Muscle power training to improve depression and walking post-stroke

摘要 抑郁是中风后最常见的神经精神表现，目前的治疗方法是 很大程度上无效。抑郁对康复反应有直接和间接影响，因此受试者 卒中后抑郁(PSD)患者通常被排除在临床试验之外，治疗方案也非常有限 有限的。我们建议确定一种新的、高强度的阻力训练计划-中风后的影响 爆炸阻力(力量)训练优化步行对卒中后抑郁症状的影响 此外，我们将确定抑郁是否会限制训练诱导的肌肉和运动能力的改善。 功能。这个项目的前提是抑郁症对神经可塑性的潜在负面影响。 应治疗而发生的变化，使康复可能不会产生与治疗相同的适应 在非抑郁症患者中也是如此。我们认为，对PSD的有效治疗将产生良性的 减少抑郁增强神经可塑性变化，从而促进功能获得的循环。那是, 有效地治疗抑郁症将使患者更好地从中风中恢复过来。此外，在 除了对抑郁症的有益影响外，众所周知，力量训练还可以改善中风后的行走，因此 为治疗抑郁症提供了一个有吸引力的选择，也为研究阿司匹林的效果提供了一个既定的工具 PSD对康复的反应。作为该项目的一部分提出的实验旨在解决 关键问题与1)力量训练对抑郁症状的影响；2)潜在的 PSD限制了训练后的改善；以及3)抑郁症的改善和 增加行走功能。该项目的顺利完成将为更大规模的建设奠定基础 关于确定剂量参数和确定力量训练疗效的试验 卒中后抑郁以及确定可能导致这些变化的机制 作为对治疗的回应。

Abstract Depression is the most common neuropsychiatric manifestation following stroke and current treatments are largely ineffective. Depression has both direct and indirect effects on response to rehabilitation, thus subjects with post-stroke depression (PSD) are routinely excluded from clinical trials and treatment options are extremely limited. We propose to determine the impact of a novel, high-intensity resistance training program, Post-stroke Optimization of Walking using Explosive Resistance (POWER) training, on post-stroke depressive symptoms. Further, we will determine if depression limits training-induced improvements in muscular and locomotor function. This project is based on the premise that depression negatively affects the potential for neuroplastic changes to occur in response to treatment such that rehabilitation may not produce the same adaptations that it does in non-depressed individuals. We propose that effective treatment for PSD would result in a virtuous cycle where reducing depression enhances neuroplastic changes, thereby facilitating functional gains. That is, effectively treating depression will make the individual better able to recover from stroke. Furthermore, in addition to its beneficial effects on depression, POWER training is known to improve post-stroke walking, thus providing an attractive option for treating depression as well as an established vehicle to study the effects of PSD on response to rehabilitation. The experiments proposed as part of this project are designed to address critical questions related to 1) the effects of POWER training on depressive symptoms; 2) the potential for PSD to limit improvements following training; and 3) the interaction between improvements in depression and increases in walking function. Successful completion of this project will provide a foundation for larger scale trials to determine dosing parameters as well as establish therapeutic effectiveness of POWER training on post-stroke depression as well as identify the mechanisms that may be responsible for the changes that occur in response to treatment.