Locomotor Recovery and Compensation Post-stroke

项目摘要 该项目的目标是早期确定患者的神经和运动恢复轨迹。 中风后和患者完成独立运动所使用的生物力学策略。这些 用于完成独立行走的恢复模式和基本运动策略将是 在常规康复战略期间和在应用物理干预措施之后进行评估， 特别是步进任务的高强度训练(HIT)，这已被证明对多个 神经和运动恢复的测量。我们之前的工作表明我们之间的关系 步法练习的强度与训练后的运动恢复(步行增加)之间的关系。 然而，这些发现与研究直接相反，研究表明， 神经恢复(使用特定的运动能力评估、个体分级来衡量 关节或反射活动)，无论提供何种类型的干预。这些差异可能是由于 神经康复与运动康复的定义不同，但也突显了 中风后不同的运动模式，在此期间神经功能可能不会完全恢复 在大多数患者中。相反，必须利用补偿性运动策略来完成运动任务。 本项目将试图描绘神经和运动恢复的变化，以及 用于执行步行任务的基本策略(目标1)。我们随后将评估在 神经功能恢复的特定模式在卒中后晚期的应用 确定这些图案的相对可塑性(目标2)。在一个单独的队列中，我们将应用这种培训 中风后早期，并通过运动能力和神经肌肉策略的变化 卒中后恢复期(目标3)。如果神经恢复确实是可预测和确定的，我们 相信运动恢复和补偿的模式也是确定性的，可以根据 观察到的运动能力和补偿量。我们进一步假设这些模式是 可能具有特定干预措施的延展性，并可更深入地了解长期功能和 卒中后早期患者的神经肌肉预后。

Project Summary The objective of this project is to identify the trajectory of neurological and locomotor recovery in patients early post-stroke and the biomechanical strategies used by patients to accomplish independent locomotion. These patterns of recovery and underlying movement strategies used to accomplish independent ambulation will be assessed during both conventional rehabilitation strategies, and following application of physical interventions, specifically high intensity training (HIT) of stepping tasks, that have been shown to strongly influence multiple measures of neurological and locomotor recovery. Our previous work suggests consistent relationships between the amount of intensity of stepping practice and locomotor recovery (walking gains) following training. However, these findings contrast directly with research that indicates a relative consistent pattern of neurological recovery (measured using specific assessments of movement capability, fractionation of individual joints, or reflex activity), irrespective of the types of interventions provided. These discrepancies may be due to differences in definitions utilized for neurological vs locomotor recovery, but also highlight the potential use of alternative movement patterns post-stroke, during which full restitution of neurological function may not occur in most patients. Rather, compensatory movement strategies must be utilized to accomplish locomotor tasks. The present project will attempt to delineate changes in neurological and locomotor recovery and the underlying strategies used to perform walking tasks (Aim 1). We will subsequently evaluate alterations in specific patterns of neurological and functional recovery in response HIT applied in the later stages post-stroke to ascertain the relative plasticity of these patterns (Aim 2). In a separate cohort, we will apply such training early post-stroke and identify alterations in movement capability and neuromuscular strategies through the recovery phases post-stroke (Aim 3). If neurological recovery is indeed predictable and deterministic, we believe patterns of locomotor recovery and compensation are also deterministic and can be categorized by the amount of movement capability and compensations observed. We further postulate that these patterns are likely malleable with specific interventions and can provide greater insight into long-term functional and neuromuscular outcomes in patients early post-stroke.