Brain Networks of Turning Performance with Aging and Stroke

衰老和中风影响转向性能的大脑网络

• 批准号: 10536898
• 负责人: Clayton Swanson
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536898
• 关键词: Accounting; Address; Adjuvant; Adult; Aging; Anodes; Appointment; Area; Award; Behavior assessment; Bilateral; Brain; Cathodes; Characteristics; Clinical; Clinical Trials; Complex; Corticospinal Tracts; Data; Elderly; Electric Stimulation; Electrodes; Enrollment; Equilibrium; Faculty; Florida; Future; Gait; Goals; Grant; Hip Fractures; Impairment; Incidence; Individual Differences; Infrastructure; Injury; Intervention; Knowledge; Learning; Left; Lower Extremity; MRI Scans; Magnetic Resonance Imaging; Measures; Medical center; Mentors; Motor Skills; Movement; Neuroanatomy; Neurologic; Outcome; Outcome Measure; Parents; Participant; Performance; Pilot Projects; Play; Prefrontal Cortex; Protocols documentation; Quality of life; Randomized; Rehabilitation therapy; Research; Rest; Risk; Role; Sampling; Scalp structure; Short-Term Memory; Stroke; Structure; Task Performances; Testing; Time; Training; Transcranial magnetic stimulation; Universities; Veterans; Walking; aged; career; career development; cognitive function; cognitive testing; design; experience; fall risk; falls; gray matter; improved; innovation; interest; mobility rehabilitation; motor learning; neural; neural circuit; neuroimaging; neuromechanism; neurophysiology; neuroregulation; noninvasive brain stimulation; novel; post intervention; post stroke; primary outcome; restoration; sensor; skills; stroke hemiparesis; stroke survivor; transcranial direct current stimulation; walking intervention; walking speed; wireless

The objective of this CDA-1 proposal is to launch my independent research career in the area of mobility function and rehabilitation in Veterans with neurological impairments. Specifically, I am interested in the neural control of turning while walking, which is often impaired for older adults and people who have had a stroke. Leveraging my prior training and experience in assessing and analyzing turning performance, I am proposing to expand my skillset by adding training in clinical trials, neuroimaging, and neuromodulation. I have assembled a mentoring team of experts in these particular fields who hold faculty appointments at Malcom Randall VA Medical Center and the University of Florida. This CDA-1 proposal is supported by the infrastructure of Dr. David Clark’s (primary mentor) ongoing Merit Review study that aims to determine the effects of prefrontal transcranial direct current stimulation (tDCS) in augmenting complex locomotor learning in older adults with mobility impairment. Recent research from Clark and colleagues indicates that the prefrontal cortical networks play a critical role in the control of complex walking tasks and the acquisition and consolidation of new motor skills (as suggested by neuroimaging and neuromodulation studies). These findings provide the scientific basis for the parent Merit Review study and supports the innovative use of tDCS as an adjuvant to enhance training for complex walking tasks. Dr. Clark’s novel complex locomotor learning protocol trains study participants to practice complex walking tasks such as walking over obstacles, over compliant (soft) terrain, and turning. While assessing a variety of functional gait measures, the parent Merit Review study does NOT include turning as an outcome measure. Turning assessments proposed in this CDA-1 will be a novel addition to the study. Notably, turning is a complex movement requiring neural control, movement planning, dynamic balance, and coordination. From the moment we wake up, to when we fall asleep, nearly half of our steps incorporate some degree of a turn, which can result in serious injury if performed poorly. For instance, a fall while turning is eight times more likely to result in a hip fracture compared to a fall while walking straight ahead. Additionally, prolonged 360˚ turn duration in older adults is strongly associated with increased fall risk, loss of independence, and reduced walking speed. However, our understanding of the specific characteristics and mechanisms of declines in turning function remain poorly understood, and the potential for restoration of turning function is uncertain. The proposed CDA-1 will study whether tDCS combined with a complex walking intervention can specifically enhance turning performance. Therefore, the objective of this proposal is to elucidate whether tDCS and complex locomotor learning can enhance turning performance and furthermore, identify associations between gains in turning performance and baseline measures of cognitive function, neuroanatomical structure and function (measured with magnetic resonance imaging; MRI), and [neurophysiological function (measured with transcranial magnetic stimulation; TMS)]. Specific Aim 1 will test the hypothesis that turn related performance gains and retention for the 360˚ and 180˚ turns will be greater for the active tDCS group vs. the sham tDCS group. To test this, we will measure turning performance at four distinct timepoints (baseline, 1-day, 1-week, and 1-month post intervention) using wireless inertial sensors. Specific Aim 2 will test the hypothesis that larger turning improvements on the 360˚ and 180˚ turn tests will be associated with – greater baseline working memory (2a), greater baseline gray matter volume (2b), and greater baseline functional network connectivity (2c). [Specific Aim 3 will test the hypothesis that participants with greater baseline cortical inhibition (measured by TMS) will demonstrate larger 360˚ and 180˚ turning performance gains.] This pilot study will enroll 40 mobility compromised older adults and 10 participants post-stroke which will provide preliminary data for a future CDA-2 grant submission, proposing a larger scale clinical trial of turning rehabilitation for mobility compromised Veterans. The long-term objectives of this research are to improve turning performance, mitigate fall risk, and improve the quality of life for Veterans.

该CDA-1提案的目的是启动我在移动功能领域的独立研究生涯 以及具有神经系统障碍的退伍军人的康复。具体而言，我对神经元控制感兴趣 步行时转动，这通常会对老年人和中风的人受到损害。利用我的 事先培训和评估和分析转向绩效的经验，我建议扩大我的 通过在临床试验，神经影像学和神经调节中增加培训来增加技能。我已经组装了一个心理 这些特定领域的专家团队在Malcom Randall VA医疗中心任教 和佛罗里达大学。大卫·克拉克（David Clark）博士的基础设施支持了该CDA-1提案（主要 导师）旨在确定前额叶直流电流的效果的持续功绩审查研究 刺激（TDC）在增加运动障碍的老年人中增强复杂的运动学习。最近的 克拉克及其同事的研究表明，前额叶皮质网络在控制中起着至关重要的作用 复杂的步行任务以及对新运动技能的收购和合并（如 神经影像学和神经调节研究）。这些发现为父母优点提供了科学基础 审查研究并支持TDC的创新使用作为可调节以增强复杂步行的培训 任务。克拉克博士的小说复杂运动学习协议训练参与者练习复杂行走 诸如走过障碍，遵守（柔软）地形和转弯之类的任务。在评估各种各样的同时 功能收集的措施，父母优秀审查研究不包括作为结果措施。 在本CDA-1中提出的转弯评估将是该研究的新补充。值得注意的是，转弯是一个复杂的 运动需要神经控制，运动计划，动态平衡和协调。从现在开始 我们醒来，到入睡时，几乎一半的步骤都包含了一定程度的转弯，这可能会导致 如果表现不佳，处于严重伤害。例如，转弯时跌倒的可能导致髋关节的八倍 裂缝与跌倒相比，直奔前方。此外，老年人长时间延长了360°的持续时间 与跌落风险增加，独立性丧失以及步行速度降低密切相关。但是，我们的 了解特定特征和转弯功能下降的机制仍然很差 理解，恢复转弯功能的潜力尚不确定。拟议的CDA-1将研究 TDC是否与复杂的步行干预措施相结合可以专门提高转弯性能。 因此，该提案的目的是阐明TDC和复杂的运动学习是否可以 提高转弯性能，此外，确定在转向绩效和 认知功能，神经解剖结构和功能的基线测量（用磁性测量 共振成像； MRI）和[神经生理功能（用经颅磁刺激测量； TMS）]。具体目标1将检验以下假设，该假设将360˚和 对于Active TDCS组与Sham TDCS组相比，180°转弯将更大。为了测试这一点，我们将测量 使用四个不同的时间点（基线，1天，1周和1个月的干预）进行扭转性能 无线惯性传感器。特定的目标2将检验以下假设，即360°的转换更大的改进 和180˚转测试将与 - 更大的基线工作记忆（2a），更大的基线灰质 体积（2B）和更大的基线功能网络连接（2C）。 [特定目标3将检验假设 具有较大基线皮质抑制（通过TMS测量）的参与者将显示出更大的360°和 180°转向性能提升。 中风后的参与者将为未来的CDA-2赠款提交提供初步数据，并提出 大规模的临床试验，以损害退伍军人的行动能力康复。长期目标 这项研究旨在提高转弯性能，减轻跌倒风险，并改善退伍军人的生活质量。