NeuroMuscular Electrical Stimulation to facilitate perturbation-based REACtive balance Training for fall-risk reduction post-stroke: The REACTplusNMES Trial

神经肌肉电刺激促进基于扰动的 REACtive 平衡训练，以减少中风后跌倒风险：REACTplusNMES 试验

• 批准号: 10731611
• 负责人: Tanvi Bhatt
• 金额: $ 43.93万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10731611
• 关键词: Adjuvant; Ankle; Balance training; Behavioral; Biomechanics; Chronic; Clinical; Clinical Trials; Communities; Controlled Environment; Data; Detection; Development; Economic Burden; Educational Intervention; Electric Stimulation; Electroencephalography; Equilibrium; Exposure to; Failure; Fall prevention; Functional Magnetic Resonance Imaging; Future; Gait; Gait speed; Impairment; Incidence; Individual; Intervention; Knowledge; Laboratories; Lead; Leg; Length; Life; Limb structure; Lower Extremity; Measures; Muscle; Neuronal Plasticity; Outcome; Paresis; Pattern; Performance; Persons; Pilot Projects; Publishing; Quality of life; Randomized, Controlled Trials; Research; Risk Reduction; Sensory; Side; Surface; Techniques; Testing; Therapeutic; Therapeutic Effect; Therapeutic Intervention; Therapeutic Uses; Training; Translating; Translations; Walking; Work; clinical application; clinical development; clinical practice; clinical translation; design; effective intervention; effectiveness evaluation; exercise training; fall risk; falls; functional electrical stimulation; functional improvement; gait rehabilitation; hemiparetic stroke; high risk; improved; motor impairment; motor learning; neuromuscular; neuromuscular examination; neuromuscular stimulation; neurophysiology; neuroregulation; novel; post stroke; preventive intervention; psychologic; quadriceps muscle; rehabilitation research; response; sensorimotor system; skills; stroke rehabilitation; success; synergism; treadmill; trial design

This study aims to improve fall prevention interventions in moderate to severely impaired people with chronic hemiparetic stroke (PwCHS) by providing synchronous neuromuscular electrical stimulation (NMES) and perturbation-based reactive balance training (REACT). REACT is an emerging intervention consisting of repeated support surface disturbances in a safe and controlled environment to improve reactive responses. Falls pose a significant physical, psychological, and economic burden, with community dwelling PwCHS falling about three-times more than their healthy counterparts. Our previous research shows that PwCHS have biomechanical impairments in reactive balance, including failure of paretic limb to provide adequate limb support during reactive stepping with the preferred non-paretic limb, especially at high intensity perturbations. Current fall prevention interventions, including conventional exercise and balance training, are limited in their ability to enhance reactive balance (protective responses following balance loss) in PwCHS. We also showed that PwCHS had slower adaptation when exposed to large magnitude slips on the paretic side. Further, we demonstrated that PwCHS with higher motor impairment showed less improvement after treadmill stance REACT. Hence, there is an urgent need to establish interventions that focus on enhancing reactive balance on paretic limb in PwCHS (especially highly impaired). NMES is an intervention known to facilitate paretic limb performance and motor learning; however, the use of NMES as a facilitatory agent to enhance reactive balance improvements (stability and limb support during stepping responses) for fall prevention has never been tested. Our published study showed that people given NMES (to paretic quadriceps) during treadmill stance slips had in lower falls than those without NMES. Further, NMES and REACT interventions both translate to improvements in clinical measures of balance (mini-BESTest), mobility (10m walk test), and falls efficacy (Activities specific Balance Confidence, ABC). Thus, this novel study aims to examine therapeutic effects of NMES provided to quadriceps muscle of the paretic limb to improve biomechanical and clinical outcomes in moderate to severely impaired PwCHS during six weeks (12 sessions) of REACT (REACT+NMES). Emerging evidence indicates that REACT and NMES independently can result in changes in cortical potentials and corticospinal excitability with corresponding changes in leg muscle activations. However, these effects have not been examined PwCHS, especially with high impairment. Therefore, we also aim to examine neuromuscular and neuroplastic effects of REACT+NMES, which would further the understanding of long-term improvements in fall-resisting skills and improve clinical translation of REACT+NMES. The findings of this study will provide evidence for feasibility of clinical translation of REACT+NMES as a technique to lower fall-risk in PwCHS. This study will aid the development of effective fall prevention interventions that potentially facilitate reactive balance improvements, reduce training times, and include persons with high impairment.

本研究旨在改善对中度至重度受损慢性阻塞性肺病患者的跌倒预防干预措施。 通过提供同步神经肌肉电刺激（NMES）治疗轻偏瘫中风（PwCHS）， 基于扰动的反应平衡训练（reactive balance training，REACT）。REACT是一种新兴的干预措施， 在安全和受控的环境中反复支撑表面扰动，以改善反应性响应。福尔斯 造成重大的身体，心理和经济负担，社区居住的PwCHS约为 是健康人的三倍我们以前的研究表明，PwCHS具有 反应性平衡中的生物力学损伤，包括麻痹肢体无法提供足够的肢体 在反应性踏步过程中使用首选的非麻痹肢体进行支持，尤其是在高强度扰动时。 目前的跌倒预防干预措施，包括传统的运动和平衡训练，在其治疗方面是有限的。 增强PwCHS反应性平衡（平衡丧失后的保护性反应）的能力。我们还展示 PwCHS在轻瘫侧出现大幅度滑动时适应较慢。我们还 结果表明，运动障碍程度较高的PwCHS在跑步机站立后改善较少 反应过来因此，迫切需要制定干预措施，重点是加强反应平衡， PwCHS中的瘫痪肢体（尤其是高度受损）。NMES是一种已知的促进瘫痪肢体的干预措施 性能和运动学习;然而，使用NMES作为促进剂，以提高反应性 用于防止跌倒的平衡改善（在步进响应期间的稳定性和肢体支撑）已经 从未被测试过。我们发表的研究表明，在跑步机上给予NMES（麻痹的四头肌）的人 与无NMES的受试者相比，站立滑移的福尔斯下降率较低。此外，NMES和REACT干预措施都将 平衡（mini-BESTest）、移动性（10米步行试验）和福尔斯疗效的临床指标改善 （具体活动平衡信心，ABC）。因此，这项新的研究旨在检查 NMES提供给瘫痪肢体的四头肌，以改善生物力学和临床结局， 在6周（12个疗程）的REACT（REACT+NMES）期间，中度至重度受损的PwCHS。新兴 有证据表明，REACT和NMES可以独立地导致皮层电位的变化， 皮质脊髓兴奋性与腿部肌肉激活的相应变化。然而，这些影响并没有 检查PwCHS，尤其是高度损伤。因此，我们还旨在检查神经肌肉 和REACT+NMES的神经可塑性作用，这将进一步了解长期改善 在抗跌倒技能和改进REACT+NMES的临床翻译方面。这项研究的结果将提供 REACT+NMES临床转化为降低PwCHS跌倒风险的技术的可行性证据。这 这项研究将有助于制定有效的跌倒预防干预措施，可能促进反应性平衡 改进，减少培训时间，并包括高度残疾的人。