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.

项目总结/摘要 中风是导致长期残疾的主要原因，是美国个人中风后往往有困难 在麻痹下肢上承重并将重量从一条腿转移到另一条腿。受损体重 转移和肢体负荷导致侧向不稳定，并与行走速度降低有关， 增加跌倒的风险。因此，恢复肢体负荷和重量转移能力是一个重要的目标， 中风后的康复尽管有相当多的康复努力旨在提高瘫痪肢体负荷， 它们在改善神经运动和功能结果方面的有效性仍然有限，可能是由于 了解肢体负荷机制和不愿使用麻痹肢体。多平面协调 在重量接受期间调节负荷力的神经肌肉动作是 功能性肢体负荷由于矢状面膝关节力矩和额面力矩之间的异常耦合， 在中风后，已经确定了平面髋关节扭矩伴随方向特异性髋关节扭矩无力， 这些异常可能会损害体重转移能力。此外，有证据表明， 站立/行走表面的运动引发反应性反应，增加髋外展肌和膝关节 伸肌活动，提示诱导髋关节和膝关节肌肉活动的潜在治疗手段 和肢体负重功能。因此，我们建议采用一种连续的 跑步机横向摆动，以参与髋关节和膝关节肌肉活动，并增强 走路该项目的长期目标是开发一个基于机制的框架， 测试新的康复干预措施的有效性，以提高下肢重量转移和肢体 增加负重以提高平衡性和机动性。该项目旨在（1）确定主要限制因素， 调节中风后肢体负荷，（2）确定跑步机振荡的即时效果 步行（TOW）对体重转移特征的影响;（3）测试6周的短期有效性 TOW干预对改善体重转移特征、步态功能和自我感知健康的影响 结果。行走期间将记录动力学、运动学和下肢肌肉激活模式。 我们认为髋外展肌扭矩调节能力的降低是肢体负荷的主要限制因素 中风后的容量。此外，我们预计与基线相比，中风患者将显示出 增加髋外展肌和膝伸肌肌肉活动和扭矩产生，并增加肢体负荷 在TOW过程中，重量转移率和减少的重量转移时间，反映了TOW可以增强重量转移 通过改善髋关节和膝关节的神经肌肉激活来实现结局。此外，我们预计，在6 在为期两周的TOW训练中，中风患者的肢体负荷增加，体重转移减少， 时间，增加步行速度，提高自我效能，这表明体重转移赤字以下 可以使用这种新颖的重量转移训练方法来治疗中风。