Cortical and spinal correlates of stroke gait rehabilitation

描述(申请人提供)：大多数中风幸存者有残留的步态缺陷。恢复行走能力是康复的主要目标。步态再训练可以提高步行速度和活动度，即使是康复出院的中风幸存者，也被认为已经达到了康复的“平台期”。然而，虽然人们一致认为步态康复可以改善中风后的步行功能，但对于哪种具体的干预措施、策略或给药方案最有效，缺乏共识。康复文献中缺乏共识的一个因素是，没有系统地研究步态康复背后的剂量-反应时间过程和神经可塑性机制。这项建议的目的是解决我们对中风后临床步态康复的神经相关性的理解上的空白，对这些知识的了解将有助于开发更有效的康复方案。为了实现这一目标，我们建议评估皮层和脊髓神经生理学相关性的时间进程，这是一种结合快速跑步机训练和功能电刺激(FastFES)的新的、有效的中风后步态康复范例。这项研究的创新之处在于对18次FastFES步态再训练中的生物力学(步态动力学和运动学)、神经可塑性(皮质和脊髓)和功能(步态速度和耐力)过程进行了同时评估。这些多模式评估将在两组中风幸存者(FastFES和剂量匹配的对照组)中进行。这项建议的研究计划的目的是(1)确定18个疗程的FastFES步态治疗是否比对照治疗在中风后患者的皮质和脊髓兴奋性方面产生更大的变化，(2)比较 研究卒中后患者FastFES步态再训练过程中皮质脊髓兴奋性、步态生物力学和行走功能变化的时间进程，以及(3)确定步态再训练后皮质脊髓兴奋性和步态生物力学变化之间的关系。对中风后临床步态康复潜在的TIE过程和神经相关性的洞察将通过帮助开发基于神经生物学原理的有效、个性化的策略来最大限度地发挥步态康复的好处，从而影响临床实践。首席研究员的博士和博士后培训传授了她在步态生物力学和步态康复方面的专业知识。首席研究员的长期目标是在生物力学、神经科学和步态康复的交界处进行高影响力的研究，深刻影响神经残疾患者的步行功能和生活质量。这项指导性研究科学家发展奖将使候选人获得额外的培训，并熟练使用TMS作为评估皮质运动控制的工具 脚踝肌肉，以及控制脚踝肌肉的脊髓回路的电生理评估。指导团队由在中风后康复和康复背后的神经可塑性机制方面拥有专业知识的知名科学家组成。

DESCRIPTION (provided by applicant): A majority of stroke survivors have residual gait deficits. Restoration of walking ability is a major goal of rehabilitation. Gait retraining can improve walking speed and activity even in stroke survivors who are discharged from rehabilitation and assumed to have reached a "plateau" in recovery. However, while there is agreement that gait rehabilitation improves post-stroke walking function, consensus is lacking on which specific interventions, strategies, or dosing regimens are most efficacious. One factor contributing to the lack of consensus in rehabilitation literature is that the dose-response time courses and neuroplasticity mechanisms underlying gait rehabilitation have not been systematically studied. The goal of this proposal is to address the gaps in our understanding of neural correlates of clinical post-stroke gait rehabilitation, the knowledge of which would inform the development of more effective rehabilitation protocols. To meet this goal, we propose to assess time courses of cortical and spinal neurophysiologic correlates underlying a novel and effective post- stroke gait rehabilitation paradigm combining fast treadmill training and functiona electrical stimulation (FastFES). The innovation of the proposed research is the concurrent evaluation of biomechanical (gait kinetics and kinematics), neuroplasticity (cortical and spinal), and functional (gait speed and endurance) processes during 18 sessions of FastFES gait retraining. These multi-modal evaluations will be performed in 2 groups of stroke survivors (FastFES versus dose-matched control). The aims of the research plan for this proposal are to (1) determine whether 18 sessions of the FastFES gait treatment produce greater changes in cortical and spinal excitability versus a control treatment in individuals post-stroke, (2) compare the time course of changes in corticospinal excitability, gait biomechanics, and walking function during FastFES gait retraining in individuals post-stroke, and (3) determine relationships among changes in corticospinal excitability and gait biomechanics after gait retraining. Insights into tie courses and neural correlates underlying clinical post- stroke gait rehabilitation will impact clinical practice by aiding with the development of effective, individualized strategies based on neuro-biological principles to maximize the benefits of gait rehabilitation. The Principal Investigator's doctoral and post-doctoral training has imparted her expertise in gait biomechanics and gait rehabilitation. The Principal Investigator's long-term goal is to conduct high-impact research at the juncture of biomechanics, neuroscience, and gait rehabilitation that profoundly impacts walking function and quality of life of individuals with neurological disability This Mentored Research Scientist Development Award will enable the candidate to gain additional training and proficiency in the use of TMS as a tool for evaluating corticomotor control of ankle muscles, and in the electrophysiological evaluation of spinal circuitry controlling the ankle muscles. The mentoring team comprises established scientists with expertise in neuroplasticity mechanisms underlying post-stroke recovery and rehabilitation.