Improve dynamic lateral balance of humans with SCI

改善 SCI 人体的动态横向平衡

• 批准号: 9029966
• 负责人: Ming Wu
• 金额: $ 37.65万
• 依托单位: REHABILITATION INSTITUTE OF CHICAGO D/B/A SHIRLEY RYAN ABILITYLAB
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-10 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9029966
• 关键词: Activities of Daily Living; Affect; Balance training; Clinical; Communities; Depressed mood; Elderly; Equilibrium; Exposure to; Gait; Goals; Human; Incidence; Individual; Knowledge; Lateral; Lead; Length; Locomotion; Lower Extremity; Medial; Motor; Muscle; Muscle Contraction; Neural Pathways; Neuronal Plasticity; Pathway interactions; Patients; Pattern; Pelvis; Placebos; Play; Population; Quality of life; Rehabilitation therapy; Research; Role; Signal Transduction; Spinal; Spinal Cord; Spinal Cord Lesions; Spinal cord injury; Spinal cord injury patients; Synapses; Testing; Time; Training; Walking; Width; base; equilibration disorder; experience; falls; functional gain; hamstring; improved; innovation; kinematics; neural circuit; patient population; post stroke; public health relevance; relating to nervous system; response; treadmill; treadmill training

 DESCRIPTION (provided by applicant): A major goal of patients with spinal cord injury (SCI) is to regain walking ability, as limitations in mobility can affect most activities of daily living In addition, patients with SCI may experience a higher incidence of falls due to impaired balance and gait. Further, the consequence of falls in patients with SCI is much greater than that for healthy older adults. Dynamic balance control plays a crucial role during locomotion in human SCI. Thus, improved dynamic balance may facilitate locomotion in this population. Current balance training paradigms can be effective in improving balance during standing, but are less effective in improving dynamic balance during locomotion in humans with SCI. Thus, there is a need to develop new paradigms for improving dynamic balance and locomotor function in patients with SCI. The goal of this proposed research is to explore motor adaptation to a mediolateral force applied at the pelvis during walking in humans with SCI and test whether pelvis perturbation training paired with transcutaneous spinal direct current stimulation (tsDCS) will be effective in improving dynamic balance and locomotor function in humans with SCI. We postulate that providing a perturbation force to the pelvis during treadmill training will increase the activation of muscles used for maintaining lateral balance while walking. Further, repeated activation of particular sensorimotor pathways (through repeated exposure to a pelvic perturbation force) may reinforce circuits and synapses used for lateral balance control through a use-dependent neural-plasticity mechanism. However, the excitability of spinal cord neural circuitries may be depressed due to the reduced descending drive signals from the upper level control center after SCI, which may reduce the efficacy of neural plastic changes achieved following rehabilitation. The excitability of neural pathways is crucial for neural reorganization achieved following rehabilitation. Recently studies indicate that tsDCS may modulate the excitability of neural circuitries of the spinal cord in patients with SCI. Thus, we postulate that controlled pelvis perturbation training paired with tsDCS will be more effective than that paired with a sham in improving dynamic balance and locomotor function in humans with SCI. Results obtained from this study will lead to an innovative clinical therapy aimed at improving balance and walking function in humans with SCI. Improvements in balance and walking function may allow for increased participation in community-based ambulation and activities, and significantly improve quality of life in humans with SCI. The improvements of scientific knowledge obtained from this study may be extended to other SCI patients with lower walking function, or other patient populations, such as individuals post-stroke.

 描述（由申请人提供）：脊髓损伤（SCI）患者的主要目标是恢复行走能力，因为活动受限会影响大多数日常生活活动。此外，SCI患者可能因平衡和步态受损而发生更高的福尔斯发生率。此外，SCI患者的福尔斯跌倒的后果比健康的老年人大得多。动态平衡控制在人体SCI运动过程中起着至关重要的作用。因此，改善的动态平衡可以促进该群体的运动。目前的平衡训练范例可以有效地改善站立期间的平衡，但在改善SCI患者运动期间的动态平衡方面效果较差。因此，需要开发新的范例来改善SCI患者的动态平衡和运动功能。这项研究的目的是探索运动适应的一个mediolateral力施加在骨盆行走在人类SCI和测试是否骨盆扰动训练配对经皮脊髓直流电刺激（tsDCS）将有效地改善动态平衡和运动功能的人SCI。我们假设，在跑步机训练期间， 行走时用来保持横向平衡的肌肉的活动。此外，特定感觉运动通路的重复激活（通过反复暴露于骨盆扰动力）可以通过使用依赖性神经可塑性机制来加强用于侧向平衡控制的回路和突触。然而，脊髓损伤后，由于上层控制中枢下行驱动信号减少，脊髓神经回路的兴奋性可能会受到抑制，这可能会降低康复后神经可塑性变化的效果。神经通路的兴奋性是康复后实现神经重组的关键。最近的研究表明，tsDCS可能调节SCI患者脊髓神经回路的兴奋性。因此，我们假设， 在改善SCI患者的动态平衡和运动功能方面，与tsDCS配对的受控骨盆扰动训练将比与假手术配对的训练更有效。从这项研究中获得的结果将导致一种创新的临床治疗，旨在改善SCI患者的平衡和行走功能。平衡和行走功能的改善可能会增加对社区活动的参与，并显着改善SCI患者的生活质量。从这项研究中获得的科学知识的改善可能会扩展到其他行走功能较低的SCI患者，或其他患者人群，如中风后的个人。