Cortical priming to optimize gait rehabilitation post stroke

皮质启动优化中风后步态康复

基本信息

批准号：
10676222
负责人：
Sangeetha Madhavan
金额：
$ 52.16万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-01-10 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10676222
关键词：
Acute Adjuvant Adult Aerobic Affect Ankle Biomechanics Brain Brain-Derived Neurotrophic Factor Cardiovascular Diseases Clinical Clinical Data Communities Community Participation Custom Data Development Educational Intervention Effectiveness Equilibrium Exercise Exhibits Gait Gait speed Genetic Polymorphism Genetic Variation Genotype Goals Health Home Impairment Individual Interval training Intervention Learning Skill Lesion Long-Term Effects Lower Extremity Measures Methods Mission Motor Motor Cortex Motor Skills Movement Muscle Neuroanatomy Outcome Outcome Measure Output Participant Patients Persons Prediction of Response to Therapy Quality of life Recovery Rehabilitation therapy Reporting Research Research Personnel Risk Serum Speed Stroke Synapses Techniques Therapeutic Time Training Transcranial magnetic stimulation United States United States National Institutes of Health Upper Extremity Variant Walking cost effectiveness demographics design exercise intensity exercise program follow-up functional independence gait rehabilitation gait symmetry improved improved outcome innovation insight interest motor learning motor rehabilitation neural neurological rehabilitation neuromechanism neurophysiology neuroregulation patient response post stroke predicting response responders and non-responders skills skills training sound spatiotemporal stroke rehabilitation stroke survivor success therapy development tool transcranial direct current stimulation treadmill treadmill training walking program walking speed

项目摘要

PROJECT SUMMARY Achieving functional ambulation post stroke continues to be a challenge for stroke survivors, clinicians and researchers. The proposed study builds on our earlier R01 where we successfully examined the feasibility of a clinically implementable walking program which involves high intensity speed-based treadmill training (HIISTT) in combination with cortical priming to improve walking speed of individuals with stroke. Cortical priming has emerged as a promising adjuvant to enhance the outcomes of motor training. Our research team has pioneered and successfully developed neuromodulation techniques for the lower limb motor cortex using non-invasive transcranial direct current stimulation (tDCS) and ankle motor skill training. In this renewal application, our goal is to quantify the effectiveness of 36 sessions of cortical priming plus HIISTT intervention in comparison to sham priming plus HIISTT. Outcome measures will include gait variables, balance, aerobic capacity, quality of life, neurophysiological measures of descending and interhemispheric corticomotor excitability measured with transcranial magnetic stimulation (TMS), and changes in serum BDNF before, immediately after and 3-months post training. There has been a growing interest in understanding responsiveness to training to personalize stroke rehabilitation. We aim to understand variability in responsiveness to training using patient-specific parameters such as participant demographics, neurophysiological measures and the presence of genetic variations such as brain derived neurotrophic factor (BDNF) polymorphism. With our innovative mechanistic approach to enhance walking recovery, we seek to optimize gait rehabilitation post stroke and characterize relationships between neural mechanisms, motor function and genetic variations. Improved gait will enable stroke survivors to be more independent in the community and advance their quality of life, which is highly relevant to the mission of the NIH.

项目摘要中风后实现功能性行动仍然是中风幸存者的挑战，临床医生和研究人员。拟议的研究建立在我们早期的R01上检查了临床实施步行计划的可行性，该计划涉及高基于强度速度的跑步机训练（HIISTT）与皮质启动相结合以改进中风的人的步行速度。皮质启动已成为有前途的佐剂增强运动训练的结果。我们的研究团队率先成功使用非侵入性的下肢运动皮层开发的神经调节技术经颅直流刺激（TDC）和踝运动技能训练。在此续约中应用，我们的目标是量化36次皮质启动会议的有效性与假底漆和HIISTT相比，HIISTT干预措施。结果指标将包括步态变量，平衡，有氧能力，生活质量，神经生理学措施通过经颅磁测量的降和半球皮质运动兴奋性刺激（TMS）和血清BDNF之前，立即和3个月后的变化训练。人们越来越有兴趣理解对培训的反应能力个性化中风康复。我们旨在了解培训响应能力的可变性使用特定于患者的参数，例如参与者人口统计学，神经生理学遗传变异的措施和存在，例如脑衍生的神经营养因子（BDNF）多态性。通过我们创新的机械方法来增强步行恢复，我们试图优化中风后的步态康复并表征神经之间的关系机理，运动功能和遗传变异。步态的改善将使中风幸存者能够在社区中更加独立并提高其生活质量，这是高度相关的执行NIH的任务。