Variable Intensive Early Walking post-Stroke (VIEWS)

项目摘要 这项II期临床试验的目的是确定运动训练参数，特别是 踏步练习的特异性和强度，影响亚急性运动障碍患者的长期活动结果 中风以前的工作表明，这些变量可以影响培训干预的有效性， 没有神经损伤的个体，有一些数据支持它们在慢性中风中的效用。然而，在这方面， 研究系统地评估这些原则在个人早期的独立和综合影响， 接下来的中风稀疏。这一关键的研究差距阻碍了临床转化，目前的临床 实践仍然坚持传统的康复理论，包括低强度干预， 潜在的损伤仅提供高强度步行训练的其他问题还包括 缺乏对运动质量的关注将导致使用补偿运动策略， 可以通过反复练习来加强，或者其他心血管事件的风险应该排除高- 高强度训练不幸的是，几乎没有数据支持这些假设，我们的研究表明， 这些训练参数的应用可以强烈地影响步行功能，以及改善基础的 并改善步态运动学。我们的方法是描述这些训练的效果 关于运动功能和质量恢复的变量，以及损伤和其他移动性的变化 在中风后早期的患者中进行任务，以评估这种训练是否会影响神经功能 恢复或患者是否使用补偿策略。在该2x2析因RCT设计中， 研究将描述与特定和强度的操作相关的移动功能的变化， 练习干预。我们将评估步态速度和耐力的功能措施，时空 对称性，以及心肺健康的措施。我们假设高- 强度，任务特定的步进实践将导致运动措施的显着增加， 与低强度或非特定训练模式相比。在目标2中，我们将描述 障碍（力量）和其他移动任务（平衡，坐到站转移），以确定是否步行 干预可以减轻中风后损害的主要损害。的定量度量 意志力将是主要的结果。在目标3中，我们将描述社区流动性的变化 和生活质量，后者可以告诉我们成本效益。总的来说，这些结果 对亚急性卒中患者进行有效运动干预的潜在影响。

Project Summary The objective of this Phase II clinical trial is to identify how exercise training parameters, particularly the specificity and intensity of stepping practice, influence long-term mobility outcomes in patients with subacute stroke. Previous work indicates these variables can influence the efficacy of training interventions in individuals without neurological injury, with some data to support their utility in chronic stroke. However, studies that systematically assess the independent and combined effects of these principles in individuals early following stroke are sparse. This critical research gap impedes clinical translation, and current clinical practices remain adherent to traditional theories of rehabilitation, including lower intensity interventions focused on underlying impairments. Additional concerns of providing only high-intensity walking training revolve around the lack of attention toward movement quality will result in use of compensatory movement strategies that could be reinforced with repeated practice, or that other risks of cardiovascular events should preclude high- intensity training. Unfortunately, there is little data to support these hypotheses, and our studies suggest that application of these training parameters can strongly influence walking function, as well as improve underlying impairments and improve gait kinematics. Our approach is to characterize the effects of these training variables on recovery of locomotor function and quality, as well as changes in impairments and other mobility tasks in patients early post-stroke, in an effort to evaluate whether such training influences neurological recovery or whether patients utilize compensatory strategies. In this 2x2 factorial RCT design, Aim 1 of the study will characterize changes in mobility function associated with manipulation of specific and intensity of exercise interventions. We will evaluate functional measures of gait speed and endurance, spatiotemporal symmetry, as well as measures of cardiopulmonary fitness. We postulate that combined application of high- intensity, task specific stepping practice will result in significantly greater increases in locomotor measures as compared to lower intensity or non-specific training paradigms. In Aim 2, we will characterize the changes in impairments (strength) and other mobility tasks (balance, sit-to-stand transfers) to determine whether stepping intervention can mitigate the major impairments underlying post-stroke impairments. Quantitative measures of volitional strength will be the primary outcomes. In Aim 3, we will characterize changes in community mobility and quality of life, the later of which can inform us about cost-effectiveness. Overall, these results have potential implications on the delivery of effective exercise interventions in person with subacute stroke.