Fatigue and mobility in stroke: a Biomechanical and Neurophysiological Investigation

这项拟议的职业发展奖（CDA-1）的长期目标是加快培训， PI的发展，使他能够建立独立的病因学研究路线， 中风后疲劳和步态及平衡功能障碍的后果。在他大学学习之前， 在美国海军陆战队服役9年，获得荣誉退役， 他的服务合同到期。PI在科罗拉多州立大学完成了人类生物能量学博士学位 在大学期间，他在同行评审的期刊上发表了15篇手稿。自从毕业以来， 另一篇论文被接受，并有两篇手稿正在审查中。目前，他正在训练的监护下， Mark G博士鲍登，PT，博士，在拉尔夫H。约翰逊退伍军人医疗中心。该提案将允许PI 获得神经生理学评估和分析，生物力学评估所需的必要技能 和分析，以及神经影像学分析，以建立和独立的VA支持的研究计划， 减少疲劳的影响，步态和平衡功能障碍，在健康和神经受损 老兵组装的指导团队由PI希望的每个技能组的专家组成， 获得。高达92%的中风后患者会感到疲劳，疲劳会对身体和精神产生负面影响。 性能下降，导致生活质量下降。疲劳还影响许多其他神经系统人群， 对VA感兴趣，如创伤性脑损伤和多发性硬化症。知识的进步和 对卒中后疲劳的理解也可能导致其他VA临床人群的类似进展。第一 目的是描述退伍军人中风后疲劳的皮质运动反应。答案将是 使用经颅磁刺激传递到下肢的皮质代表进行评估 肌肉，例如，胫骨前肌和比目鱼肌。疲劳严重程度和皮质运动反应变量将相关 建立神经生理学改变和中风后疲劳之间的联系。我们希望看到更长，更低 MEP振幅，刺激潜伏期，和皮质沉默期的参与者与高水平的疲劳， 这表明疲劳的中枢机制可以在未来的脑刺激疗法中成为目标。第二 本研究的目的是确定高度疲劳的参与者是否表现出独特的步态生物力学 特色将计算自选和禁食舒适步行速度之间的差异， 步态的动力学和运动学特性。这些差异，即，步行能力/储备，代表一种可能的 对中风后疲劳的行为适应，以最大限度地减少由于高感知疲劳而产生的努力。我们预计 中风后疲劳程度较高的退伍军人将以较低的百分比（自我选择）行走， 最大容量（最快舒适）。这一目标预计将确定中风后的行为后果， 疲劳可能会加剧与流动性差和身体/社会活动参与有关的健康结果。

The long-term goal of this proposed career development award (CDA-1) is to accelerate the training and development of the PI, allowing him to establish and independent line of research into the etiology and consequences of post-stroke fatigue and dysfunctions of gait and balance. Prior to his collegiate studies the PI served on active duty in the United States Marine Corps for nine years, receiving an Honorable Discharge upon the expiration of his service contract. The PI completed his PhD in Human Bioenergetics at Colorado State University and published 15 manuscripts in peer-reviewed journals during his time there. Since graduating has had another paper accepted and has two manuscripts under review. Currently he is training under the tutelage of Dr. Mark G. Bowden, PT, PhD, at the Ralph H. Johnson VA Medical Center. This proposal will allow the PI to gain the necessary skills needed in neurophysiological assessment and analysis, biomechanical assessment and analysis, and neuroimaging analysis to establish and independent VA backed research program focusing on reducing the impact of fatigue, and gait and balance dysfunctions in healthy and neurologically impaired Veterans. The assembled mentorship team is composed of experts in each of the skillsets the PI is hoping to obtain. Up to 92% of people post-stroke experience fatigue and fatigue negatively affects physical and mental performance and leads to a lower quality of life. Fatigue also affects many other neurological populations of interest to the VA, such as traumatic brain injury and multiple sclerosis. Advances in the knowledge and understanding of post-stroke fatigue may also lead to similar advances in other VA clinical populations. The first aim is to characterize the corticomotor response in Veterans with post-stroke fatigue. The response will be assessed using transcranial magnetic stimulation delivered to the cortical representations of lower extremity muscles, e.g., tibialis anterior and soleus. Fatigue severity and corticomotor response variables will be correlated to establish the link between altered neurophysiology and post-stroke fatigue. We expect to see longer, Lower MEP amplitudes, stimulation latency, and corticosilent periods in participants with high levels of fatigue, signifying a central mechanism of fatigue that can be targeted in future brain stimulation therapies. The second aim of this study is to determine if participants with high levels of fatigue display unique gait biomechanical characteristics. Differences between self-selected and fasted comfortable walking speeds will be calculated for kinetic and kinematic properties of gait. These differences, i.e., walking capacity/reserve, represent a possible behavioral adaptation to post-stroke fatigue to minimize effort due to high perceived fatigue. We expect that Veteran’s with higher reported post-stroke fatigue will walk at a lower percentage (self-selected) of their maximal capacity (fastest comfortable). This aim is expected to identify behavioral consequences of post-stroke fatigue that may exacerbate health outcomes related to poor mobility and physical/social activity participation.