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

项目总结/摘要 瞄准性空间忽略（aiming spatial neglect，SN）是SN的一种亚型，是运动有意性空间忽略的启动/执行功能障碍。 行为SN成分，如方向性运动功能减退、转向行为、负重不对称，以及 在直行路径上转向会对步行产生不利影响。然而，缺乏针对性的治疗方法， 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， 针对SN，并建立了棱镜适应疗法（PAT）作为减少病理性 针对SN，改善卒中后上肢功能。然而，尽管传统的PAT仍然有效， 针对上肢，仅在身体健全的人中研究了其对行走的推广。在 与此同时，其他研究表明，施加到受影响侧的电刺激改善了SN缺陷， 中风幸存者，但电刺激和PAT的叠加效应在很大程度上是未知的。Dr. Kesar（co- 申办者）具有卒中后步态生物力学和步态康复治疗方面的专业知识， 刺激.凯萨博士已经证明，在步态训练中增加电刺激可以增强运动学习， 增强力量产生，恢复步态缺陷，并改善行走功能。重要的是， 在SN卒中幸存者中增加电刺激以增强PAT和步态训练的效果 并没有得到很好的研究。因此，这项F31研究提案旨在生成支持新的运动空间的数据。 再训练的方法，可以提高康复的SN和步态表现在个人中风后。 我将评估PAT、电刺激和步态训练的新颖组合，这些组合是有效的 先前在隔离中研究的康复范例，以及它们对Aiming SN和中风后步态的影响。 具体而言，本F31提案将评估PAT和电刺激组合的效果（目标1）， 以及PAT和步态训练（Aim 2），Aiming SN和卒中后Aiming SN中的步态表现。我假设 在PAT期间对被忽略的上肢增加刺激将导致Aiming SN的更大改善 与没有电刺激的PAT相比，有电刺激的PAT将诱导更大的 一般化到步态表现。另外，我假设 步态训练 刺激左下角 肢体 在PAT之前进行的步态训练比刺激步态训练更能改善步态表现 一个人本F31提案将利用PI的临床培训和指导团队在卒中后的专业知识 旨在进行SN（申办者Barrett）和步态（共同申办者Kesar）康复，以解决 中风后SN患者。这项工作将产生新的信息，将告知未来的新设计 和有针对性的治疗方案，以证据为基础的康复空间忽视和步态功能障碍后， 改善中风幸存者的步态功能和生活质量。

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.