Novel spatial-motor approaches targeting post-stroke spatial neglect and gait deficits

针对中风后空间忽视和步态缺陷的新型空间运动方法

• 批准号: 10606908
• 负责人: Olufisayo O Aloba
• 金额: $ 5.02万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-17 至 2026-03-16
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606908
• 关键词: Address; Affect; Attention; Attentional deficit; Behavior; Biomechanics; Combined Modality Therapy; Data; Detection; Diagnosis; Electric Stimulation; Electric Stimulation Therapy; Electrodes; Evidence based treatment; Failure; Functional disorder; Future; Gait; Goals; Hypokinesia; Impairment; Individual; Knowledge; Left; Length of Stay; Lower Extremity; Measures; Mentors; Motor; Movement; National Research Service Awards; Neurologist; Output; Paresis; Pathologic; Performance; Persons; Physical Rehabilitation; Production; Protocols documentation; Quality of life; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Research Personnel; Research Proposals; Sampling; Scientist; Side; Spatial Behavior; Stimulus; Stroke; Surface; System; Testing; Therapeutic; Therapeutic Effect; Training; Treatment Protocols; Upper Extremity; Walking; Weight-Bearing state; Work; behavior measurement; clinical training; cognitive function; combinatorial; common symptom; design; disability; effective therapy; evidence base; fall risk; gait rehabilitation; improved; inattention; motor learning; neglect; neuroimaging marker; neuromuscular stimulation; novel; physical therapist; post stroke; rehabilitation paradigm; simulation; spatial neglect; stroke rehabilitation; stroke survivor; targeted treatment; treatment response

PROJECT SUMMARY/ABSTRACT Aiming spatial neglect (SN) is a sub-type of SN that is a dysfunction in initiation/execution of motor–intentional behavior. SN components such as directional hypokinesia, turning behavior, weight-bearing asymmetry, and veering with straight-walking path adversely affect walking. However, there is a paucity of treatments targeting gait dysfunction caused by SN. Dr. Barrett (sponsor) is a leading rehabilitation researcher who has characterized Aiming SN and has established prism adaptation therapy (PAT) as an effective treatment to reduce pathological Aiming SN and improve upper extremity function post-stroke. However, while traditional PAT remains effective for targeting the upper extremity, its generalization to walking has only been studied in able-bodied people. In parallel, other studies have shown that electrical stimulation applied to the affected side improves SN deficits in stroke survivors, but the additive effects of electrical stimulation and PAT are largely unknown. Dr. Kesar (co- sponsor) has expertise in post-stroke gait biomechanics and gait rehabilitation treatments incorporating electrical stimulation. Dr. Kesar has shown that adding electrical stimulation during gait training enhances motor learning, augments force production, restores gait deficits, and improves walking function. Importantly, the feasibility and effects of adding electrical stimulation to augment the effects of PAT and gait training in stroke survivors with SN are not well-studied. Thus, this F31 research proposal seeks to generate data supporting novel motor spatial retraining approaches that can enhance the rehabilitation of SN and gait performance in individuals post-stroke. I will evaluate novel combinations of PAT, electrical stimulation, and gait training, which are effective rehabilitation paradigms previously studied in isolation, as well as their effects on Aiming SN and gait post-stroke. Specifically, this F31 proposal will evaluate the effects of combining PAT and electrical stimulation (Aim 1), as well as PAT and gait training (Aim 2), on Aiming SN and gait performance in post-stroke Aiming SN. I hypothesize that adding stimulation to the neglected upper limb during PAT will induce larger improvements in Aiming SN versus PAT without electrical stimulation and that PAT with electrical stimulation will induce greater generalization to gait performance. In addition, I hypothesize that gait training with stimulation to the left lower limb preceded by PAT will induce larger improvements in gait performance than gait training with stimulation alone. This F31 proposal will capitalize on the PI’s clinical training and mentoring team’s expertise in post-stroke Aiming SN (sponsor Barrett) and gait (co-sponsor Kesar) rehabilitation to address SN and gait deficits in individuals with SN post-stroke. This work will generate novel information that will inform future design of new and targeted treatment protocols for evidence-based rehabilitation of spatial neglect and gait dysfunctions post- stroke, to improve gait function and quality of life in stroke survivors.

项目摘要/摘要 瞄准空间忽略是运动意向启动/执行功能障碍的一种亚型 行为。SN成分，如方向性运动减退，转身行为，负重不对称，以及 转向走笔直的小路会对走路产生不利影响。然而，有针对性的治疗方法很少。 SN引起的步态障碍。巴雷特博士(赞助商)是一位领先的康复研究人员，他的特点是 针对SN，建立了棱镜适应疗法(PAT)作为一种有效的治疗方法来减少病理 针对SN，改善中风后上肢功能。然而，尽管传统的PAT仍然有效 至于针对上肢的研究，其推广到行走只在健全的人身上进行过研究。在……里面 平行的，其他研究表明，对患侧施加电刺激可以改善大脑中的黑质缺失。 中风幸存者，但电刺激和PAT的相加效应在很大程度上是未知的。Kesar博士(联合- 赞助商)在中风后步态生物力学和步态康复治疗方面拥有专业知识 刺激。凯萨尔博士已经证明，在步态训练中增加电刺激可以增强运动学习。 增加力量生产，恢复步态缺陷，并改善行走功能。重要的是，它的可行性和 增加电刺激对卒中后SN患者PAT和步态训练效果的影响 都没有得到很好的研究。因此，该F31研究提案寻求生成支持新型电机空间的数据 可提高卒中后患者SN康复和步态表现的再训练方法。 我将评估PAT、电刺激和步态训练的新组合，这些组合都是有效的 以前单独研究的康复范例，以及它们对中风后瞄准SN和步态的影响。 具体地说，这份F31提案将评估PAT和电刺激(目标1)的组合效果，如 以及帕特和步态训练(目标2)，关于瞄准SN和中风后瞄准SN的步态表现。我假设 在PAT期间对被忽视的上肢增加刺激将导致瞄准SN的较大改善 与没有电刺激的PAT相比，有电刺激的PAT将产生更大的 对步态表现的概括。另外，我假设 步态训练 左下方有刺激 四肢 比起有刺激的步态训练，先于帕特的步态训练将在步态表现上带来更大的改善 独自一人。这份F31提案将利用PI的临床培训和指导团队在中风后的专业知识 针对SN(赞助商Barrett)和步态(共同赞助商Kesar)康复，以解决SN和步态缺陷 卒中后SN患者的个体。这项工作将产生新的信息，将为未来的新设计提供信息 和有针对性的治疗方案，用于空间忽视和步态功能障碍的循证康复。 卒中，改善卒中幸存者的步态功能和生活质量。