Development of sensory augmentation methods to improve post-stroke gait stability

开发感觉增强方法以改善中风后步态稳定性

• 批准号: 10189739
• 负责人: JESSE C. DEAN
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10189739
• 关键词: Address; Adherence; Adverse event; American; Amputation; Balance training; Behavior; Body Image; Clinic; Clinical Trials; Communities; Cues; Cutaneous; Development; Device Designs; Devices; Equilibrium; Exposure to; Fall prevention; Feedback; Foundations; Future; Gait; Goals; Healthcare Systems; Hip region structure; Human; Incidence; Individual; Intervention; Knowledge; Laboratory Research; Location; Locomotor training; Lower Extremity; Mechanics; Methods; Motion Perception; Movement; Participant; Patients; Pattern; Pelvis; Perception; Physiological; Population; Positioning Attribute; Proprioception; Quality of life; Rehabilitation device; Rehabilitation therapy; Research; Sensory; Shapes; Stimulus; Stroke; Techniques; Testing; Therapeutic Intervention; Time; Traumatic Brain Injury; Variant; Veterans; Walking; Width; Work; base; body sense; care costs; chronic stroke; collaborative environment; experience; experimental study; fall risk; falls; fear of falling; foot; gait rehabilitation; improved; individual patient; individual response; innovation; insight; interest; motor learning; novel; novel strategies; patient response; portability; post stroke; prevent; rehabilitation paradigm; research clinical testing; response; safety and feasibility; sensory feedback; stroke intervention; stroke recovery; stroke survivor; success; therapy design; vibration

Following a stroke, deficits in independent mobility are a primary contributor to decreased quality of life. Many stroke survivors, including the approximately 15,000 American veterans who experience a stroke each year, are prevented from returning to their prior levels of activity participation or involvement in the community. A major cause of mobility deficits is gait instability, which can result in an increased risk of falls or an increased fear of falling, either of which can limit independent function. While several common rehabilitation methods (e.g. locomotor training, strengthening, balance training) can improve some aspects of function, they have failed to address gait instability, as evidenced by a lack of improvement in fall incidence. In part, this lack of success is likely due to current interventions not being targeted toward the specific mechanisms causing post- stroke gait instability. A long-term goal of this research is to develop mechanism-based interventions that can improve post-stroke gait stability and be implemented in the clinic or community. As a step toward this goal, this project focuses on one promising potential mechanistic cause of post-stroke gait instability. Specifically, post-stroke deficits in the mechanically-appropriate step-by-step adjustments of step width will be targeted. The central hypothesis of this work is that augmented sensory feedback will increase the mechanics-dependent modulation of step width, an important gait stabilization strategy that is often disrupted in chronic stroke survivors. Promisingly, non-invasive sensory stimulation has been shown to shape an individual’s perception of the motion of their pelvis during walking, thus influencing their step-by-step control. The objective of this proposal is to develop and test a method of providing real-time augmentation of hip proprioceptive feedback through vibratory stimuli delivered using tactors during post-stroke walking. This will be accomplished through three Specific Aims. The first Specific Aim is to identify the physiological mechanism underlying the beneficial effects of sensory augmentation on step-by-step gait stabilization. Beyond being of scientific interest, the results will provide insight into the mechanism that should be targeted for the future development of a portable device to be used in the clinic or community. The second Specific Aim is to determine whether personalizing sensory augmentation methods to individual participants produces greater beneficial effects on post-stroke gait stability, which will allow us to account for potential variation in patient responsiveness to sensory stimulation. Finally, the third Specific Aim is to establish the safety, feasibility, and efficacy of a rehabilitation intervention centered on repeated exposure to sensory augmentation during gait. The results will provide justification for a future larger-scale clinical trial. Overall, the results of the proposed work will form the foundation for the development of a novel rehabilitation device that can assist gait balance outside of a research laboratory setting. The proposed project is based on the combined theoretical frameworks of human gait mechanics and motor learning, and will quantify the potential of a mechanism-based intervention using novel sensory stimulation to restore the typical gait stabilization strategy in stroke survivors. The resultant knowledge has the potential to make an important contribution to the development of a larger-scale rehabilitation paradigm in which therapeutic interventions are targeted to a patient’s specific limitations.

中风后，独立移动性中的定义是改善生活质量的主要因素。许多 中风冲浪者，包括每年经历中风的约15,000名美国退伍军人 阻止他们返回其先前的活动参与水平或参与社区。一个 机动性定义的主要原因是敏捷的不稳定性，这可能导致跌倒的风险增加或增加 害怕跌倒，这两种都会限制独立功能。而几种常见的康复方法 （例如，运动训练，加强，平衡训练）可以改善功能的某些方面，它们具有 无法解决侵略不稳定，这证明了秋季事件的改善。在某种程度上缺乏 成功很可能是由于目前的干预措施未针对导致造成后的特定机制 中风的病情。 这项研究的一个长期目标是开发基于机制的干预措施，以改善势后 步态稳定性并在诊所或社区中实施。作为朝着这个目标迈出的一步，该项目专注于 一个人承诺潜在的机械原因导致后冲刺后的不稳定性。具体而言，击球后定义 机械适合步长的逐步调整将是针对的。中心假设 工作是增强的感觉反馈将增加机制依赖性步骤宽度的调制，这是一个 重要的步态稳定策略通常在慢性中风存活中被破坏。有希望的，无创的 已显示感官刺激可以塑造个人对骨盆运动在 步行，从而影响他们的分步控制。该提议的目的是开发和测试 通过传递的振动刺激提供实时增强髋关节本体感受反馈的方法 在击球后步行期间使用触电者。这将通过三个具体目标来实现。 第一个具体目的是确定感觉的有益作用的物理机制 逐步步态稳定的增强。除了具有科学利益之外，结果将提供 深入了解应将其用于使用的便携式设备开发的机制 在诊所或社区。第二个具体目的是确定个性化感官是否个性化 对单个参与者的增强方法对势后增强稳定性产生更大的有益影响， 这将使我们能够说明患者对感觉刺激的反应能力的潜在变化。最后， 第三个具体目的是建立以康复干预为中心的安全性，可行性和效率 步态过程中反复暴露于感觉增强时。结果将为未来提供理由 大型临床试验。总体而言，拟议工作的结果将构成发展的基础 一种新型的康复装置，可以在研究实验室环境之外达到平衡。 拟议的项目基于人步态力学和运动的合理理论框架 学习，并将使用新的感觉刺激量化基于机制的干预的潜力 恢复中风存活中典型的步态稳定策略。由此产生的知识有可能 为发展大规模康复范式的发展做出重要贡献 治疗干预措施针对患者的特定局限性。