Cortical priming to optimize gait rehabilitation post stroke

项目摘要/摘要 尽管步态研究在过去十年中取得了进展，但社区步行的恢复仍然是 对400多万中风患者来说，这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参与，强调需要发展研究范式 这有助于更好地了解皮质机制，以便开发更有效的步行训练 协议。经颅直流电刺激(Tdcs)是一种很有前途的增强任务的工具。 上肢的定向治疗。然而，对于下肢来说，关于大脑在运动中的作用知之甚少 步态恢复。这项研究的目的是开发一种新的治疗干预措施，其基础是 了解神经适应性以改善中风幸存者的步态。在这项研究中，我们提出大脑皮层 启动训练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。在本实验中，中度到严重损伤的后遗症 中风患者将在服用以下三种药物之一后接受快速跑步机训练(FTT)方案 启动范式：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)或休息时的促进性tDCS(tDCS-REST)。在……里面 此外，对照组患者(CONT)将在没有任何启动的情况下参与FTT方案 干预。目的1确定tdcs-AMT对小鼠步态速度、步态对称性和踝关节活动度的影响。 动议。目标2将确定tdcs-AMT在皮质脊髓机制上的有效性，通过 经颅磁刺激(TMS)。目标3将确定tdcs-amt治疗偏瘫踝关节的疗效。 运动控制和功能结果。通过我们的机械方法来增强功能，我们寻求 优化卒中后步态康复并表征神经机制与 功能恢复。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，这与美国国立卫生研究院的使命有关。

Project Summary/ Abstract 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 the 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 one 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.