Mechanisms underlying impaired postural corrections following stroke

中风后姿势矫正受损的机制

基本信息

批准号：
9269590
负责人：
CLAIRE F. HONEYCUTT
金额：
$ 24.46万
依托单位：
ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-02-05 至 2019-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9269590
关键词：
Address Agonist Automobile Driving Bilateral Caring Complex Data Development Effectiveness Elderly Electromyography Equilibrium Fall prevention Family Flexor Future Goals Hospitals Impairment Incidence Individual Involuntary Movements Knowledge Lead Limb structure Link Measures Mediating Motor Movement Muscle Outcome Study Paresis Patients Pattern Performance Persons Population Posture Prevention program Public Health Quality of life Recovery Reflex action Rehabilitation therapy Reporting Risk Factors Role Shapes Stereotyping Stimulus Stroke Surface Time Toes Training Training Programs Translations United States Weight Work arm arm movement base cost effective therapy exercise intervention fall risk falls improved individualized medicine kinematics limb movement medical complication motor impairment post stroke programs relating to nervous system response stroke survivor treadmill

项目摘要

PROJECT ABSTRACT/SUMMARY Fall prevention programs have had mixed results highlighting the need for more effective therapies that tackle the most common medical complication in stroke survivors. Task-specific training, which directly targets improving an individual's response during a fall, offers potential. The long-term goal of this proposal is to develop task-specific training that accounts for the unique balance challenges of stroke survivors that is both effective and time efficient. The ability to implement a task-specific training program in stroke survivors is thwarted by a lack of empirical evidence about which factors and mechanisms lead to a failed recovery during a balance disturbance in this population. An essential component of a successful recovery (avoidance of a fall) is compensatory limb movement – taking a step to regain balance or reaching to a stable surface. We recently noted important similarities between compensatory movements and startle-evoked movements – the involuntary release of planned movement when exposed to startling stimuli. Specifically, startle-evoked and compensatory movements share similar deficits following stroke – delayed, diminished muscle activity, and inappropriate patterns of muscle activation. Thus our central hypothesis is that deficits in compensatory movements post-stroke are driven by deficits in startle-evoked movements. In Aim 1, our objective is to quantify stroke survivors' response during a balance disturbance identifying the key, trainable factors that lead to unsuccessful recovery (i.e. a fall). In brief, stroke survivors will be exposed to backward translations of a treadmill while quantifying stability measures, trunk and step kinematics, paretic limb parameters, and electromyography. Factors will be assessed for their ability to classify successful (fall avoidance) and failed (fall) recoveries. These factors can then be assessed for trainability in future task-specific training paradigms for stroke survivors. In Aim 2, we will pursue identification of the mechanism driving deficits in compensatory movements to arm perturbation in stroke survivors. Our objective is to evaluate the impact of deficits in startle- evoked movement on the ability of stroke survivors to effectively compensate during an arm perturbation. To precisely control perturbation parameters and allow bilateral assessment of paretic and non-paretic limbs, we will evaluate subjects while seated. In Aim 3, we will combine knowledge gained in Aims 1 & 2 and evaluate the link between factors that contribute to falls and the mechanisms proposed. Our objectives are to 1) evaluate the link between triggering a startle-evoked movement and successful compensatory movement during a balance challenge in unimpaired individuals and 2) evaluate the relationship between deficits in startle-evoked movement and deficits in compensatory limb movements post-stroke. The rationale for the proposal is to establish both the factors and mechanisms driving unsuccessful recovery during a fall post- stroke in order to generate an effective task-specific training paradigm in the next application.

项目摘要/摘要秋季预防计划的结果混合了结果，强调了对解决方案的更有效疗法的需求中风生存中最常见的医学并发症。特定于任务的培训，直接针对在秋季提高个人的反应，可以提供潜力。该提议的长期目标是开发特定于任务的培训，以解决两者的中风生存的独特平衡挑战有效和时间效率。在中风生存中实施特定于任务的培训计划的能力是由于缺乏关于哪些因素和机制导致恢复失败的经验证据而挫败该人群的平衡灾难。成功恢复的重要组成部分（避免跌倒）是补偿性肢体运动 - 迈出一步以重复平衡或达到稳定的表面。我们最近注意到补偿性运动和惊吓诱发的运动之间的重要相似之处 - 暴露于令人震惊的刺激时，计划运动的非自愿释放。具体来说，惊吓诱人和中风后具有相似的补偿性运动 - 延迟，肌肉活动减少，并且肌肉激活的不适当模式。我们的中心假设是在补偿性中定义中风后的运动是由惊吓诱发的运动中的定义驱动的。在AIM 1中，我们的目标是在平衡灾难中量化中风生存的反应，以识别钥匙，可训练的因素失败的恢复（即秋天）。简而言之，中风生存将暴露于跑步机在量化稳定性措施，躯干和步骤运动学，副肢体参数和肌电图。将评估因素对成功分类（避免秋天）的能力并失败（秋季）恢复。然后可以评估这些因素以在未来的特定任务培训范例中进行培训中风存活。在AIM 2中，我们将识别驱动补偿性缺陷的机制动作中风存活中的动作。我们的目的是评估缺陷在惊吓中的影响唤起了行程生存能力在手臂扰动过程中有效补偿的能力的运动。到精确控制扰动参数，并允许双边评估术和非肢体，我们座位时会评估受试者。在AIM 3中，我们将结合获得目标1和2的知识并评估导致跌倒的因素与提出的机制之间的联系。我们的目标是1）评估触发惊吓诱人运动与成功的补偿运动之间的联系在未启示的个人的平衡挑战中，2）评估缺陷之间的关系惊吓诱发的运动，并在中风后定义了补偿性肢体运动。理由提议是建立在秋季后秋季恢复失败的因素和机制 - 中风是为了在下一个应用程序中生成有效的特定任务培训范例。