Fatigue and mobility in stroke: a Biomechanical and Neurophysiological Investigation

中风时的疲劳和活动能力：生物力学和神经生理学研究

• 批准号: 10631848
• 负责人: John Harvey Kindred
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10631848
• 关键词: Adult; Affect; Ankle; Area; Award; Back; Behavioral; Bioenergetics; Biomechanics; Brain; Caring; Characteristics; Clinical; Clinical Research; Colorado; Contract Services; Development; Doctor of Philosophy; Elements; Environment; Equilibrium; Esthesia; Etiology; Exertion; Fasting; Fatigue; Functional disorder; Future; Gait; Gait speed; Goals; Health; High Prevalence; Hip region structure; Human; Impairment; Individual; Intervention; Investigation; Ischemic Stroke; Journals; K-Series Research Career Programs; Kinetics; Knee; Knowledge; Laboratories; Laboratory Research; Lead; Lesion; Link; Lower Extremity; Magnetism; Manuscripts; Medical center; Mentors; Mentorship; Motor; Motor Evoked Potentials; Multiple Sclerosis; Muscle; Musculoskeletal System; Nervous system structure; Neuraxis; Neurologic; Neurologic Symptoms; Outcome; Output; Paper; Paresis; Participant; Pattern; Peer Review; Perception; Performance; Peripheral; Persons; Physical Function; Physical Rehabilitation; Physiological; Population; Positioning Attribute; Postdoctoral Fellow; Property; Psyche structure; Publishing; Quality of life; Rehabilitation therapy; Reporting; Research; Risk; Severities; Skeletal Muscle; Soleus Muscle; Stroke; System; Task Performances; Techniques; Time; Training; Transcranial magnetic stimulation; Traumatic Brain Injury; United States; Universities; Veterans; Walking; active duty; biomechanical test; care outcomes; cognitive function; college; design; effective therapy; experience; experimental study; expiration; improved; insight; interdisciplinary approach; interest; kinematics; negative affect; neuroimaging; neurophysiology; neuroregulation; post stroke; programs; psychologic; recruit; reduce symptoms; rehabilitation strategy; research facility; response; skills; social; stem; stroke recovery; therapeutic target; tibialis anterior muscle; tool; walking speed

The long-term goal of this proposed career development award (CDA-1) is to accelerate the training and development of the PI, allowing him to establish and independent line of research into the etiology and consequences of post-stroke fatigue and dysfunctions of gait and balance. Prior to his collegiate studies the PI served on active duty in the United States Marine Corps for nine years, receiving an Honorable Discharge upon the expiration of his service contract. The PI completed his PhD in Human Bioenergetics at Colorado State University and published 15 manuscripts in peer-reviewed journals during his time there. Since graduating has had another paper accepted and has two manuscripts under review. Currently he is training under the tutelage of Dr. Mark G. Bowden, PT, PhD, at the Ralph H. Johnson VA Medical Center. This proposal will allow the PI to gain the necessary skills needed in neurophysiological assessment and analysis, biomechanical assessment and analysis, and neuroimaging analysis to establish and independent VA backed research program focusing on reducing the impact of fatigue, and gait and balance dysfunctions in healthy and neurologically impaired Veterans. The assembled mentorship team is composed of experts in each of the skillsets the PI is hoping to obtain. Up to 92% of people post-stroke experience fatigue and fatigue negatively affects physical and mental performance and leads to a lower quality of life. Fatigue also affects many other neurological populations of interest to the VA, such as traumatic brain injury and multiple sclerosis. Advances in the knowledge and understanding of post-stroke fatigue may also lead to similar advances in other VA clinical populations. The first aim is to characterize the corticomotor response in Veterans with post-stroke fatigue. The response will be assessed using transcranial magnetic stimulation delivered to the cortical representations of lower extremity muscles, e.g., tibialis anterior and soleus. Fatigue severity and corticomotor response variables will be correlated to establish the link between altered neurophysiology and post-stroke fatigue. We expect to see longer, Lower MEP amplitudes, stimulation latency, and corticosilent periods in participants with high levels of fatigue, signifying a central mechanism of fatigue that can be targeted in future brain stimulation therapies. The second aim of this study is to determine if participants with high levels of fatigue display unique gait biomechanical characteristics. Differences between self-selected and fasted comfortable walking speeds will be calculated for kinetic and kinematic properties of gait. These differences, i.e., walking capacity/reserve, represent a possible behavioral adaptation to post-stroke fatigue to minimize effort due to high perceived fatigue. We expect that Veteran’s with higher reported post-stroke fatigue will walk at a lower percentage (self-selected) of their maximal capacity (fastest comfortable). This aim is expected to identify behavioral consequences of post-stroke fatigue that may exacerbate health outcomes related to poor mobility and physical/social activity participation.

这项拟议的职业发展奖(CDA-1)的长期目标是加快培训和 PI的发展，使他能够建立和独立的病因学和 中风后疲劳以及步态和平衡功能障碍的后果。在他的大学学习之前，Pi 在美国海军陆战队现役9年，在 他的服务合同期满。他在科罗拉多州立大学完成了人类生物能量学博士学位。 在大学期间，他在同行评议的期刊上发表了15篇手稿。自毕业以来， 已经接受了另一篇论文，并有两篇手稿正在审查中。目前他正在指导下进行训练。 马克·G·鲍登博士在退伍军人事务部拉尔夫·H·约翰逊医学中心获得PT、博士学位。这项提议将允许私人投资公司 掌握神经生理评估和分析、生物力学评估所需的必要技能 和分析，以及神经成像分析，以建立独立的退伍军人事务部支持的研究计划 减少疲劳、步态和平衡功能障碍对健康人和神经病患者的影响 退伍军人。组建的辅导团队由国际和平协会希望掌握的每一种技能的专家组成 获取。高达92%的人在中风后经历疲劳，疲劳对身心健康产生负面影响 并导致生活质量下降。疲劳也会影响到许多其他神经病学的人群 对退伍军人管理局感兴趣，如创伤性脑损伤和多发性硬化症。知识和技术方面的进展 对卒中后疲劳的了解也可能在其他VA临床人群中导致类似的进展。第一 目的是描述患有中风后疲劳的退伍军人的皮质运动反应。回应将是 使用经颅磁刺激对下肢皮质表现进行评估 肌肉，例如胫骨前肌和比目鱼肌。疲劳严重程度和皮质运动反应变量将相互关联 建立神经生理学改变和中风后疲劳之间的联系。我们预计会看到更长时间，更低 高度疲劳的参与者的MEP波幅、刺激潜伏期和皮质静默期， 标志着疲劳的中心机制，可以在未来的脑刺激疗法中进行靶向治疗。第二 这项研究的目的是确定高度疲劳的参与者是否表现出独特的步态生物力学 特点。将计算自选步行速度和禁食舒适步行速度之间的差异 步态的运动学和运动学特性。这些差异，即步行能力/储备，代表了一种可能的 对中风后疲劳的行为适应，以最大限度地减少因高度感知疲劳而产生的努力。我们期待着 报告中风后疲劳程度较高的退伍军人将以较低的百分比(自选)行走 最大容量(最快、最舒适)。这一目标有望确定中风后的行为后果。 疲劳，可能会加剧与行动不便和参与体力/社会活动有关的健康后果。