Constraint induced movement therapy for walking in individuals post stroke

 描述（由申请人提供）：拟议研究的目的是测试在运动训练期间，通过强制使用受影响的腿来提高运动训练的有效性。我们还将确定中风后个体训练后运动功能改善的神经机制。使用跑步机的运动训练是一种很有前途的技术，它为改善中风后个体的行走能力提供了一个安全和方便的环境。虽然跑步机训练后步行功能的改善具有统计学意义，但许多患者的功能增益相对较小。跑台训练效果不佳的主要原因之一可能是由于患者在运动训练期间采用的补偿运动策略，即，轻偏瘫患者在跑步机训练期间通常更依赖于未受影响的腿来进行双足行走。以这种方式重复练习实际上可能导致加强补偿性运动策略，这导致受影响腿的运动控制的有限改善，导致训练后的有限功能增益，这表明需要开发新的训练范例以最大化功能增益。约束诱导运动疗法（CIMT）已被用于改善运动功能的受影响的手臂在个人中风后，通过强迫使用他们的受影响的手臂，并通过限制运动的未受影响的arm. Previous研究表明，有前途的改善运动技能和使用受影响的手臂和手在日常活动后CIMT。然而，由于双足步态期间两条腿之间的强耦合和跌倒的风险，这种干预尚未有效地应用于中风后个体的下肢训练。因此，我们建议开发一种新的策略来测试CIMT， 中风后患者的下肢训练。具体而言，我们将对骨盆和/或未受影响的腿施加受控的力，这将有助于克服患者采用的补偿运动策略，并在运动训练期间诱导受影响腿的强制使用。我们的中心假设是，通过向骨盆施加受控的辅助力和/或向未受影响的腿施加阻力以减少未受影响的腿的代偿运动，并在训练期间诱导中风后个体的受影响的腿的强制使用，运动训练的功效将得到改善。这项研究的结果将导致一个创新的临床治疗模式，旨在改善中风后个体的运动功能。我们希望这项研究将证明一种新的机器人训练策略的可行性，即，在运动训练期间，向骨盆和/或未受影响的腿施加受控的力以诱导受影响的腿的强制使用。成功完成拟议的研究将有很大的潜力，使在运动康复领域的个人后， 通过应用一种新的治疗模式来治疗中风。该范例也可以应用于其他患者群体，例如患有轻偏瘫性脑瘫的患者。

 DESCRIPTION (provided by applicant): The objective of the proposed study is to test whether the efficacy of locomotor training will be improved through the application of constraint induced forced use of the affected leg during locomotor training. We will also identify the neural mechanisms underlying the improvements in locomotor function after training in individuals post-stroke. Locomotor training using a treadmill is a promising technique that provides a safe and convenient environment for improving walking capability in individuals post-stroke. While the improvements in walking function after treadmill training are statistically significant, the functional gains are relatively small for many patients. One of primary reasons of the less effectiveness of treadmill training may be due to the compensatory motor strategies employed by patients during locomotor training, i.e., patients with hemiparesis often rely more on the unaffected leg for performing bipedal walking during treadmill training. Repetitive practice in thi manner may actually lead to reinforcing the compensatory motor strategies, which results in limited improvement in motor control of the affected leg, resulting in limited functional gains aftr training, which suggests a need of developing new training paradigms in order to maximize functional gains. Constraint induced movement therapy (CIMT) has been utilized to improve motor function of the affected arm in individuals post-stroke through forced use of their affected arm and by restricting movements of the unaffected arm. Previous studies have shown promising improvements in motor skills and in the use of the affected arm and hand in daily activities after CIMT. However, such interventions have not been effectively applied to lower limb training in individuals post-stroke due to the strong coupling between the two legs during bipedal gait and the risk of falling. Thus, we propose to develop a novel strategy to test CIMT for lower limb training in individuals post-stroke. Specifically, we will apply a controlled force to te pelvis and/or unaffected leg, which will serve to overcome the compensatory motor strategies employed by patients, and induce forced use of the affected leg during locomotor training. Our central hypothesis is that the efficacy of locomotor training will be improved by applying a controlled assistance force to the pelvis and/or resistance force to the unaffected leg to reduce the compensatory movements of the unaffected leg, and induce forced use of the affected leg of individuals post-stroke during training. Results from this study will lead to an innovative clinica therapy paradigm aimed at improving locomotor function in individuals post-stroke. We expect that this study will demonstrate the feasibility of a novel robotic training strategy, i.e., applyig a controlled force to the pelvis and/or the unaffected leg to induce forced use of the affected leg during locomotor training. The successful completion of the proposed study will have a high potential to make a significant impact on the field of locomotor rehabilitation in individuals post stroke through the application of a novel treatment paradigm. This paradigm may also be applied to other patient populations, such as patients with hemiparetic cerebral palsy.