Priming the Rehabilitation Engine: Aerobic Exercise as the Fuel to Spark Behavioral Improvements in Stroke

启动康复引擎：有氧运动作为改善中风行为的燃料

• 批准号: 10553140
• 负责人: Ryan Ross
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10553140
• 关键词: Address; Adjuvant; Admission activity; Aerobic Exercise; Award; Behavioral; Biological Markers; Blood specimen; Brain; Brain-Derived Neurotrophic Factor; Cognition; Cognitive; Coupled; Data; Dedications; Development; Ducks; Effectiveness; Environment; Exercise; Exposure to; Fostering; Foundations; Funding; Future; Goals; Health; Impairment; Individual; Infrastructure; Institution; Intervention; Long-Term Potentiation; Lower Extremity; Measures; Medical; Medical center; Mental Depression; Mentors; Motor; Movement; Neurobiology; Neurologic; Neuronal Plasticity; Outcome; Participant; Patient Self-Report; Physical Function; Physical Performance; Physical Rehabilitation; Physical assessment; Play; Positioning Attribute; Prevalence; Process; Psyche structure; Quality of life; Randomized; Rehabilitation therapy; Research; Research Personnel; Resources; Role; South Carolina; Stretching; Stroke; Synapses; Therapeutic Intervention; Training; Transcranial magnetic stimulation; Treatment Efficacy; United States; United States National Institutes of Health; Universities; Upper Extremity; Veterans; Work; arm function; cardiovascular health; chronic stroke; cognitive function; cohort; data acquisition; depressive symptoms; design; disability; effective intervention; executive function; experience; functional improvement; improved; innovation; insight; mental function; mortality; motor learning; motor rehabilitation; multidisciplinary; neurological rehabilitation; neuropsychiatry; post stroke; predicting response; psychologic; rehabilitation paradigm; rehabilitation research; rehabilitation strategy; rehabilitative care; response; skills; stroke outcome; stroke recovery; stroke rehabilitation; stroke survivor; tool; virtual reality

Stroke is a leading cause of disability in the United States and poses a significant burden to Veterans. The effectiveness of current intervention approaches is limited and many individuals following stroke live with persistent functional, cognitive and psychological impairments that significantly reduce long-term quality of life. The prevalence of post-stroke disability coupled with reduced stroke mortality rates reflects an increasing need to develop effective rehabilitation strategies aimed at reducing disability and improving quality of life for Veteran stroke survivors. Aerobic exercise (AEx) promotes numerous functional, cognitive, and psychological benefits. Additionally, AEx may enhance neuroplasticity through increases in circulating brain-derived neurotrophic factor (BDNF) and corticomotor excitability (CME). Emerging evidence also supports the use of AEx as a priming tool to enhance motor outcomes following targeted rehabilitation. Our conceptual framework involves priming with AEx prior to targeted motor rehabilitation to enhance the ‘neuroplastic environment” and make the brain more amenable to adaptation, thereby enhancing response to rehabilitation. Specifically, we propose to pair AEx with an upper extremity virtual reality rehabilitation game called Duck Duck Punch (DDP), developed by our team (Co-mentor: Woodbury) as the platform for examining the adjunctive potential of AEx. Therefore the primary aim of this proposal is to evaluate the priming effects of AEx on a motor rehabilitation intervention (i.e. DDP) for chronic stroke survivors. This will be accomplished by examining a cohort of stroke survivors who will be randomly assigned to receive 8 weeks (3 sessions/week) of DDP preceded by either 15 minutes of AEx (AEx+DDP) or a stretching control (CON+DDP). Assessment of physical function before and after the intervention will provide insight into the ability of AEx to enhance the response to motor rehabilitation. The secondary aim of this proposal is to gain insight into the mechanisms that underlie the priming effects of AEx through assessment of circulating BDNF and CME. Additionally, since stroke survivors often experience cognitive and psychological impairments we will also explore the influence of cognitive and psychological function on response to AEx+DDP. A potentially exciting possibility is that AEx facilitates an enhanced neuroplastic environment, which fosters improved function in a variety of aspects of stroke recovery including physical, cognitive, and psychological function. This proposal will be supported by the infrastructure and resources provided by the South Carolina Research Center for Recovery from Stroke (NIH P20 GM109040). Furthermore, the combination of the Ralph H. Johnson VA Medical Center and its affiliated academic institution, Medical University of South Carolina is uniquely positioned to fill the aforementioned gap in understanding for several reasons: 1) Charleston, South Carolina has one of the highest rates of stroke in the nation, and 2) in the last 5 years we have received over $23 million in research funds to support rehabilitation research in stroke recovery. During the award period, the applicant will capitalize on the opportunity to utilize these resources to develop the requisite skills and understanding of neurobiological data acquisition, analysis, and interpretation through direct hands-on training from local renowned experts. The overall goal of this CDA-2 application is to expose the candidate to a rich local environment for stroke recovery research, providing the foundation for his development into an independent VA researcher studying the effects of exercise- based interventions, alone or as adjuvants, for the treatment of Veterans. To accomplish this goal, the proposed training plan will enhance the candidate’s understanding of the neurobiological effects of AEx and the design and delivery of neurorehabilitation trials. The data generated will inform the development of additional AEx-based interventions aimed at improving function and quality of life for individuals following stroke and perhaps other neurological or neuropsychiatric conditions.

中风是美国残疾的主要原因，给退伍军人带来了沉重的负担。 当前干预方法的有效性有限，许多中风患者仍患有中风 持续的功能、认知和心理障碍，显着降低长期生活质量。 中风后残疾的流行以及中风死亡率的降低反映了日益增长的需求 制定有效的康复策略，旨在减少退伍军人的残疾并提高其生活质量 有氧运动 (AEx) 可促进许多功能、认知和心理益处。 此外，AEx 可能通过增加循环脑源性神经营养因子来增强神经可塑性 (BDNF) 和皮质运动兴奋性 (CME) 的新证据也支持使用 AEx 作为启动工具。 为了增强有针对性的康复后的运动效果，我们的概念框架涉及启动 AEx 之前有针对性的康复运动，以增强“神经可塑性环境”并使大脑更 易于适应，增强对康复的反应，具体来说，我们建议将 AEx 与 AEx 配对。 我们团队开发的一款上肢虚拟现实康复游戏，名为 Duck Duck Punch (DDP) （共同导师：Woodbury）作为检查 AEx 辅助潜力的平台，因此是主要的。 该提案的目的是评估 AEx 对运动康复干预的启动效应（即 DDP）针对慢性中风幸存者 这将通过检查一组中风幸存者来完成。 将被随机分配接受 8 周（每周 3 次）的 DDP，然后接受 15 分钟的 AEx (AEx+DDP) 或拉伸对照 (CON+DDP) 前后的身体功能评估。 干预将深入了解 AEx 增强运动康复反应的能力。 该提案的第二个目的是深入了解 AEx 启动效应的机制 另外，通过评估循环 BDNF 和 CME，因为中风幸存者经常经历。 我们还将探讨认知和心理障碍的影响 一个潜在的令人兴奋的可能性是 AEx 促进了增强。 神经可塑性环境，可促进中风恢复各个方面的功能改善，包括 该提案将得到基础设施和心理功能的支持。 资源由南卡罗来纳州中风康复研究中心 (NIH P20 GM109040) 提供。 此外，拉尔夫·H·约翰逊退伍军人医疗中心及其附属学术机构的结合， 南卡罗来纳医科大学具有独特的优势，可以填补所讨论的理解空白 有几个原因：1) 南卡罗来纳州查尔斯顿是全国中风发病率最高的城市之一，2) 过去 5 年，我们收到了超过 2300 万美元的研究资金来支持中风康复研究 在奖励期间，申请人将利用这些资源来恢复。 培养神经生物学数据采集、分析和解释的必要技能和理解 通过当地知名专家的直接实践培训 该 CDA-2 应用程序的总体目标是 让候选人接触丰富的当地环境以进行中风康复研究，提供 为他发展成为一名独立的退伍军人管理局研究员研究运动的影响奠定了基础- 为实现这一目标，单独或作为辅助手段治疗退伍军人。 拟议的培训计划将增强候选人对 AEx 和 神经康复试验的设计和实施所产生的数据将为其他项目的开发提供信息。 基于 AEx 的干预措施旨在改善中风后个体的功能和生活质量 也许还有其他神经或神经精神疾病。