权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Corticospinal Efficacy as a Prognostic Indicator for Walking Recovery Post-stroke

皮质脊髓功效作为中风后步行恢复的预后指标

基本信息

批准号：
10665005
负责人：
Carolynn Patten
金额：
--
依托单位：
VA NORTHERN CALIFORNIA HEALTH CARE SYS
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-06-01 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10665005
关键词：
Accounting Acute Address Adult Affect Ankle Articulation Biomechanics Characteristics Chronic Clinical Compensation Corticospinal Tracts Data Development Distal Flexor Functional disorder Gait Gait speed Generations Goals Healthcare Systems Heterogeneity Hip region structure Hospitalization Impairment Individual Intervention Joints Knowledge Leg Limb structure Link Locomotion Locomotor Recovery Lower Extremity Measures Metabolic Motor Motor Evoked Potentials Motor output Movement Muscle Neurologic Outcome Paresis Pattern Persons Physiological Physiological Adaptation Prediction of Response to Therapy Production Quality of life Recovery Rehabilitation therapy Research Residual state Role Spinal Stroke Therapeutic Intervention Training Transcranial magnetic stimulation Treatment outcome United States Vertebral column Veterans Walking Work ankle joint dorsiflexor behavioral outcome design disability efficacious intervention functional disability gait rehabilitation hemiparesis improved innovation insight neurological rehabilitation neurophysiology neuroregulation novel strategies physically handicapped post intervention post stroke predicting response preservation primary outcome prognostic indicator public health relevance recruit rehabilitation strategy remediation responders and non-responders response restoration spinal reflex stroke survivor walking rehabilitation walking speed

项目摘要

DESCRIPTION (provided by applicant): Stroke is the leading cause of serious, chronic disability in adults worldwide. Over 750,000 cases of first- ever stroke occur in the United States each year accounting for over half of all acute neurological hospital admissions. While two-thirds of persons who suffer a stroke regain the ability to walk, the resulting gait pattern is slow, asymmetrical and metabolically inefficient Walking dysfunction represents one of the greatest physical limitations post-stroke and improved walking is among the most frequently articulated goals of neurorehabilitation. To date, rehabilitation for walking dysfunction post-stroke has produced highly variable outcomes revealing minimal genuine change in walking function including walking speed or pattern. Our long-term goal is to improve walking post-stroke. The objective of this proposal is to investigate the neurophysiological mechanisms that underlie the capacity for locomotor recovery post-stroke. Specifically, our aim is to identify neurophysiologic measures differentiating stroke survivors who do or do not to a therapeutic intervention. We postulate that the efficacy of descending motor tracts to the distal leg muscles (plantar and dorsiflexors) is greatly reduced in low functioning stroke survivors, while this efficacy is at least partially preserved in higher functioning individuals. The first aim of this project seeks to differentiate high and low functioning stroke survivors based upon the proportion of distinguishable motor evoked potentials (MEPs) observed in the distal leg muscles during walking. We anticipate lower functioning individuals will have a smaller percentage of distinguishable MEPs compared to higher functioning individuals. In the second aim of this project we will evaluate the relationship between corticomotor function in the distal leg and biomechanical function during walking. Our preliminary data suggest a link between the corticospinal function and force production during walking. Specifically, we expect MEP modulation across the gait cycle correlates with ankle plantarflexor power generation during walking. In the third aim of the proposal we will evaluate whether corticospinal efficacy can predict post-intervention improvements in walking function. Using an efficacious intervention developed in our previous work, we will conduct a study of power training to pilot comparisons of pre-intervention measures of corticospinal efficacy with post-intervention gains in walking function. We anticipate that individuals with higher corticospinal efficacy will show the largest improvements in gait speed and locomotor function post-intervention. The results of this study will fill a gap in current knowledge by providing a prognostic indicator of an individual's capacity to recover walking function post-stroke. Furthermore, insights gained from this study can be used to develop targeted rehabilitation strategies to maximize neurorehabilitation.

描述(由申请人提供)：中风是全世界成年人严重、慢性残疾的主要原因。美国每年发生的首次中风病例超过75万例，占所有急性神经科住院病例的一半以上。虽然三分之二的中风患者恢复了行走能力，但由此产生的步态模式缓慢、不对称和新陈代谢效率低下，步行障碍是中风后最大的身体限制之一，改善步行是神经康复最常见的目标之一。到目前为止，中风后步行功能障碍的康复治疗产生了高度可变的结果，揭示了步行功能(包括步行速度或模式)最小的真实变化。我们的长期目标是改善中风后的步行能力。本研究的目的是探讨卒中后患者运动能力恢复的神经生理机制。具体地说，我们的目标是确定神经生理学指标，以区分接受或不接受治疗干预的中风幸存者。我们推测，在功能低下的卒中幸存者中，运动束下行至腿部远端肌肉(足底和背屈肌)的有效性大大降低，而在功能较高的个体中，这种有效性至少部分保留。该项目的第一个目标是根据行走过程中腿部远端肌肉中可分辨的运动诱发电位(MEP)的比例来区分高功能和低功能中风幸存者。我们预计，与功能较高的人相比，功能较低的人具有较小比例的可区分的MEP。在这个项目的第二个目标中，我们将评估这一关系行走时小腿远端皮质运动功能与生物力学功能之间的关系。我们的初步数据表明，行走过程中皮质脊髓功能和力量产生之间存在联系。具体地说，我们预计步态周期中的MEP调制与步行过程中踝趾屈肌的能量产生相关。在该提案的第三个目标中，我们将评估皮质脊髓疗效是否可以预测干预后行走功能的改善。利用我们先前工作中开发的有效干预方法，我们将进行一项力量训练研究，以试点比较干预前皮质脊髓疗效措施与干预后步行功能改善的比较。我们预计在干预后，皮质脊髓疗效较高的个体在步态速度和运动功能方面的改善最大。这项研究的结果将填补目前知识的空白，为中风后个人恢复行走功能的能力提供一个预测指标。此外，从这项研究中获得的见解可以用于制定有针对性的康复策略，以最大限度地促进神经康复。