Cortical priming to optimize gait rehabilitation post stroke

项目摘要 实现卒中后功能性截肢仍然是卒中幸存者面临的挑战， 临床医生和研究人员。拟议的研究建立在我们早期的R01上，我们成功地 研究了临床上可实施的步行计划的可行性， 基于速度的强度跑步机训练（HIISTT）结合皮层启动，以改善 中风患者的步行速度。皮层启动已成为一种有前途的佐剂 来提高运动训练的效果。我们的研究团队开创并成功地 开发了下肢运动皮层的神经调节技术， 经颅直流电刺激（tDCS）和踝关节运动技能训练。在这次更新中， 应用程序，我们的目标是量化36个会议的皮层启动加 HIISTT干预与假预充加HIISTT的比较。结果指标将包括 步态变量，平衡，有氧能力，生活质量，神经生理学指标， 经颅磁共振测量下行和半球间皮质运动兴奋性 刺激（TMS）前、后即刻和3个月后血清BDNF的变化 训练人们越来越有兴趣了解对培训的反应， 个性化中风康复。我们的目标是了解训练反应的可变性 使用患者特异性参数，例如参与者人口统计学、神经生理学 措施和遗传变异（例如脑源性神经营养因子）的存在 （BDNF）多态性。通过我们创新的机械方法来提高步行恢复， 我们试图优化中风后的步态康复，并描述神经元之间的关系， 机制、运动功能和遗传变异。改善步态将使中风幸存者 在社区中更加独立，提高他们的生活质量，这是高度相关的 国家卫生研究院的使命。

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.