Paired Associative Stimulation to Facilitate Plantarflexor Power Following Stroke

项目摘要/摘要 拟议的尖顶建立在初步工作的基础上，在这些工作中，我们观察到了 提供足底屈肌和行走功能的皮质脊髓束，尤指踝屈肌力。 慢性卒中后偏瘫患者。我们观察到：i)PF之间存在强烈的关联 皮质脊髓疗效，以及ii)皮质脊髓动力和PF功率的调节，特别是在接受治疗后的个体。 卒中。重要的是，临床和人口学因素包括：年龄、卒中慢性病和病变部位，两者都没有 解释或修改这些关联。总而言之，这些发现导致了我们的核心前提，即 提供足屈肌的皮质脊髓束效率的提高将使踝关节PF力量得到增强 并有助于改善中风后患者的行走功能。在这里，我们建议调查使用 配对联合刺激(PAS)通过靶向增强皮质脊髓和足底屈肌的疗效 神经可塑性。我们将探索PAS的三种方法来确定其增强神经的有效性：i)神经 反应，ii)生物力学效应(A2)，以及iii)保留神经和生物力学效应。 目标。拟议的SPIRE侧重于优化考绩制度效力所需的方法学变量： A)皮质脊髓对足屈肌的疗效，以及b)退伍军人的步行功能(量化为A2)。 中风行走功能障碍。通过实现我们的目标，从这个尖顶产生的数据将有助于 开发更有针对性和相关性的假设，以便在未来的研究中进行测试，通过 竞争功绩回顾。然而，在推动一项更大规模的研究之前，我们首先寻求确定显著程度 和PAS影响的大小。除了探索与考绩相关的方法学问题外，产生的数据 将使我们能够确定未来项目的适当范围，包括样本 大小和剂量。我们的目标与尖顶(RX-20-009)的方案指导方针一致， 尤其是当他们与高级调查员有关时。具体地说：一)这项工作以前没有得到资助；二) 这项建议中要解决的问题代表了一个新的研究领域和新的合作 PI，以及III)我们寻求发展我们的方法，确定可行性，并产生初步/探索性数据 为了确定效应大小和计算统计能力，以便将来在人体内进行大规模研究 研究对象。我们将比较PAS在分娩时对踝关节屈膝的影响：在休息时，在 次最大活动量，以及在散步时。

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.