权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Augmentation of Locomotor Adaptation Post-Stroke

中风后运动适应的增强

基本信息

批准号：
9261392
负责人：
Mark G. Bowden
金额：
--
依托单位：
RALPH H JOHNSON VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-04-01 至 2018-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9261392
关键词：
Acceleration Address Ankle Award Biological Assay Biomechanics Brain Clinical Trials Complex Development Electric Stimulation Electrical Stimulation of the Brain Electrodes Elements Enrollment Foundations Functional disorder Goals Human Impairment Individual Intervention Investigation Knowledge Laboratory Research Learning Learning Skill Literature Locomotion Locomotor Recovery Locomotor adaptation Lower Extremity Medical center Mentors Mentorship Methods Modification Motor Motor Activity Motor output Movement Muscle Neurologic Neuromechanics Outcome Paresis Pattern Performance Persons Physicians Positioning Attribute Productivity Recovery Recruitment Activity Rehabilitation Outcome Rehabilitation therapy Research Research Personnel Resources Risk Scientific Inquiry Selection for Treatments Stroke Techniques Training Translational Research Upper Extremity Walking Work base brain tissue career career development chronic stroke clinical decision-making cost experience hemiparesis improved individualized medicine interest locomotor tasks motor control motor disorder motor learning multidisciplinary neural circuit novel post stroke programs relating to nervous system research study response skills stroke hemiparesis theories therapy development tool translational research program treadmill treatment program

项目摘要

DESCRIPTION My ultimate goal is to develop therapies based on an understanding of the mechanisms of human movement and how that understanding can be utilized to re-train walking in the most effective manner possible. A fundamental understanding of the specific mechanisms underlying locomotor dysfunction is required for developing individualized rehabilitation programs targeting improved walking performance. Therapists will improve clinical decision-making if detailed knowledge of the relationship between these mechanistic underpinnings and response to rehabilitation allows them to target specific neuromechanical contributors to motor dysfunction. Furthermore, knowledge of how individuals with neurological impairments adapt to training tasks will assist in the optimization of treatment programs, which essentially aim to promote long-term learning. This application reflects the goal of indivually-based, theory-driven interventions by targeting specific biomechanical elements of walking, assaying motor learning, and applying adjunctive non-invasive electrical stimulation to decrease neural activation impairments. The proposed work will continue my training in motor control and learning under my current CDA-1 mentor Dr. Steven Kautz. An exciting new element that will be incorporated into the proposed work is electrical stimulation of the brain as an intervention to potentially improve motor adaptations and motor learning potential. I will attain this new skill under the direction of mentor Dr. Mark George, a world leader in brain stimulation and a physician investigator at the Ralph H. Johnson VA Medical Center. The proposed project seeks to identify effective strategies for training a specific locomotor adaptation, to establish the optimal configuration of electrodes to activate neural circuits involved in post-stroke locomotion, and to improve adaptations via adjunctive non- invasive brain stimulation. Over the next five years, we propose to focus on three specific goals: 1) develop skills associated with applying transcranial direct current stimulation (tDCS) for locomotor recovery post-stroke; 2) progress motor adaptation assessment skills; and 3) perform a foundational research study that prepares investigator for subsequent Merit Award. For Goal 1, we will recruit 40 individuals with chronic stroke (greater than six months post-stroke) in order to determine the optimal configuration of tDCS to elicit immediate lower extremity muscle activation in those with post-stroke hemiparesis. Recent investigations of tDCS in the upper extremity post-stroke indicate that ipsilesional excitation and contralesional inhibition are both effective at increasing motor control, but we hypothesize that a combination of the two placements will produce the largest improvements in lower extremity motor activation and interlimb coordination required for a locomotor task. For Goal 2, we will recruit 40 individuals with chronic stroke to distinguish between two approaches (treadmill incline walking and COM-assisted walking) for retraining the center of mass acceleration (COMa) in those post-stroke presenting with propulsion deficits. For this goal, we hypothesize that treadmill incline walking will demonstrate normalization of the COMa curve, increased paretic propulsion, and improved smoothness of the COMa curve (harmonic ratio) > COM-assisted walking > than walking on a treadmill alone. Lastly, for Goal 3 we will enroll the same 40 individuals from Goal 2 to determine the effect of combining tDCS with COMa training. We hypothesize that training with the optimal electrode configuration (determined in Aim 1) and the optimal method for training COMa (determined from individual assessments in Aim 2) will be superior to training COMa with sham stimulation. Furthermore, we hypothesize that multiple days of training will increase cortical excitability and demonstrate improved modification of the COMa. This work will not only yield important contributions to the literature regarding motor learning specific to locomotion, but also will provide the necessary information to propose a Merit Award at the end of the Career Development period.

描述我的最终目标是开发基于对人类运动机制的理解的治疗方法，以及如何利用这种理解以最有效的方式重新训练行走。为了开发以改善步行能力为目标的个性化康复计划，需要对运动功能障碍的具体机制有一个基本的了解。如果对这些机械基础和康复反应之间的关系的详细了解使治疗师能够针对导致运动功能障碍的特定神经机械因素，治疗师将改善临床决策。此外，了解神经障碍患者如何适应训练任务将有助于优化治疗方案，其主要目的是促进长期学习。这项应用反映了以个人为基础、理论驱动的干预目标，通过针对步行的特定生物力学元素，分析运动学习，并应用辅助非侵入性电刺激来减少神经激活损伤。这项拟议的工作将在我目前的CDA-1导师Steven Kautz博士的指导下继续我在运动控制和学习方面的培训。一个令人兴奋的新元素将被纳入拟议的工作中，即对大脑进行电刺激，作为一种干预措施，潜在地改善运动适应能力和运动学习潜力。我将在马克·乔治博士的指导下获得这项新技能，他是脑刺激领域的世界领先者，也是拉尔夫·H·约翰逊退伍军人医学中心的内科研究员。拟议的项目旨在确定训练特定运动适应的有效策略，建立激活中风后运动所涉及的神经回路的电极的最佳配置，并通过辅助性非侵入性脑刺激提高适应性。在接下来的五年中，我们建议专注于三个具体目标：1)发展与应用经颅直流电刺激(TDCS)用于中风后运动恢复相关的技能；2)进步运动适应评估技能；以及3)进行基础研究研究，为后续的功勋奖的研究人员做好准备。对于目标1，我们将招募40名慢性中风患者(中风后6个月以上)，以确定tDCs的最佳配置，以诱导中风后偏瘫患者立即激活下肢肌肉。最近对中风后上肢的tDCs的研究表明，自身兴奋和抑制都能有效地增强运动控制，但我们假设，这两种定位的结合将在运动任务所需的下肢运动激活和肢体间协调方面产生最大的改善。对于目标2，我们将招募40名慢性卒中患者来区分两种方法(跑步机倾斜行走和COM辅助行走)，以对那些卒中后出现推进功能缺陷的患者进行重心加速(COM)的再训练。为了达到这个目标，我们假设与单独在跑步机上行走相比，跑步机倾斜行走将显示昏迷曲线正常化，偏瘫推进力增加，昏迷曲线(谐波率)和平坦度提高。最后，对于目标3，我们将招募与目标2相同的40人，以确定将tDC与昏迷训练相结合的效果。我们假设，使用最优电极配置(在目标1中确定)和训练昏迷的最佳方法(由目标2中的个体评估确定)的训练将优于使用假刺激的训练昏迷。此外，我们假设，多天的训练将增加皮质的兴奋性，并证明改善了昏迷的改善。这项工作不仅将对与运动有关的运动学习文献做出重要贡献，而且还将提供必要的信息，以在职业发展期结束时提出优秀奖。