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过程中，通过强制使用受影响的腿，是否会改善运动训练的效果。我们还将确定中风后患者训练后运动功能改善的神经机制。使用跑步机进行运动训练是一种很有前途的技术，它为提高中风后个人的步行能力提供了安全和方便的环境。虽然跑步机训练后行走功能的改善在统计学上是显著的，但对许多患者来说，功能改善相对较小。跑步机训练效果较差的一个主要原因可能是患者在运动训练中采用的代偿性运动策略，即偏瘫患者在跑步机训练中往往更依赖于未受影响的腿进行两足行走。以这种方式重复练习实际上可能导致加强代偿运动策略，从而导致患肢运动控制的有限改善，导致训练后有限的功能增益，这表明需要开发新的训练范例以最大限度地提高功能增益。强制诱导运动疗法(CIMT)已被用于改善中风后患者患臂的运动功能，方法是强迫患者使用患臂，并限制非患臂的运动。以前的研究表明，CIMT术后在运动技能和受影响的手臂和手在日常活动中的使用方面有很大的改善。然而，由于两足步态中双腿之间的强耦合和跌倒的风险，这种干预措施尚未有效地应用于中风后患者的下肢训练。因此，我们建议开发一种新的策略来测试CIMT 卒中后个体的肢体训练。具体地说，我们将在骨盆和/或未受影响的腿上施加受控力量，这将有助于克服患者采用的代偿运动策略，并在运动训练期间诱导受影响的腿被迫使用。我们的中心假设是，通过对骨盆施加受控的辅助力量和/或对未受影响的腿部施加阻力来减少未受影响的腿部的代偿运动，并在训练期间诱导中风后个体强迫使用受影响的腿部，运动训练的效果将得到改善。这项研究的结果将导致一种旨在改善中风后个人运动功能的创新临床治疗范例。我们期望这项研究将证明一种新的机器人训练策略的可行性，即在运动训练中对骨盆和/或未受影响的腿施加控制力，以诱导强迫使用受影响的腿。拟议研究的成功完成将极有可能对个人岗位的运动康复领域产生重大影响 通过应用一种新的治疗模式治疗中风。这一范例也可应用于其他患者群体，如偏瘫脑瘫患者。

 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.