Non-invasive Cerebellar Stimulation to Improve Locomotion

描述(申请人提供)：有运动障碍和步态异常的中风患者需要干预以增强体育锻炼的有益效果。小脑对于让行走变得流畅、准确和适应性很重要。我们已经证明，脑损伤的个体仍然能够使用一些小脑依赖的学习机制来暂时改善行走，这表明这些机制可能有助于步态障碍的康复。具体地说，在分裂带跑步机上训练步态不对称的中风患者会产生后遗症，导致更对称的运动模式。这一效果是有希望的，因为它表明这些人仍然有神经灵活性来改变他们的步态模式。然而，随着回到基线异常，这种有益的影响是短暂的。经颅直流电刺激(TDC)是一种非侵入性、无痛苦的刺激形式，当应用于感觉运动皮质时，可以调节皮质运动的兴奋性，提高手运动任务的运动能力和学习能力。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，我们提出了一项假设，即小脑tdcs将增强健康和中风脑损伤患者的运动适应能力。在平行双盲设计中，Aim 1将在健康个体中确定小脑TDCs(阳极、阴极或假)对(A)运动适应的影响，以及(B)通过经颅磁刺激(TMS)皮质脊髓兴奋性的变化。目的2，将使用类似的设计，研究因脑损伤而导致步态异常的卒中患者小脑TDCs引起的行为变化。这项研究将使用两项强大和互补的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。目前还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TDC可以演变为一种经济且易于实施的策略，以帮助解决中风后步态障碍这一重大公共健康负担。公共卫生相关性：这项提案将调查经颅直流电刺激(TDC)对小脑的行为和生理影响，TDC是一种非侵入性、非痛苦的刺激形式。目标是增强小脑功能，这将导致运动学习的改善。我们将在健康人和有步态障碍的中风患者中测试这种干预措施。如果成功，tdcs可能成为一种简单且廉价的治疗干预措施，用于加强中风患者和其他神经疾病患者的运动训练。

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.