Variable Intensive Early Walking post-Stroke (VIEWS)

项目摘要 这项第二阶段临床试验的目标是确定运动训练参数，特别是 踏步练习的特异性和强度影响亚急性患者的长期活动结果 卒中。以前的工作表明，这些变量可以影响培训干预的有效性 没有神经损伤的个体，有一些数据支持他们在慢性中风中的效用。然而， 早期系统地评估这些原则对个体的独立和综合影响的研究 随之而来的是稀疏的。这一关键的研究差距阻碍了临床翻译，而当前的临床 实践仍然遵循传统的康复理论，包括侧重于较低强度的干预 关于潜在的减损。只提供高强度步行训练的其他担忧围绕着 缺乏对运动质量的关注将导致使用补偿性运动策略， 可以通过反复练习来加强，或者心血管事件的其他风险应该排除高- 高强度训练。不幸的是，几乎没有数据支持这些假设，我们的研究表明 这些训练参数的应用可以极大地影响步行功能，并改善基础 损害和改善步态运动学。我们的方法是描述这些培训的效果 运动功能和质量恢复的变量，以及损伤和其他活动能力的变化 中风后早期患者的任务，以努力评估这种训练是否影响神经学 康复或患者是否使用代偿策略。在这个2x2析因RCT设计中，目标1是 研究将表征与操纵特定和强度的运动功能相关的变化 运动干预。我们将评估步态速度和耐力的功能测量，时空 对称性，以及心肺健康的衡量标准。我们假设，结合应用高- 强度、特定任务的步进练习将导致运动测量的显著增加，因为 与强度较低或非特定的训练模式相比。在目标2中，我们将描述以下方面的变化 减损(力量)和其他活动任务(平衡，坐立转移)，以确定是否步态 干预可以减轻卒中后损害的主要损害。量化衡量标准 意志力将是主要的结果。在目标3中，我们将描述社区流动性的变化 和生活质量，后者可以让我们了解成本效益。总体而言，这些结果 对亚急性卒中患者实施有效运动干预的潜在影响。

Project Summary The objective of this Phase II clinical trial is to identify how exercise training parameters, particularly the specificity and intensity of stepping practice, influence long-term mobility outcomes in patients with subacute stroke. Previous work indicates these variables can influence the efficacy of training interventions in individuals without neurological injury, with some data to support their utility in chronic stroke. However, studies that systematically assess the independent and combined effects of these principles in individuals early following stroke are sparse. This critical research gap impedes clinical translation, and current clinical practices remain adherent to traditional theories of rehabilitation, including lower intensity interventions focused on underlying impairments. Additional concerns of providing only high-intensity walking training revolve around the lack of attention toward movement quality will result in use of compensatory movement strategies that could be reinforced with repeated practice, or that other risks of cardiovascular events should preclude high- intensity training. Unfortunately, there is little data to support these hypotheses, and our studies suggest that application of these training parameters can strongly influence walking function, as well as improve underlying impairments and improve gait kinematics. Our approach is to characterize the effects of these training variables on recovery of locomotor function and quality, as well as changes in impairments and other mobility tasks in patients early post-stroke, in an effort to evaluate whether such training influences neurological recovery or whether patients utilize compensatory strategies. In this 2x2 factorial RCT design, Aim 1 of the study will characterize changes in mobility function associated with manipulation of specific and intensity of exercise interventions. We will evaluate functional measures of gait speed and endurance, spatiotemporal symmetry, as well as measures of cardiopulmonary fitness. We postulate that combined application of high- intensity, task specific stepping practice will result in significantly greater increases in locomotor measures as compared to lower intensity or non-specific training paradigms. In Aim 2, we will characterize the changes in impairments (strength) and other mobility tasks (balance, sit-to-stand transfers) to determine whether stepping intervention can mitigate the major impairments underlying post-stroke impairments. Quantitative measures of volitional strength will be the primary outcomes. In Aim 3, we will characterize changes in community mobility and quality of life, the later of which can inform us about cost-effectiveness. Overall, these results have potential implications on the delivery of effective exercise interventions in person with subacute stroke.