A novel, comprehensive approach to post-stroke gait rehabilitation

项目摘要 本项目的目标是确定一种新颖的综合方法的可行性和最佳参数 用于慢性中风患者的步态训练。目前中风后步态训练遵循两种不同的方法 针对步态功能障碍的不同领域（如国际功能分类所定义， 健康和残疾）。基于生物反馈的步态训练通常用于治疗步行模式障碍 (e.g.,相对于健全对照的运动学偏差）;然而，基于有氧运动强度的步态 训练是目前治疗行走活动限制的黄金标准（例如，缓慢的步行速度）。这里我们 建议测试将这些方法合并为单一干预措施的影响， 为中风后患者制定更有效、更全面的步态康复方法。的 中心假设是，慢性中风患者有能力使用生物反馈来减少运动 在一系列推荐的有氧运动强度区域行走时的步态偏差。目标1将确定 步态生物反馈变量，elvent最大的减少肢体间不对称的人中风后。目的2 将决定中风后患者在肢体间进行生物反馈驱动的减少的能力 在三种不同的有氧运动强度下行走时的不对称。目标1中的慢性卒中受试者 每人完成三节实验课，目标2的参与者将完成一节实验课。 生物力学分析和生理评估将用于这两个目标，以测试我们的工作 假设我们希望表明，麻痹性推进的生物反馈导致肢体间的最大减少， 不对称，参与者有能力使生物反馈驱动的肢体间不对称减少 而步行在所有三个有氧强度，但减少的幅度将是最大的在一个中等 有氧步行强度这项拟议中的工作是创新的，因为它将是第一个测试相对影响的工作。 不同步态生物反馈变量对脑卒中后患者全下肢运动学的影响， 两种成熟的步态训练方法（基于生物反馈和强度）的新组合， 神经系统患者人群。这是推动中风后步态康复领域的关键下一步 性新预计结果将产生很大的影响，因为它将提供基础证据来支持 随后的R 01提案旨在评估与以下方面相关的作用机制和长期疗效： 这个新颖的综合性步态康复方案如果成功的话，这一系列的工作将对 改善目前中风后步态康复的护理标准。

PROJECT SUMMARY The goal of this project is to determine the feasibility and optimal parameters of a novel, comprehensive approach to gait training in individuals with chronic stroke. Current post-stroke gait training follows two distinct approaches that target different domains of gait dysfunction (as defined by the International Classification of Functioning, Health, and Disability). Biofeedback-based gait training is typically employed to treat walking pattern impairments (e.g., kinematic deviations relative to able-bodied controls); whereas, aerobic exercise intensity-based gait training is the current gold-standard to treat walking activity limitations (e.g., slow walking speeds). Here, we propose to test the impact of combining these approaches into a single intervention to work toward the development of a more effective, comprehensive approach to gait rehabilitation for persons post-stroke. The central hypothesis is that individuals with chronic stroke have the capacity to use biofeedback to reduce kinematic gait deviations while walking at a range of recommended aerobic exercise intensity zones. Aim 1 will identify the gait biofeedback variable that elicits the largest reduction in interlimb asymmetry in persons post-stroke. Aim 2 will determine the capacity for persons post-stroke to make biofeedback-driven reductions in their interlimb asymmetry while walking at three different aerobic exercise intensities. Participants with chronic stroke in Aim 1 will each complete three experimental sessions and participants in Aim 2 will complete 1 experimental session. Biomechanical analyses and physiologic assessments will be used across both aims to test our working hypotheses. We expect to show that biofeedback of paretic propulsion leads to the greatest reduction in interlimb asymmetry and that participants have the capacity to make biofeedback-driven interlimb asymmetry reductions while walking at all three aerobic intensities, but the magnitude of reduction will be the largest at a moderate aerobic walking intensity. The proposed work is innovative because it will be the first to test the relative effects of different gait biofeedback variables on whole lower extremity kinematics in persons post-stroke and test a novel combination of two well-established gait training approaches (biofeedback- and intensity-based) for neurologic patient populations. This is a critical next step in moving the post-stroke gait rehabilitation field forward. The results are expected to have a high impact because it will provide foundational evidence to support a subsequent R01 proposal aimed to assess the mechanisms of action and long-term efficacy associated with this novel, comprehensive gait rehabilitation protocol. If successful, this line of work stands to significantly improve the current standard of care in gait rehabilitation post-stroke.