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.

项目总结 步态障碍在卒中后随处可见，导致大多数卒中幸存者持续的活动障碍。 对这些损害的评估指导患者护理和临床干预的使用，但获得 全面了解这些赤字背后的因素仍然是一项持续的挑战。目前的临床医生 使用在静息状态下获得的粗略、定性的指标，结合功能性指标评估中风后患者 行走的评估和目视检查。但是，这些工具仅支持对外部 作为患者症状基础的变化，并且无法洞察可能导致这些变化的内部变化 症状。这些内部特性--包括关节的硬度和粘度在整个运动过程中如何变化-- 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，而关节粘度描述了步态中的阻力，但这些 目前，在临床决策中，概念是无法解释或被错误判断的。例如，踝关节 临床医生认为中风后僵硬和粘滞会增加，但令人惊讶的是 与受影响较小的一侧相比减少或保持不变。此外，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--可能会进一步降低这些 财产，这可能会对行动不便。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度是如何受到影响的。 在这项拟议的工作中，我们超越了传统的步态描述，使用了脚踝的快速移位 测量它的机械响应。我们使用这些数据来测量关节硬度和粘度在 走路。在以前的工作中，我们率先采用这种方法来量化运动过程中的关节刚度和粘度。在……里面 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 属性。在本项目中，三个目标通过两项调查为卒中后治疗的转型奠定了基础 脚踝僵硬和黏度的新评估技术，以及如何量化抗痉挛治疗 (即BONT疗法)会影响这些特性。在我们的第一个目标中，我们扩展R21的结果以评估如何 中风后踝关节僵硬和黏度的变化。在我们的第二个目标中，我们量化肉毒杆菌的效果 神经毒素，以了解这种治疗如何影响脚踝僵硬和粘度，步态生物力学，以及 功能结果。这一目标也得到了我们的初步数据的支持，这些数据表明BONT可以减少关节 僵硬。最后，在我们的第三个目标中，我们研究了关节刚度的一个更简单的替代度量，即 关节扭矩-角度曲线的斜率，这可以提高我们的手术入路的临床可行性。虽然这件事 研究建立在我们以前工作的基础上，拟议的研究将提供内部变化的清晰图景 这会导致步态缺陷，可以用来指导治疗，如注射和矫形器。