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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要中风后的步态障碍无处不在，导致大多数中风存活中的持续移动定义。对这些障碍的评估指导患者护理和使用临床干预措施，但获得了这些缺陷依据的因素的完整情况仍然是一个持续的挑战。临床医生目前在静止时获得的粗略定性指标在势后评估患者，并结合功能步行的评估和视觉检查。但是，这些工具只能评估外部病人症状是基础的变化，无法洞悉可能导致这些变化的内部变化症状。这些内部特性（包括关节刚度和粘度在整个运动中的变化）是控制人体运动的基本机械描述。关节刚度是关键因素能源存储和向前运动，而关节粘度则描述了聚集期间的抵抗力，但是这些目前，概念在临床决策中尚未提出或忽略。例如，踝关节临床医生认为僵硬和粘度是中风后增加的，令人惊讶地发现与受影响较小的一侧相比，减少或不变。另外，肉毒神经毒素（BONT）注射剂 - 一种通常用于降低关节刚度的药物 - 可能导致这些进一步降低属性，这可能是确定移动性的。这些最初的结果突出了需要进行治疗解释了中风和注射疗法后如何影响关节刚度和粘度。在拟议的工作中，我们超越了传统的描述，即使用踝关节快速位移测量其机械响应。我们使用这些数据来测量关节刚度和粘度在步行。在先前的工作中，我们开创了这种方法，以量化运动过程中的关节刚度和粘度。这个项目，我们将扩展我们的方法，以确定中风和BONT注射治疗如何影响这些特性。在这个项目中，三个目标是通过调查后触摸后改变治疗的基础新的评估技术，用于踝关节刚度和粘度，还量化了抗痉挛治疗的方式（即BONT疗法）影响这些特性。在我们的第一个目标中，我们将结果从R21扩展到评估中风后脚踝的刚度和粘度改变。在第二个目标中，我们量化了肉毒杆菌的影响神经毒素了解这种治疗如何影响踝关节刚度和粘度，步态生物力学和功能结果。我们的初步数据也支持了这个目标，该数据证明了BONT会减少关节刚性。最后，在我们的第三个目标中，我们研究了一个更简单的替代措施，以实现关节刚度，即关节扭矩曲线的斜率可以改善我们方法的临床可行性。同时研究以我们先前的工作为基础，拟议的研究将为内部变化提供清晰的了解该驱动器聚集定义可用于指导治疗，例如注射和矫形器。