Non-invasive Cerebellar Stimulation to Improve Locomotion

描述（由申请人提供）：运动障碍和步态异常的卒中患者需要干预以增强体育训练的有益效果。小脑对于使行走平稳、准确和适应性很重要。我们已经证明，脑损伤的个体保留了使用一些小脑依赖性学习机制暂时改善行走的能力，这表明这些机制可能有助于步态障碍的康复。具体来说，训练中风患者的步态不对称的分裂带跑步机上的后效，诱导一个更对称的运动模式。这种效果是有希望的，因为它表明这些人仍然具有改变步态模式的神经灵活性。然而，这种有益的效果是短暂的，恢复到基线异常。经颅直流电刺激（transcranial direct current stimulation，tDCS）是一种非侵入性无痛刺激，当应用于感觉运动皮层时，可以调节皮质运动兴奋性，增强运动表现和手部运动任务的学习。然而，在健康和中风患者的小脑上应用tDCS是否可以增强运动功能尚不清楚。在这里，我们提出了测试的假设，小脑tDCS将提高运动适应在健康和中风患者脑损伤。在平行双盲设计中，目标1将确定健康个体中小脑tDCS（阳极、阴极或假手术）对（a）使用运动分析的运动适应和（B）使用经颅磁刺激（TMS）的皮质脊髓兴奋性变化的影响。目的2，将使用类似的设计，研究由于脑损伤导致步态异常的中风患者中小脑tDCS引起的行为变化。这项研究将使用两种强大的互补技术来阐明一种新的科学合理的策略的潜在用途和潜在机制，以增强中风后的运动功能。没有普遍接受的治疗方法来提高中风后的训练效果。在这种情况下，小脑tDCS可以发展成为一种经济和易于实施的策略，以帮助解决重大的公共卫生负担，中风后步态障碍。公共卫生相关性：本提案将研究将经颅直流电刺激（tDCS）（一种非侵入性无痛刺激形式）应用于小脑的行为和生理效应。目标是增强小脑功能，这将导致运动学习的改善。我们将在健康个体和伴有步态障碍的中风患者中测试这种干预。如果成功，tDCS可能成为一种简单而廉价的治疗干预，以加强中风患者和其他神经系统疾病的运动训练。

DESCRIPTION (provided by applicant): Stroke patients with locomotor impairment and gait abnormalities require interventions to enhance the beneficial effects of physical training. The cerebellum is important for making walking smooth, accurate, and adaptable. We have shown that individuals with cerebral damage retain their ability to use some cerebellum dependent learning mechanisms to temporarily improve walking, suggesting that these mechanisms could be useful in rehabilitating gait impairment. Specifically, training stroke patients with gait asymmetries on a split belt treadmill resulted in after-effects that induce a more symmetric locomotor pattern. This effect is promising, since it shows that these individuals still have the neural flexibility to change their gait pattern. However, this beneficial effect is short-lived with return to baseline abnormalities. Transcranial direct current stimulation (tDCS), a form of non-invasive non-painful stimulation, can modulate corticomotor excitability and enhance motor performance and learning of hand motor tasks when applied over the sensorimotor cortex. However, whether tDCS can enhance locomotor function when applied over the cerebellum in healthy and stroke patients is unknown. Here, we proposed to test the hypothesis that cerebellar tDCS will enhance locomotor adaptation in healthy and stroke patients with cerebral damage. In a parallel double blind design, aim 1 will determine in healthy individuals the effects of cerebellar tDCS (anodal, cathodal or sham) on (a) locomotor adaptation using motion analysis, and (b) corticospinal excitability changes using transcranial magnetic stimulation (TMS). Aim 2, will use a similar design, to study behavioral changes resulting from cerebellar tDCS in stroke patients with gait abnormalities due to cerebral damage. This investigation will use two powerful and complimentary technologies to clarify the potential use and underlying mechanisms of a new scientifically sound strategy to enhance locomotor function after stroke. There is no universally accepted treatment to enhance training effects after stroke. In this setting, cerebellar tDCS could evolve into an economical and easily implemented strategy to help address a significan public health burden, gait impairment after stroke. PUBLIC HEALTH RELEVANCE: This proposal will investigate the behavioral and physiological effects of applying transcranial direct current stimulation (tDCS), a form of non-invasive non-painful stimulation, to the cerebellum. The goal is to enhance cerebellar function, which would result in an improvement in locomotor learning. We will test this intervention in healthy individuals and stroke patients with gait impairment. If successful, tDCS could become an easy and inexpensive therapeutic intervention to enhance locomotor training in stroke patients and other neurological conditions.