Neuromuscular and Biomechanical Control of Weight Transfer during Gait in Individuals Post-stroke

中风后个体步态过程中体重转移的神经肌肉和生物力学控制

• 批准号: 10676974
• 负责人: Hao-Yuan Hsiao
• 金额: $ 20.22万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-04 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10676974
• 关键词: Affect; Age; Biomechanics; Body Weight decreased; Characteristics; Clinical; Control Groups; Coupling; Effectiveness; Equilibrium; Extensor; Force of Gravity; Gait; Gender; Goals; Health; Hip Joint; Hip region structure; Impairment; Individual; Intervention; Intervention Studies; Joints; Kinetics; Knee; Knee joint; Lateral; Leg; Limb structure; Link; Lower Extremity; Mediating; Modeling; Movement; Muscle; Neuromechanics; Outcome; Paresis; Participant; Pattern; Pelvis; Performance; Population; Process; Production; Psychological Transfer; Reaction; Regulation; Rehabilitation therapy; Research; Self Efficacy; Spinal; Stroke; Surface; Testing; Therapeutic; Time; Torque; Training; Training Programs; Vertebral column; Walking; Weight; Weight maintenance regimen; Weight-Bearing state; adduct; cost; design; disability; effectiveness testing; efficacy outcomes; fall risk; functional outcomes; gait rehabilitation; improved; joint mobilization; kinematics; neuromuscular; novel; post stroke; remediation; response; stroke rehabilitation; success; treadmill; vector; walking intervention; walking speed

Project Summary/Abstract Stroke is the leading cause of long-term disability is the U.S. Individuals post-stroke often have difficulty bearing weight on the paretic lower extremity and transferring weight from one leg to the other. Impaired weight transfer and limb loading contribute to lateral instability and are associated with decreased walking speed and increased risk of falling. Consequently, restoring limb loading and weight transfer ability is an important goal for rehabilitation post-stroke. Despite considerable rehabilitation efforts aimed at enhancing paretic limb loading, their effectiveness on improving neuromotor and functional outcomes remains limited possibly due to poorly understood limb loading mechanisms and the reluctance to use the paretic limb. Multi-planar coordination of neuromuscular actions to regulate loading force during weight acceptance is an important component of functional limb loading. Because abnormal coupling between the sagittal plane knee torque and the frontal plane hip torque accompany direction-specific hip torque weakness has been identified following stroke, it is possible that these abnormalities may impair weight transfer ability. In addition, evidence showed that lateral movements of standing/walking surface triggered reactive responses that increased hip abductor and knee extensor muscle activity, suggesting a potential therapeutic means for inducing hip and knee muscle activity and improving weight transfer and limb loading functions. Accordingly, we propose to apply a continuous lateral oscillation of treadmill to engage hip and knee muscle activity and enhance weight transfer during walking. The long term objective of this project is to develop a mechanism-based framework for designing and testing the effectiveness of novel rehabilitation interventions to enhance lower limb weight transfer and limb loading to improve balance and mobility. This project aims to (1) identify the major limiting factors for regulating limb loading following stroke, (2) determine the immediate effect of treadmill oscillation walking (TOW) on weight transfer characteristics and (3) test the short-term effectiveness of a 6-week TOW intervention on improving weight transfer characteristics, gait function, and self-perceived health outcomes. Kinetic, kinematic, and lower extremity muscle activation patterns will be recorded during walking. We expect that the reduced ability to modulate hip abductor torque is the primary limiting factor of limb loading capacity following stroke. In addition, we expect that compared to baseline, participants with stroke will show increased hip abductor and knee extensor muscle activity and torque production, and increased limb loading rate and reduced weight transfer time during TOW, reflecting that TOW could enhance weight transfer outcomes through improved hip and knee neuromuscular activation. Furthermore, we expect that following 6 weeks of TOW training, participants with stroke will show increased limb loading, decreased weight transfer time, increased walking speed, and improved self-efficacy, suggesting that weight transfer deficits following stroke may be remediated using this novel weight transfer training approach.

项目摘要/摘要 中风是长期残疾的主要原因是中风后美国个人经常遇到困难 在偏式下肢上轴承重量，并将重量从一条腿转移到另一只腿。体重受损 转移和肢体负荷有助于横向不稳定，并且步行速度降低和 增加跌倒的风险。因此，恢复肢体加载和体重转移能力是一个重要目标 中风后康复。尽管旨在增强右肢负荷的康复工作，但 它们在改善神经运动和功能结果方面的有效性可能是由于很差 理解的肢体载荷机制和不愿使用右肢的不愿。多平面协调 在体重接受期间调节负载力的神经肌肉动作是 功能肢体加载。因为矢状平面膝盖扭矩与额叶之间的异常耦合 平面髋部扭矩伴随着方向特异性的髋关节扭矩无力，在中风后，它是 这些异常可能会损害体重转移能力。此外，有证据表明横向 站立/行走表面的运动触发反应反应，增加了髋关节和膝盖 伸肌活动，表明诱导髋关节和膝关节活动的潜在治疗手段 并改善重量转移和肢体加载功能。因此，我们建议使用连续的 跑步机的横向振荡以参与臀部和膝盖肌肉活动，并增强体重转移 步行。该项目的长期目标是开发一个基于机制的设计框架，以设计和 测试新型康复干预措施的有效性以增强下肢体重转移和肢体 加载以提高平衡和流动性。该项目的目的是（1）确定主要限制因素 调节中风后的肢体负荷，（2）确定跑步机振荡的直接影响 在体重转移特征上行走（拖车），（3）测试6周的短期有效性 拖曳干预改善体重转移特征，步态功能和自我感知的健康 结果。在步行期间，将记录动力学，运动学和下肢肌肉激活模式。 我们预计调节髋关节外展扭矩的能力降低是肢体负荷的主要限制因素 中风后的容量。此外，我们希望与基线相比，中风的参与者将显示 增加了髋部外展和膝盖伸肌的肌肉活动和扭矩产生，并增加了肢体负荷 拖车期间的速率和减轻体重的转移时间减少，反映出拖车可以增强体重的转移 通过改善髋关节和膝神经肌肉激活的结果。此外，我们希望在6 数周的拖曳训练，中风的参与者将显示肢体负荷增加，体重减轻减轻 时间，提高步行速度并提高自我效能感，表明重量转移缺陷以下 可以使用这种新型的重量转移训练方法来修复中风。