Paired Associative Stimulation to Facilitate Plantarflexor Power Following Stroke

配对联想刺激以促进中风后的跖屈肌力量

• 批准号: 10734031
• 负责人: Carolynn Patten
• 金额: --
• 依托单位: VA NORTHERN CALIFORNIA HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10734031
• 关键词: Accounting; Acute; Address; Admission activity; Adult; Age; Age Years; Ankle; Area; Behavioral; Biomechanics; Caring; Chronic; Clinical; Collaborations; Contralateral; Corticospinal Tracts; Data; Demographic Factors; Development; Dose; Failure; Flexor; Functional disorder; Funding; Future; Gait; Gait speed; Goals; Guidelines; Health; Health Care Costs; Hip region structure; Hospitalization; Human; Individual; Inpatients; Intervention; Kinetics; Knowledge; Lead; Learning; Lesion; Limb structure; Location; Measurable; Mechanics; Medical; Methodology; Methods; Motor; Motor Evoked Potentials; Movement; Neurologic; Neuromechanics; Neuronal Plasticity; Outcome; Paresis; Persons; Productivity; Recovery; Recovery of Function; Rehabilitation therapy; Research; Research Personnel; Rest; Sample Size; Speed; Statistical Computing; Stroke; Testing; Transcranial magnetic stimulation; United States; United States Department of Veterans Affairs; Veterans; Walking; Work; care costs; chronic stroke; cost; disability; expectation; follow-up; human subject; improved; intervention effect; neural; neural correlate; neuroregulation; novel; post stroke; rehabilitation strategy; response; restoration; stroke hemiparesis; stroke recovery; stroke rehabilitation; stroke survivor; walking speed

Project Summary/Abstract The proposed SPiRE builds on preliminary work in which we have observed a relationship between efficacy of the corticospinal tract serving the plantarflexors and walking function, specifically ankle plantarflexor power, in individuals with chronic post-stroke hemiparesis. We have observed robust associations between: i) PF corticospinal efficacy, and ii) modulation of corticospinal drive, and PF power, particularly in individuals post- stroke. Importantly, clinical and demographic factors including: age, stroke chronicity, and lesion location, neither explain, nor modify, these associations. In combination, these findings lead to our central premise, that improved efficacy of the corticospinal tract serving the plantarflexors will enable augmentation of ankle PF power and contribute to improved walking function in individuals post-stroke. Here we propose to investigate use of paired associative stimulation (PAS) to enhance corticospinal efficacy and to the plantarflexors through targeted neuroplasticity. We will explore three approaches to PAS to determine its efficacy for enhancing: i) neural responses, ii) biomechanical effects (A2), and iii) retention of neural and biomechanical effects. Objectives. The proposed SPiRE focused on methodological variables required to optimize efficacy of PAS on: a) corticospinal efficacy to the plantarflexors, and b) walking function (quantified as A2) in Veterans with post- stroke walking dysfunction. By achieving our aims, data generated from this SPiRE will contribute to development of more focused and relevant hypotheses to be tested in future studies supported through competitive Merit Review. However, before motivating a larger study, we first seek to determine the salience and magnitude of effects of PAS. In addition to exploring methodological issues related to PAS, data generated from the proposed SPiRE will enable us to determine the appropriate scope of a future project including sample size and dosing. Our objectives are consistent with the programmatic guidelines of the SPiRE (RX-20-009), particularly as they relate to senior investigators. Specifically: i) this work has not previously been funded; ii) the question to be addressed in this proposal represents a new area of research, and a new collaboration, for the PI, and iii) we seek to develop our methodology, determine feasibility, and generate preliminary/exploratory data for sake of determining effect sizes and computing statistical power for future large scale studies in human subjects. We will compare effects of PAS targeting ankle plantarflexion when delivered: at rest, during submaximal activity, and during walking.

项目摘要/摘要 拟议的尖峰建立在初步工作的基础上，我们观察到的有效性 为plant弹器和步行功能，特别是脚踝反射器功率提供的皮质脊髓道， 慢性冲程后偏瘫患者。我们观察到：i）PF之间的强大关联 皮质脊髓疗效，ii）皮质脊髓驱动和PF功率的调节，尤其是在 中风。重要的是，临床和人口统计学因素，包括：年龄，中风慢性和病变位置，都不 解释这些关联，也不修改。结合起来，这些发现导致了我们的中心前提 为plos骨反射器提供的皮质脊髓道的提高功效将增强踝关节PF功率 并在中风后个人的步行功能提高。在这里，我们建议调查使用 配对的缔合刺激（PAS），以增强皮质脊髓功效和通过靶向 神经可塑性。我们将探索三种对PA的方法，以确定其增强功效：i）神经 反应，ii）生物力学效应（A2）和iii）保留神经和生物力学效应。 目标。拟议的尖峰着重于优化PAS疗效所需的方法学变量： a）在具有后的退伍军人中，对足底反射剂的皮质脊髓疗效，b）步行功能（量化为A2） 行走功能障碍。通过实现我们的目标，从此尖峰产生的数据将有助于 在未来通过支持的研究中开发更集中和相关的假设 竞争优点评论。但是，在激励大型研究之前，我们首先寻求确定显着性 和PA的效果的大小。除了探索与PAS相关的方法论问题外，数据还产生了 提议的尖峰将使我们能够确定未来项目的适当范围，包括样本 尺寸和剂量。我们的目标与Spire的程序指南（RX-20-009）一致， 特别是在与高级调查员有关的时候。具体来说：i）这项工作以前尚未得到资助； ii） 该提案中要解决的问题代表了一个新的研究领域，以及一个新的合作。 pi和iii）我们试图开发我们的方法论，确定可行性并生成初步/探索性数据 为了确定效应大小和计算人类未来大规模研究的统计能力 主题。我们将比较靶向靶向脚踝plotharflexion的效果：在 次最大的活动以及步行期间。