Cortical and spinal correlates of stroke gait rehabilitation

描述（由申请人提供）：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治疗的主要目标。步态再训练可以提高行走速度和活动，即使是那些从康复中心出院的中风幸存者，他们在康复过程中被认为已经达到了“平台期”。然而，虽然步态康复可以改善中风后的行走功能，但对于哪种特定的干预措施、策略或给药方案最有效，还缺乏共识。导致康复文献缺乏共识的一个因素是，步态康复的剂量-反应时间过程和神经可塑性机制尚未得到系统研究。本提案的目的是解决我们对临床中风后步态康复的神经相关知识的理解差距，这些知识将为更有效的康复方案的发展提供信息。为了实现这一目标，我们建议评估脑卒中后快速跑步机训练和功能性电刺激（FastFES）相结合的一种新颖有效的步态康复模式的皮层和脊髓神经生理学相关的时间过程。提出的研究的创新之处在于在18次FastFES步态再训练中同时评估生物力学（步态动力学和运动学）、神经可塑性（皮质和脊柱）和功能（步态速度和耐力）过程。这些多模式评估将在两组脑卒中幸存者中进行（FastFES与剂量匹配对照组）。本提案的研究计划的目的是：(1)确定18次FastFES步态治疗是否会在中风后个体的皮质和脊髓兴奋性方面产生比对照治疗更大的变化，(2)进行比较

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.