Cortical priming to optimize gait rehabilitation post stroke

描述（由申请人提供）：尽管在过去十年中步态研究取得了进展，但对于超过400万中风患者来说，恢复社区行走仍然是一个未完成的目标。最近的人类研究强调了运动皮层在行走中的重要作用，强调需要开发研究范式，以更好地理解皮层机制，从而开发更有效的行走训练方案。经颅直流电刺激（tDCS）正在成为一种有前途的工具，用于加强上肢的任务导向治疗。然而，对于下肢，关于大脑在步态恢复中的作用知之甚少。本研究的目的是开发一种新的 基于对神经适应性的理解的治疗干预，以改善中风幸存者的步态。在这项研究中，我们提出，皮层启动结合踝关节运动控制训练，有望改善麻痹踝关节的意志控制，并将增强步态训练的有益效果。在这项实验中，中度至重度受损的中风后 在施用三种启动模式的OE后，个体将接受快速踏车训练（FTT）方案：与踝运动训练任务组合的易化tDCS（tDCS-AMT）、与踝运动训练任务组合的假tDCS（sham-AMT）或休息期间的易化tDCS（tDCS-rest）。此外，对照组患者（CONT）将在没有任何预激干预的情况下参与FTT方案。目标1将确定 tDCS-AMT对步态速度、步态对称性和踝关节活动度有效性。目的2将通过经颅磁刺激（TMS）测定tDCS-AMT对皮质脊髓机制的有效性。目的3将确定tDCS-AMT对麻痹踝关节运动控制和功能结局的有效性。通过我们的机械方法来增强功能，我们寻求优化中风后的步态康复，并表征神经机制和功能恢复之间的关系。改善步态将使中风幸存者在社区中更加独立，并提高他们的生活质量，这与NIH的使命有关。

DESCRIPTION (provided by applicant): Despite advances in gait research in the last decade, restoration of community walking continues to be an unaccomplished goal for over four million persons with stroke. Recent human studies have highlighted the significant involvement of the motor cortex in walking, emphasizing the need to develop research paradigms that provide a better understanding of cortical mechanisms in order to develop more effective walking training protocols. Transcranial direct current stimulation (tDCS) is emerging as a promising tool for enhancing task- oriented therapy of the upper limb. However, for the lower limb little is known regarding the role of the brain in gait recovery. The objective of this study is to develop a novel therapeutic intervention that is based on understanding neural adaptations to enhance gait in stroke survivors. In this study we propose that cortical priming combined with ankle motor control training is expected to improve volitional control of the paretic ankle and will enhance th beneficial effects of gait training. In this experiment, moderate to severely impaired post- stroke individuals will receive a fast treadmill training (FTT) protocol following the administration of oe of three priming paradigms: facilitatory tDCS in combination with an ankle motor training task (tDCS-AMT), sham tDCS in combination with an ankle motor training task (sham-AMT) or facilitatory tDCS during rest (tDCS-rest). In addition, a control group of patients (CONT) will participate in the FTT protocol in the absence of any priming intervention. Aim 1 will identify the effectiveness of tDCS-AMT on gait speed, gait symmetry and ankle range of motion. Aim 2 will determine the effectiveness of tDCS-AMT on corticospinal mechanisms as measured by transcranial magnetic stimulation (TMS). Aim 3 will determine the effectiveness of tDCS-AMT on paretic ankle motor control and functional outcomes. With our mechanistic approach to enhance function, we seek to optimize gait rehabilitation post stroke and characterize relationships between neural mechanisms and functional recovery. Improved gait will enable stroke survivors to be more independent in the community and advance their quality of life, which is relevant to the mission of the NIH.