Development of sensory augmentation methods to improve post-stroke gait stability

中风后，独立活动能力不足是导致生活质量下降的主要原因。许多 中风幸存者，包括每年中风的大约1.5万名美国退伍军人， 被阻止回到他们以前的活动参与或参与社区的水平。一个 活动障碍的主要原因是步态不稳定，这可能会导致摔倒或 害怕跌倒，其中任何一种都会限制独立功能。虽然几种常见的康复方法 (如运动训练、力量训练、平衡训练)可以改善某些方面的机能，他们有 未能解决步态不稳定问题，跌倒发生率缺乏改善就是明证。在一定程度上，这种缺乏 成功很可能是因为目前的干预措施没有针对导致后应激障碍的具体机制 中风步态不稳定。 这项研究的长期目标是开发基于机制的干预措施，以改善中风后的状况 步态稳定，并可在诊所或社区实施。作为迈向这一目标的一步，该项目侧重于 中风后步态不稳定的一个有希望的潜在机制原因。具体地说，中风后的赤字 目标是机械上适当地逐步调整步幅宽度。这一点的中心假设是 工作是，增强的感觉反馈将增加对步幅的机械依赖的调制，以及 重要的步态稳定策略，在慢性中风幸存者中经常被破坏。有希望的，非侵入性 感官刺激已被证明可以塑造个人对骨盆运动的感知 行走，从而影响他们的步幅控制。该提案的目标是开发和测试 通过传递的振动刺激提供髋关节本体感觉反馈的实时增强的方法 卒中后步行时使用手掌。这将通过三个具体目标来实现。 第一个具体目标是确定感官有益效果的生理机制。 增强步态步态的稳定性。除了具有科学价值外，研究结果还将提供 洞察未来要使用的便携设备开发应针对的机制 在诊所或社区。第二个具体目标是确定个性化感官 对个别参与者的增强方法对中风后步态稳定性产生更大的有利影响， 这将使我们能够解释患者对感觉刺激反应的潜在变化。最后， 第三个具体目标是建立以康复干预为中心的安全性、可行性和有效性。 在步态中反复暴露于感觉增强。结果将为未来的发展提供理由 更大规模的临床试验。总的来说，拟议工作的结果将构成发展的基础 一种新型的康复设备，可以在研究实验室的环境外帮助步态平衡。 建议的项目基于人体步态力学和运动学的综合理论框架。 学习，并将量化基于机制的干预的潜力，使用新的感觉刺激来 恢复中风幸存者的典型步态稳定策略。由此产生的知识有可能 为制定更大规模的康复范例作出重要贡献 治疗性干预针对患者的特定限制。

Following a stroke, deficits in independent mobility are a primary contributor to decreased quality of life. Many stroke survivors, including the approximately 15,000 American veterans who experience a stroke each year, are prevented from returning to their prior levels of activity participation or involvement in the community. A major cause of mobility deficits is gait instability, which can result in an increased risk of falls or an increased fear of falling, either of which can limit independent function. While several common rehabilitation methods (e.g. locomotor training, strengthening, balance training) can improve some aspects of function, they have failed to address gait instability, as evidenced by a lack of improvement in fall incidence. In part, this lack of success is likely due to current interventions not being targeted toward the specific mechanisms causing post- stroke gait instability. A long-term goal of this research is to develop mechanism-based interventions that can improve post-stroke gait stability and be implemented in the clinic or community. As a step toward this goal, this project focuses on one promising potential mechanistic cause of post-stroke gait instability. Specifically, post-stroke deficits in the mechanically-appropriate step-by-step adjustments of step width will be targeted. The central hypothesis of this work is that augmented sensory feedback will increase the mechanics-dependent modulation of step width, an important gait stabilization strategy that is often disrupted in chronic stroke survivors. Promisingly, non-invasive sensory stimulation has been shown to shape an individual’s perception of the motion of their pelvis during walking, thus influencing their step-by-step control. The objective of this proposal is to develop and test a method of providing real-time augmentation of hip proprioceptive feedback through vibratory stimuli delivered using tactors during post-stroke walking. This will be accomplished through three Specific Aims. The first Specific Aim is to identify the physiological mechanism underlying the beneficial effects of sensory augmentation on step-by-step gait stabilization. Beyond being of scientific interest, the results will provide insight into the mechanism that should be targeted for the future development of a portable device to be used in the clinic or community. The second Specific Aim is to determine whether personalizing sensory augmentation methods to individual participants produces greater beneficial effects on post-stroke gait stability, which will allow us to account for potential variation in patient responsiveness to sensory stimulation. Finally, the third Specific Aim is to establish the safety, feasibility, and efficacy of a rehabilitation intervention centered on repeated exposure to sensory augmentation during gait. The results will provide justification for a future larger-scale clinical trial. Overall, the results of the proposed work will form the foundation for the development of a novel rehabilitation device that can assist gait balance outside of a research laboratory setting. The proposed project is based on the combined theoretical frameworks of human gait mechanics and motor learning, and will quantify the potential of a mechanism-based intervention using novel sensory stimulation to restore the typical gait stabilization strategy in stroke survivors. The resultant knowledge has the potential to make an important contribution to the development of a larger-scale rehabilitation paradigm in which therapeutic interventions are targeted to a patient’s specific limitations.