Functional implications of stroke and Botulinum Neurotoxin on ankle stiffness and viscosity during gait

中风和肉毒杆菌神经毒素对步态过程中踝关节僵硬和粘度的功能影响

• 批准号: 10633500
• 负责人: CHANDRAMOULI KRISHNAN
• 金额: $ 61.98万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10633500
• 关键词: Address; Affect; Age; Ankle; Bilateral; Biomechanics; Botulinum Toxins; Clinic; Clinical; Data; Equipment; Evaluation; Exhibits; Fostering; Foundations; Functional disorder; Funding; Gait; Goals; Grant; Impairment; Individual; Injection of therapeutic agent; Injections; Intervention; Investigation; Joints; Knowledge; Leg; Locomotion; Manuals; Measurement; Measures; Mechanics; Motion; Movement; Muscle; Nervous System Trauma; Orthotic Devices; Outcome; Patient Care; Patients; Persons; Pharmaceutical Preparations; Phase; Process; Property; Qualifying; Quality of life; Research; Resistance; Rest; Side; Social Interaction; Stroke; Symptoms; System; Techniques; Testing; Time; Torque; Viscosity; Visual; Walking; Work; ankle joint; botulinum neurotoxin injection; botulinum toxin treatment; clinical decision-making; experience; functional outcomes; improved; improved mobility; innovation; insight; joint stiffness; mechanical properties; negative affect; novel; post stroke; response; spasticity; statistics; stem; stroke rehabilitation; stroke survivor; stroke therapy; tool

PROJECT SUMMARY Gait impairments are ubiquitous after stroke, leading to persistent mobility deficits in most stroke survivors. Assessment of these impairments guides patient care and the use of clinical interventions, yet obtaining a complete picture of the factors that underlie these deficits remains an ongoing challenge. Clinicians currently assess patients post-stroke with coarse, qualitative metrics obtained at rest, combined with functional evaluations and visual inspection of walking. However, these tools only enable assessment of the external changes that underlie patient symptoms and cannot provide insight into internal changes that may cause these symptoms. These internal properties—including how joint stiffness and viscosity vary throughout locomotion— are fundamental mechanical descriptions that govern the movement of the body. Joint stiffness is a key factor in energy storage and forward movement, while joint viscosity describes resistance during gait, and yet these concepts are currently unaccounted for or misjudged in clinical decision making. For example, ankle joint stiffness and viscosity, which clinicians believe to be increased post-stroke, were surprisingly found to be reduced or unchanged when compared to the less-affected side. Additionally, Botulinum Neurotoxin (BoNT) injections—a commonly-used medication for lowering joint stiffness—may cause further reduction in these properties, which could be detrimental to mobility. These initial results highlight the need for treatment that accounts for how joint stiffness and viscosity are affected after stroke and injection therapy. In the proposed work, we go beyond traditional descriptions of gait using quick displacements of the ankle while measuring its mechanical response. We use these data to measure how joint stiffness and viscosity vary during walking. In previous work, we pioneered this approach to quantify joint stiffness and viscosity during motion. In this project, we will extend our approach to determine how stroke and BoNT injection treatment affect these properties. In this project, three aims lay the foundation to transform treatment post-stroke by both investigating new assessments techniques for ankle stiffness and viscosity, and also quantifying how anti-spastic treatment (i.e. BoNT therapy) affects these properties. In our first Aim, we extend the results from our R21 to assess how ankle stiffness and viscosity change post-stroke. In our second Aim, we quantify the effect of Botulinum Neurotoxin to understand how this treatment affects ankle stiffness and viscosity, gait biomechanics, and functional outcomes. This aim is also supported by our preliminary data that demonstrates BoNT reduces joint stiffness. Finally, in our third Aim, we investigate a simpler, surrogate measure for joint stiffness, namely the slope of the joint's torque-angle curve, which could improve the clinical feasibility of our approach. While this research builds upon our previous work, the proposed studies will provide a clear picture of the internal changes that drive gait deficits which can be used to guide treatment, such as injections and orthoses.

项目摘要 中风后步态障碍普遍存在，导致大多数中风幸存者持续的活动能力不足。 对这些损伤的评估指导了患者护理和临床干预的使用， 全面了解造成这些赤字的各种因素仍然是一项持续的挑战。临床医生目前 使用静息时获得的粗略定性指标评估卒中后患者， 步行的评估和目视检查。然而，这些工具只能评估外部 患者症状的基础变化，无法提供对可能导致这些变化的内部变化的洞察力 症状这些内部特性--包括关节的硬度和粘性在整个运动过程中的变化-- 是支配身体运动的基本力学描述。关节刚度是一个关键因素， 能量储存和向前运动，而关节粘性描述步态期间的阻力，然而这些 目前在临床决策中概念是未考虑的或错误判断的。例如，踝关节 临床医生认为中风后增加的硬度和粘度，令人惊讶地发现， 与受影响较少的一侧相比，减少或不变。肉毒杆菌神经毒素（BoNT） 注射-一种常用的降低关节僵硬的药物-可能会导致这些进一步减少 这可能对流动性不利。这些初步结果强调了治疗的必要性， 解释了中风和注射治疗后关节僵硬和粘性的影响。 在拟议的工作中，我们超越了传统的描述步态使用快速位移的脚踝， 测量其机械响应。我们使用这些数据来测量关节刚度和粘度如何变化， 走路在以前的工作中，我们开创了这种方法来量化运动过程中的关节刚度和粘度。在 在这个项目中，我们将扩展我们的方法来确定中风和BoNT注射治疗如何影响这些 特性.本项目的三个目标是通过调查和研究为脑卒中后治疗的变革奠定基础 踝关节僵硬度和粘性的新评估技术，以及量化抗痉挛治疗 (i.e. BoNT疗法）影响这些特性。在我们的第一个目标中，我们扩展了R21的结果，以评估如何 中风后踝关节僵硬和粘度变化。在我们的第二个目标中，我们量化了肉毒杆菌的作用， 神经毒素，以了解这种治疗如何影响踝关节僵硬度和粘度，步态生物力学， 功能性成果。这一目标也得到了我们初步数据的支持，这些数据表明BoNT减少了关节炎的发生。 刚度最后，在我们的第三个目标中，我们研究了一种更简单的关节刚度替代测量方法，即 关节扭矩-角度曲线的斜率，这可以提高我们方法的临床可行性。虽然这 研究建立在我们以前的工作基础上，拟议的研究将提供一个内部变化的清晰画面 导致步态缺陷的基因，可以用来指导治疗，比如注射和矫形。