫·H·约翰逊退伍军人医疗中心 (Ralph H. Johnson VA Medical Center) 的医师研究员。该项目旨在确定训练特定运动适应的有效策略，建立电极的最佳配置来激活参与中风后运动的神经回路，并 通过辅助性非侵入性脑刺激提高适应能力。在接下来的五年中，我们建议重点关注三个具体目标：1）发展与应用经颅直流电刺激（tDCS）以促进中风后运动恢复相关的技能； 2）进步运动适应评估技能； 3) 进行基础研究，为研究者获得后续优异奖做好准备。对于目标 1，我们将招募 40 名慢性中风患者（中风后超过六个月），以确定 tDCS 的最佳配置，以引起中风后偏瘫患者立即激活下肢肌肉。最近对中风后上肢 tDCS 的研究表明，同侧兴奋和对侧抑制均可有效增强运动控制，但我们假设这两种放置方式的组合将对下肢运动激活和运动任务所需的肢体间协调产生最大的改善。对于目标 2，我们将招募 40 名慢性中风患者，以区分两种方法（跑步机倾斜步行和 COM 辅助步行），以重新训练中风后出现推进力缺陷的人的质心加速度 (COMa)。为了实现这一目标，我们假设跑步机上斜行走将表现出 COMa 曲线的正常化、增加的麻痹推进力以及 COMa 曲线平滑度的改善（谐波比） > COM 辅助行走 > 与单独在跑步机上行走相比。最后，对于目标 3，我们将招募与目标 2 相同的 40 名人员，以确定将 tDCS 与 COMa 训练相结合的效果。我们假设使用最佳电极配置（在目标 1 中确定）和训练 COMa 的最佳方法（根据目标 2 中的个体评估确定）进行训练将优于使用假刺激训练 COMa。此外，我们假设多天的训练将增加皮质兴奋性并证明 COMa 的修改得到改善。这项工作不仅将对运动特定的运动学习文献做出重要贡献，而且还将提供必要的信息，以便在职业发展期结束时提出优异奖。