Movement Amplification Training to Enhance Walking Balance Post-Stroke

项目摘要 慢性中风（PwCS）患者存在严重的步行平衡功能障碍，限制了独立性， 参加步行活动。迫切需要开发有效的方法来增强步行能力 在PwCS中的平衡。放大自发运动的干预措施可能会加速运动学习， 增强个人对运动错误的感知。这种方法可以潜在地应用于帮助PwCS 改善行走平衡。为此，我们开发了一种电缆驱动的机器人， 在跑步机行走期间的放大环境（MAE）。MAE挑战步行平衡， 施加到骨盆的横向力，其大小与实时横向质心（COM）速度成比例。 在这里，我们建议评估步态训练的影响，在一个MAE步行平衡PWCS。目标1将量化 PwCS在MAE中维持行走平衡并评估MAE影响的运动适应 力量是步态训练的关键变量。此外，我们亦会研究工务局在控制 MAE后即刻行走期间的横向COM偏移（可量化的行走平衡测量） 训练目标2将评估5周高血压后步行平衡和每日步行的长期变化， 在MAE中进行的强度步态训练干预。对于目标1，我们将进行一次单次横断面调查， 研究，其中20名PwCS将各自参与两个实验，评估步态生物力学（全身 质心动力学和步进模式）。自发 将检查在MAE中行走期间的适应和MAE强度（低、中和高）的影响。 我们将立即测量PwCS在行走过程中控制其横向COM偏移的能力的变化 在走在MAE之前和之后。结果将评估短期步行平衡是否立即增强 暴露于MAE后。对于目标2，我们将采用前后研究设计，其中10名PwCS将参与 10-在MAE中进行的高强度步态训练。我们将评估术前到术后的步行变化 使用临床步态和平衡测量、生物力学评估以及日常步行参与的平衡 （步数/天）。结果将评估MAE步态训练后是否增强了长期步行平衡。我们 创新的训练模式，放大个人自己的自我产生的运动，是一个根本的背离， 目前的做法，并可以大大提高步行平衡PwCS。这项研究将提供有价值的 关于PwCS在MAE中维持行走平衡所采用的机制的见解，如果有益， 行为在MAE训练后持续存在。成功的结果将激励随机对照试验， 评估MAE训练对PwCS步行平衡的有效性。我们提案的广泛目标与以下方面密切一致： NINDS/NIMH探索性神经科学研究基金R21项目使命是支持早期 寻求开发新方法以减轻神经系统疾病负担的项目。

Project Summary People with chronic stroke (PwCS) have substantial walking balance dysfunctions that limit independence and participation in walking activities. There is a pressing need to develop effective methods to enhance walking balance in PwCS. Interventions that amplify self-generated movements may accelerate motor learning by enhancing an individual’s perception of movement errors. This method could potentially be applied to help PwCS improve walking balance. To this end, we have developed a cable-driven robot to create a Movement Amplification Environment (MAE) during treadmill walking. The MAE challenges walking balance by applying lateral forces to the pelvis that are proportional in magnitude to real-time lateral center of mass (COM) velocity. Here we propose to evaluate the effects of gait training in a MAE on walking balance in PwCS. Aim 1 will quantify locomotor adaptations that PwCS make to maintain walking balance in a MAE and evaluate the impact of MAE strength, a key gait training variable. We will also examine short-term changes in the ability of PwCS to control their lateral COM excursion during walking (a quantifiable walking balance measure) immediately after MAE training. Aim 2 will evaluate long-term changes in walking balance and daily walking following a 5-week high- intensity gait training intervention performed in a MAE. For Aim 1, we will conduct a single-session cross sectional study wherein twenty PwCS will each participate in two experiments evaluating gait biomechanics (whole body center of mass dynamics and stepping patterns) during and immediately following MAE training. Locomotor adaptations during walking in a MAE and the effect of MAE strength (low, medium, and high) will be examined. We will measure changes in the ability of PwCS to control their lateral COM excursion during walking immediately before and after walking in a MAE. Outcomes will assess if short-term walking balance is enhanced immediately following MAE exposure. For Aim 2, we will employ a pre-post study design wherein ten PwCS will participate in 10-sessions of high intensity gait training performed in a MAE. We will assess pre- to post- changes in walking balance using clinical gait and balance measures, biomechanical assessments, and participation in daily walking (steps/day). Outcomes will assess if long-term walking balance is enhanced following MAE gait training. Our innovative training paradigm, amplifying individuals own self-generated movements, is a radical departure from current practice and could substantially enhance walking balance in PwCS. This study will provide valuable insights about the mechanisms employed by PwCS to maintain their walking balance in a MAE and if beneficial behaviors persist following MAE training. Successful outcomes will motivate a randomized controlled trial to assess efficacy of MAE training on walking balance in PwCS. The broad aim of our proposal aligns closely with the mission of NINDS/NIMH Exploratory Neuroscience Research Grant R21 program to support early-stage projects that seek to develop novel methodology to reduce the burden of neurological disease.