Locomotor Recovery and Compensation Post-stroke

项目摘要 该项目的目标是尽早确定患者神经和运动恢复的轨迹 中风后和患者用于实现独立运动的生物力学策略。这些 恢复模式和基本的运动战略，用于实现独立的american将是 在常规康复策略期间和物理干预应用后进行评估， 特别是高强度训练（HIT）的步进任务，已被证明强烈影响多个 神经和运动恢复的测量。我们之前的研究表明 之间的强度的踏步练习和运动恢复（步行收益）的训练。 然而，这些发现与研究直接形成对比，研究表明， 神经恢复（使用运动能力的特定评估、个体的分级来测量） 关节或反射活动），而不管所提供的干预类型。这些差异可能是由于 用于神经学与运动恢复的定义存在差异，但也突出了 中风后的替代运动模式，在此期间可能不会发生神经功能的完全恢复 在大多数患者中。相反，必须利用补偿运动策略来完成运动任务。 本项目将试图描述神经和运动恢复的变化， 用于执行行走任务的基本策略（目标1）。我们随后将评估 卒中后后期应用HIT后神经和功能恢复的特定模式 以确定这些模式的相对可塑性（目标2）。在一个单独的队列中，我们将应用这种培训 早期中风后，并确定运动能力和神经肌肉策略的变化，通过 中风后恢复阶段（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，可以通过 观察到的运动能力和补偿量。我们进一步假设，这些模式是 可能具有特定干预的延展性，可以更深入地了解长期功能和 卒中后早期患者的神经肌肉结局。

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.