Cortical and spinal correlates of stroke gait rehabilitation

描述（由申请人提供）：大多数卒中幸存者有残余步态缺陷。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，即使是在中风幸存者谁从康复出院，并假定已达到“高原”的恢复。然而，虽然步态康复可以改善卒中后步行功能，但对于哪些具体的干预措施、策略或给药方案最有效缺乏共识。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。该提案的目标是解决我们对临床中风后步态康复的神经相关性的理解中的差距，这些知识将为更有效的康复方案的开发提供信息。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过程，这些相关性是结合快速跑步机训练和功能电刺激（FastFES）的新型有效的卒中后步态康复范例的基础。拟议研究的创新之处是在18次FastFES步态再训练期间同时评价生物力学（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。这些多模式评价将在2组卒中幸存者中进行（FastFES组与剂量匹配对照组）。该提案的研究计划旨在（1）确定18次FastFES步态治疗是否会使卒中后个体的皮质和脊髓兴奋性发生更大变化，（2）比较 脑卒中后个体在FastFES步态再训练过程中皮质脊髓兴奋性、步态生物力学和步行功能变化的时间过程，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。深入了解脑卒中后步态康复的临床基础课程和神经相关因素，将有助于根据神经生物学原理制定有效的个性化策略，从而最大限度地发挥步态康复的益处，从而影响临床实践。主要研究者的博士和博士后培训赋予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结合点进行高影响力的研究，深刻影响神经残疾人的行走功能和生活质量。该指导研究科学家发展奖将使候选人获得额外的培训和熟练使用TMS作为评估皮质运动控制的工具。 的踝关节肌肉，并在控制踝关节肌肉的脊髓电路的电生理评价。指导团队由在脑卒中后恢复和康复的神经可塑性机制方面具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.