Locomotor Adaptation in Individuals Post-Stroke

描述(申请人提供)：这项拟议研究的目标是使用一种新型的机器人疗法来改善中风后患者的体重支持跑步机训练(BWSTT)的有效性，这种疗法在步态的摆动阶段对瘫痪的腿施加力量。行动能力受损是决定中风后身体残疾程度的重要因素。虽然高达80%的中风患者最终可能恢复短距离行走的能力，但他们中的大多数人无法达到社区步行所需的运动能力。因此，人们渴望开发新的技术来提高这一人群的治疗效果。虽然BWSTT在步行恢复方面有统计上的显著改善，但目前尚不清楚这种训练的治疗效果是否最大化。此外，BWSTT的一个主要限制是要求更多的物理治疗师参与。机器人辅助的BWSTT显示了在运动训练中减少治疗师劳动的有效性，但对一些患者来说功能改善相对有限。因此，我们的目标是通过在跑步机训练期间对瘫痪的腿施加必要的辅助或耐受的阻力来提高BWSTT的疗效。来自动物研究的证据表明，步态再训练在需要帮助的情况下比在固定轨迹模式下更有效。同样，人类手臂研究的结果表明，通过使用错误增强训练来导致适应可能是促进中风患者功能运动恢复的有效方法。我们假设，根据患者的运动表现，根据需要提供辅助或根据耐受负荷提供阻力，将通过增强患者的努力有效地参与适应性感觉运动过程来改善BWSTT的训练结果。因此，我们的具体目标是：Aim1。演示中风后个体对所施加的负荷的运动适应。具体地说，我们的目标是评估中风后个体对阻力/辅助负荷的运动适应。将记录下肢体的肌肉活动和运动学，以量化阻力/辅助负荷对运动适应的影响。我们期望腿部肌肉活动和肢体运动学能适应所施加的负荷，并在移除时表现出后遗症；目的2.改进以阻力为耐受策略的步态训练范式。我们的目标是使用耐受阻力/需要时辅助的策略来评估运动恢复，以控制在BWSTT期间应用于瘫痪腿的负荷。在训练前、训练后和随访时，将获得步态运动学和临床损害和步行功能的测量。与援助训练组相比，预计BWSTT与阻力相结合的情况将有显著改善。这项研究的结果将导致旨在改善中风后患者运动恢复的创新临床疗法。我们预计，这项技术将有助于通过机器人辅助的BWSTT改善卒中后个体的步态。公共卫生相关性：拟议研究的目的是使用一种新型的机器人疗法来提高中风后患者的体重支持跑步机训练(BWSTT)的有效性，这种疗法在行走过程中对瘫痪的腿施加受控力量。这项研究的结果将导致旨在改善中风后患者运动恢复的创新临床疗法。我们预计，这项技术将有助于通过机器人辅助的BWSTT改善卒中后个体的步态。

DESCRIPTION (provided by applicant): The goal of this proposed research is to improve the efficacy of body weight supported treadmill training (BWSTT) in people post-stroke using a novel robotic therapy that applies forces to the paralyzed leg during the swing phase of gait. Impaired mobility is an important factor in determining the degree of physical disability after stroke. While up to 80% of individuals with stroke may ultimately recover the ability to walk short distance, most of them do not achieve the locomotor capacity necessary for community ambulation. As a result, there is a desire to develop new techniques to enhance the therapeutic effect in this population. While statistically significant improvements in walking recovery with BWSTT have been shown, it remains unclear whether therapeutic effects of such training are maximized. In addition, a major limitation of BWSTT is the requirement of greater involvement of physical therapist. Robotic assisted BWSTT demonstrates effectiveness in reducing therapist labor in locomotor training but shows relatively limited functional gains for some patients. Our goal is therefore to enhance the efficacy of BWSTT by applying assistance as needed or resistance as tolerated to the paralyzed leg during treadmill training. Evidence from animal studies indicates that gait retraining is more effective with assistance as needed than with a fixed trajectory paradigm. Similarly, results from human arm study indicated that causing adaptation by using error-augmentation training might be an effective way to promote functional motor recovery for patients with stroke. We postulate that providing assistance as needed or resistance as tolerated load based on the motor performance of the patient will improve the training outcomes of BWSTT through enhanced patient effort that effectively engages adaptive sensorimotor processes. Accordingly, our specific aims are: Aim1. Demonstrate motor adaptation to applied loads in individuals post stroke. Specifically, we aim to assess the motor adaptation to a resistance/assistance load in individuals post stroke. The muscle activities and kinematics of the lower extremities will be recorded to quantify the motor adaptive effects of resistance/assistance loads. We expect that leg muscle activity and limb kinematics will adapt to the applied loads and show aftereffects when removed; Aim 2. Improve gait training paradigms using resistance as tolerated strategy. We aim to assess locomotor recovery using resistance as tolerated/assistance as needed strategy to control the load applied to the paralyzed leg during BWSTT. Gait kinematics and clinical measurements of impairment and walking function will be obtained at pre, post training, and at the follow up. Significant improvements are expected in the BWSTT combined with resistance, compared to the assistance training group. The results from this study will lead to innovative clinical therapies aimed at improving locomotor recovery in patients post stroke. We anticipate that this technique will be useful for improving gait in individuals post stroke through robotic-assisted BWSTT. PUBLIC HEALTH RELEVANCE: The purpose of the proposed research is to improve the efficacy of body weight supported treadmill training (BWSTT) in people post-stroke using a novel robotic therapy that applies controlled forces to the paralyzed leg during walking. The results from this study will lead to innovative clinical therapies aimed at improving locomotor recovery in patients post stroke. We anticipate that this technique will be useful for improving gait in individuals post stroke through robotic-assisted BWSTT.