Elucidating the role of the contralesional corticoreticulospinal tract for lower limb function after stroke.

阐明对侧皮质脊髓束对中风后下肢功能的作用。

• 批准号: 10667897
• 负责人: Sangeetha Madhavan
• 金额: $ 23.99万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667897
• 关键词: Address; Affect; Ankle; Area; Bilateral; Brain; Cerebral hemisphere; Chronic; Corticospinal Tracts; Data; Development; Diffusion Magnetic Resonance Imaging; Dimensions; Fiber; Functional Magnetic Resonance Imaging; Goals; Health Care Costs; Healthcare; Impairment; Individual; Ipsilateral; Knowledge; Lesion; Limb structure; Lower Extremity; Measurement; Measures; Methodology; Modeling; Motor; Motor Pathways; Movement; Neural Pathways; Paresis; Participant; Pathway interactions; Performance; Phase; Physical activity; Quality of life; Recovery; Rehabilitation therapy; Reporting; Research; Role; Severities; Side; Stroke; Testing; Transcranial magnetic stimulation; Walking; Work; blood oxygen level dependent; brain pathway; care burden; chronic stroke; community involvement; disability; gait rehabilitation; imaging study; improved; innovation; insight; motor control; neuroregulation; novel; post stroke; response; reticulospinal tract; societal costs; stroke recovery; stroke rehabilitation; tool; walking rehabilitation; walking speed

Project Summary/Abstract Chronic walking impairments such as decreased walking speed, endurance, and independence are common after stroke and limit physical activity, quality of life, and community involvement. These walking impairments contribute to high healthcare costs and the development of secondary disabilities. Walking impairments tend to persist despite gait rehabilitation, partly because we lack a comprehensive understanding of which brain pathways contribute to lower limb and walking recovery after stroke. Emerging evidence suggests that ipsilaterally-descending motor pathways from the non-lesioned hemisphere to the stroke-affected limb, specifically the corticoreticulospinal tract, may be enhanced. However, the measurement tools used in prior work, when considered in isolation, provide limited insight into whether this pathway is functional enhanced and contributes to improved lower limb function. The primary objective of this proposal is to address this question with the long-term goal of improving gait rehabilitation after stroke by identifying recovery-related motor pathways that can be targeted. Our central hypothesis is that the corticoreticulospinal tract from the non-lesioned brain hemisphere to the more affected limb will be enhanced after stroke. The secondary objective of this proposal is to determine whether the strength of the corticoreticulospinal tract from the non-lesioned brain hemisphere influences lower limb motor control. To achieve the objectives of this proposal, two specific aims will be tested in individuals with chronic stroke with a range of impairment. In Aim 1, we will develop a multi-dimensional estimate of whether the corticoreticulospinal tract is enhanced after stroke by combining three measures used in prior research: functional magnetic resonance imaging (non-lesioned brain activation), diffusion tensor imaging (structural integrity), and transcranial magnetic stimulation (functional excitability). In Aim 2, the association between the strength of the corticoreticulospinal tract from the non-lesioned hemisphere and lower limb motor control will be assessed. This analysis will account for measures of stroke severity (lesion load and lower limb impairment). The proposed work would be the first to use a multifaceted approach to comprehensively and rigorously assess whether brain pathways from the non-lesioned hemisphere to the stroke-affected lower limb are enhanced after stroke. Results from this work will improve our understanding of the brain pathways that contribute to walking recovery after stroke, essential information for improving walking rehabilitation. The proposed work will also provide insight into how stroke impairment influences the mechanisms of recovery and the optimal rehabilitative strategy. Support for the central hypothesis will be a major breakthrough that supports the potential for neuromodulation applied to non-lesioned brain pathways pathways to lead to improvements in walking recovery after stroke. Improvements in walking rehabilitation that result from the proposed work could lead to substantial reductions in chronic walking impairment, disability, and societal cost of stroke.

项目总结/摘要 慢性行走障碍，如行走速度，耐力和独立性下降是常见的 中风后，限制身体活动，生活质量和社区参与。这些行走障碍 造成高昂的医疗费用和继发性残疾。行走障碍往往 尽管步态康复，但仍然存在，部分原因是我们缺乏对哪个大脑的全面了解。 通路有助于中风后下肢和步行恢复。新出现的证据表明 同侧下行运动通路从非损伤半球到中风影响的肢体， 特别是皮质网状脊髓束的功能可能会增强。然而，先前工作中使用的测量工具， 当单独考虑时，对该途径是否功能增强提供有限的见解， 有助于改善下肢功能。这项建议的主要目的是解决这个问题 其长期目标是通过识别与恢复相关的运动路径来改善中风后的步态康复 可以被瞄准。我们的中心假设是，来自非病变大脑的皮质网状脊髓束 中风后，大脑半球对患肢的反应会增强。这项建议的第二个目的是 以确定来自未损伤大脑半球的皮质网状脊髓束的强度是否 影响下肢运动控制。为了实现本建议的目标，将测试两个具体目标 在患有慢性中风并伴有一系列损伤的个体中。在目标1中，我们将开发一个多维 通过结合使用的三种测量方法来估计卒中后皮质网状脊髓束是否增强 在先前的研究中：功能性磁共振成像（非损伤性脑激活），扩散张量成像 （结构完整性）和经颅磁刺激（功能兴奋性）。目标2：协会 来自非损伤半球的皮质网状脊髓束的强度与下肢运动之间的关系 控制将被评估。该分析将考虑卒中严重程度的测量（病变负荷和下肢损伤）。 损伤）。拟议的工作将是第一个采用多层面办法， 严格评估从非损伤半球到中风影响下肢的大脑通路 在中风后会增强这项工作的结果将提高我们对大脑通路的理解， 有助于中风后的步行恢复，这是改善步行康复的重要信息。的 拟议的工作还将提供深入了解中风损害如何影响恢复的机制， 最佳康复策略对中心假设的支持将是一个重大突破， 将神经调节应用于非病变脑通路的潜力， 中风后的步行恢复改善步行康复的结果，从拟议的工作， 导致慢性行走障碍、残疾和中风社会成本显著降低。