Cortical priming to optimize gait rehabilitation post stroke

项目总结 对于中风幸存者来说，实现中风后的功能性行走仍然是一个挑战， 临床医生和研究人员。建议的研究建立在我们早先的R01基础上，在那里我们成功地 研究了一种临床上可实施的步行计划的可行性，该计划涉及高 基于速度的强度跑步机训练(HIISTT)与皮质启动相结合以提高 中风患者的步行速度。皮质引爆已成为一种很有前途的佐剂 以提高运动训练的效果。我们的研究团队开创并取得了成功 开发的用于下肢运动皮质的非侵入性神经调节技术 经颅直流电刺激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次皮质启动加治疗的有效性 HIISTT干预与假启动加HIISTT的比较。成果衡量标准将包括 步态变量，平衡，有氧能力，生活质量，神经生理学测量 经颅磁测量下行和大脑半球间皮质运动兴奋性 刺激(TMS)前、后即刻和术后3个月血清脑源性神经营养因子的变化 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。我们的目标是了解培训反应的可变性。 使用特定于患者的参数，例如参与者的人口统计、神经生理学 脑源性神经营养因子等遗传变异的测量和存在 (BDNF)多态。随着我们创新的机械方法来增强步行恢复， 我们寻求优化中风后步态康复并表征神经之间的关系 机制、运动功能和遗传变异。改善步态将使中风幸存者能够 在社区中更加独立，提高他们的生活质量，这是高度相关的 美国国立卫生研究院的使命。

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.