Cortical priming to optimize gait rehabilitation post stroke

描述(申请人提供)：尽管步态研究在过去十年中取得了进展，但对于400多万中风患者来说，社区步行的恢复仍然是一个未实现的目标。最近的人体研究强调了运动皮质在行走中的重要作用，强调需要发展研究范式，更好地了解皮质机制，以便制定更有效的步行训练方案。经颅直流电刺激(Tdcs)是一种很有前途的工具，可用于加强上肢的任务导向治疗。然而，对于下肢来说，关于大脑在步态恢复中的作用知之甚少。这项研究的目的是开发一种新的 基于了解神经适应以增强中风幸存者步态的治疗干预。在这项研究中，我们认为皮质启动结合踝关节运动控制训练有望改善偏瘫踝关节的意志控制，并将增强步态训练的有益效果。在这个实验中，中风后的中度到严重的损害 在实施三种启动模式后，个体将接受快速跑步机训练(FTT)方案：促进性tDCS结合踝关节运动训练任务(tDCS-AMT)、假tDCS结合踝关节运动训练任务(Sham-AMT)或休息时促进性tDCS(tDCS-REST)。此外，对照组患者(CONT)将在没有任何启动干预的情况下参与FTT方案。目标1将确定 TDC-AMT对步态速度、步态对称性和踝关节活动度的影响。目的2将通过经颅磁刺激(TMS)来确定tDCSAMT对皮质脊髓机制的有效性。目的3将确定tdcs-AMT对偏瘫踝关节运动控制和功能结果的有效性。通过我们增强功能的机械方法，我们试图优化中风后的步态康复，并表征神经机制和功能恢复之间的关系。改善步态将使中风幸存者在社区中更加独立，并提高他们的生活质量，这与NIH的使命相关。

DESCRIPTION (provided by applicant): Despite advances in gait research in the last decade, restoration of community walking continues to be an unaccomplished goal for over four million persons with stroke. Recent human studies have highlighted the significant involvement of the motor cortex in walking, emphasizing the need to develop research paradigms that provide a better understanding of cortical mechanisms in order to develop more effective walking training protocols. Transcranial direct current stimulation (tDCS) is emerging as a promising tool for enhancing task- oriented therapy of the upper limb. However, for the lower limb little is known regarding the role of the brain in gait recovery. The objective of this study is to develop a novel therapeutic intervention that is based on understanding neural adaptations to enhance gait in stroke survivors. In this study we propose that cortical priming combined with ankle motor control training is expected to improve volitional control of the paretic ankle and will enhance th beneficial effects of gait training. In this experiment, moderate to severely impaired post- stroke individuals will receive a fast treadmill training (FTT) protocol following the administration of oe of three priming paradigms: facilitatory tDCS in combination with an ankle motor training task (tDCS-AMT), sham tDCS in combination with an ankle motor training task (sham-AMT) or facilitatory tDCS during rest (tDCS-rest). In addition, a control group of patients (CONT) will participate in the FTT protocol in the absence of any priming intervention. Aim 1 will identify the effectiveness of tDCS-AMT on gait speed, gait symmetry and ankle range of motion. Aim 2 will determine the effectiveness of tDCS-AMT on corticospinal mechanisms as measured by transcranial magnetic stimulation (TMS). Aim 3 will determine the effectiveness of tDCS-AMT on paretic ankle motor control and functional outcomes. With our mechanistic approach to enhance function, we seek to optimize gait rehabilitation post stroke and characterize relationships between neural mechanisms and functional recovery. Improved gait will enable stroke survivors to be more independent in the community and advance their quality of life, which is relevant to the mission of the NIH.