fMRI Predictor Model for Stroke Locomotor Rehabilitation

描述（由申请人提供）：目的是确定功能磁共振成像（fMRI）是否可以帮助预测任务导向的物理治疗是否可能增强与行走相关的结果，以及fMRI是否可以告知临床医生治疗的最佳持续时间和强度。在偏瘫性中风6-18个月后，32名受试者仍以低于社区行走所需的最低速度行走，他们将接受一种称为体重支持跑步机训练（BWSTT）和地面行走的标准化治疗。受试者按初始步行速度（<40 cm/sec vs 40-75 cm/sec）进行分层，这与行走限制和神经功能障碍有关。该研究连续量化了与治疗相关的步行速度、耐力、步态模式和与运动控制相关的生理指标的变化。与此同时，采用标准化的瘫腿被动和自愿踝关节背屈激活模式进行了一系列功能磁共振成像研究。fMRI将量化初级和非初级大脑感觉运动区域突触活动的变化，并反映皮层下和脊柱的可塑性，以及参与注意力和学习的区域的活动，因为强化的渐进式康复策略使更好的运动控制根深蒂固。在这种纵向设计中，受试者继续以12个阶段为一组进行训练，直到他们的步行速度达到平台，并且在每个阶段结束时进行的fMRI检查没有发现进一步的重组。我们预计，随着训练时间的推移，踝关节背屈运动控制的增益将反映在行走网络棘上成分表征可塑性的可量化变化中。使用统计模型，我们将检查在治疗过程中步行相关收益与fMRI模式之间的关系。人们非常感兴趣的是，大脑活动的初始模式或早期训练诱导的进化是否可以作为一种生理分析来预测被更多治疗调节的备用网络的持续能力。然后，我们将通过训练一组新的12名受试者来测试统计推导的预测模型。这项研究是朝着使用功能磁共振成像作为一种工具来开发基于理论和证据的实践来减轻中风后的残疾迈出的一步。

DESCRIPTION (provided by applicant): The aim is to determine if functional magnetic resonance imaging (fMRI) can help predict whether task-oriented physical therapy is likely to enhance outcomes related to walking and whether fMRI can inform clinicians about the optimal duration and intensity of treatment. A standardized therapy called body weight-supported treadmill training (BWSTT) and over ground walking will be given to 32 subjects who, at 6-18 months after hemiparetic stroke, still walk at less than the minimal velocity needed for community ambulation. Subjects are stratified by initial walking speed (<40 cm/sec vs 40-75 cm/sec), which relates to walking limitations and neurological impairment. The study serially quantifies therapy-related changes in walking speed, endurance, gait pattern, and physiological measures relevant to gains in motor control. In parallel, serial fMRI studies are performed using a standardized activation paradigm of passive and voluntary ankle dorsiflexion of the paretic leg. fMRI will quantify changes in synaptic activity within primary and nonprimary cerebral sensorimotor regions and reflect subcortical and spinal plasticity, as well as activity in areas engaged for attention and learning, as better motor control is engrained by the intensive, progressive rehabilitation strategy. For this longitudinal design, subjects continue training in blocks of 12 sessions, until their walking speed reaches a plateau and no further reorganization is found by fMRI performed at the end of each block. We anticipate that gains in motor control for ankle dorsiflexion will be reflected over time of training in quantifiable changes in representational plasticity within the supraspinal constituents of the network for walking. Using statistical modeling, we will examine relationships between walking related gains and the fMRI patterns induced over the course of therapy. Of great interest is whether the initial pattern or the early training-induced evolution of cerebral activity can serve as a physiological assay to predict the ongoing capacity of the spared network to be modulated by more therapy. We will then test a statistically derived predictive model by training a new group of 12 subjects. The study is a step toward using fMRI as a tool to develop theory- and evidencebased practices that lessen disabilities after stroke.