A novel, comprehensive approach to post-stroke gait rehabilitation

一种新颖、综合的中风后步态康复方法

• 批准号: 10375424
• 负责人: Kristan A. Leech
• 金额: $ 16.5万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-15 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10375424
• 关键词: Address; Aerobic; Aerobic Exercise; Applications Grants; Award; Back; Biofeedback; Brain; Classification; Crossover Design; Development; Experimental Designs; Foundations; Functional disorder; Gait; Goals; Gold; Health; Heart Rate; Impairment; Individual; International; Intervention; Lead; Learning; Length; Limb structure; Link; Lower Extremity; Motor; Movement; Neurologic; Neuronal Plasticity; Outcome; Outcome Measure; Paresis; Participant; Pattern; Performance; Persons; Physiological; Prefrontal Cortex; Process; Protocols documentation; Randomized; Research; Research Personnel; Structure; Testing; Time; Training; United States National Institutes of Health; Walking; Work; base; biomechanical test; cardiovascular fitness; career; chronic stroke; cohort; disability; exercise intensity; feeding; gait rehabilitation; improved; innovation; kinematics; motor learning; neurotrophic factor; novel; novel strategies; patient population; post stroke; primary outcome; standard of care; stroke survivor; walking speed

PROJECT SUMMARY The goal of this project is to determine the feasibility and optimal parameters of a novel, comprehensive approach to gait training in individuals with chronic stroke. Current post-stroke gait training follows two distinct approaches that target different domains of gait dysfunction (as defined by the International Classification of Functioning, Health, and Disability). Biofeedback-based gait training is typically employed to treat walking pattern impairments (e.g., kinematic deviations relative to able-bodied controls); whereas, aerobic exercise intensity-based gait training is the current gold-standard to treat walking activity limitations (e.g., slow walking speeds). Here, we propose to test the impact of combining these approaches into a single intervention to work toward the development of a more effective, comprehensive approach to gait rehabilitation for persons post-stroke. The central hypothesis is that individuals with chronic stroke have the capacity to use biofeedback to reduce kinematic gait deviations while walking at a range of recommended aerobic exercise intensity zones. Aim 1 will identify the gait biofeedback variable that elicits the largest reduction in interlimb asymmetry in persons post-stroke. Aim 2 will determine the capacity for persons post-stroke to make biofeedback-driven reductions in their interlimb asymmetry while walking at three different aerobic exercise intensities. Participants with chronic stroke in Aim 1 will each complete three experimental sessions and participants in Aim 2 will complete 1 experimental session. Biomechanical analyses and physiologic assessments will be used across both aims to test our working hypotheses. We expect to show that biofeedback of paretic propulsion leads to the greatest reduction in interlimb asymmetry and that participants have the capacity to make biofeedback-driven interlimb asymmetry reductions while walking at all three aerobic intensities, but the magnitude of reduction will be the largest at a moderate aerobic walking intensity. The proposed work is innovative because it will be the first to test the relative effects of different gait biofeedback variables on whole lower extremity kinematics in persons post-stroke and test a novel combination of two well-established gait training approaches (biofeedback- and intensity-based) for neurologic patient populations. This is a critical next step in moving the post-stroke gait rehabilitation field forward. The results are expected to have a high impact because it will provide foundational evidence to support a subsequent R01 proposal aimed to assess the mechanisms of action and long-term efficacy associated with this novel, comprehensive gait rehabilitation protocol. If successful, this line of work stands to significantly improve the current standard of care in gait rehabilitation post-stroke.

项目总结 该项目的目标是确定一种新的、全面的方法的可行性和最佳参数 目的：对慢性中风患者进行步态训练。目前中风后的步态训练遵循两种截然不同的方法 针对步态功能障碍的不同领域(根据国际功能分类的定义， 健康和残疾)。基于生物反馈的步态训练通常用于治疗步行模式障碍 (例如，相对于健全的对照组的运动学偏差)；而有氧运动强度为基础的步态 训练是目前治疗步行活动限制(例如，缓慢的步行速度)的黄金标准。在这里，我们 建议测试将这些方法合并为单一干预措施的影响，以实现 为中风后患者开发一种更有效、更全面的步态康复方法。这个 中心假设是，慢性中风患者有能力使用生物反馈来减少运动学 在推荐的有氧运动强度范围内行走时的步态偏差。目标1将确定 步态生物反馈变量，可最大限度地减少中风后肢体间的不对称性。目标2 将决定中风后患者在生物反馈驱动下肢体间的减少能力 在三种不同有氧运动强度下行走时的不对称性。AIM 1中的慢性中风参与者 每个人将完成三个实验阶段，目标2的参与者将完成一个实验阶段。 生物力学分析和生理评估将用于这两个目标，以测试我们的工作 假设。我们期望能证明瘫痪推进的生物反馈能最大程度地减少肢体间的距离。 不对称性和参与者有能力进行生物反馈驱动的肢体间不对称性减少 在所有三种有氧强度下行走，但在中等有氧强度下减少的幅度最大 有氧步行强度。这项拟议的工作具有创新性，因为它将是第一个测试相对影响的工作 不同步态生物反馈变量对卒中后患者整体下肢运动学的影响及测试 两种成熟的步态训练方法(生物反馈和强度训练)的新组合 神经科患者群体。这是推进中风后步态康复领域的关键下一步。 往前走。预计这一结果将产生很大影响，因为它将提供基础证据来支持 随后的R01提案旨在评估与以下方面相关的行动机制和长期疗效 这一新颖、全面的步态康复方案。如果成功，这项工作将极大地 提高目前卒中后步态康复的护理标准。