Mechanism-based Strategies to Restore Post-Stroke Gait Stability through Targeted Motor Adaptation

通过有针对性的运动适应恢复中风后步态稳定性的基于机制的策略

• 批准号: 9317366
• 负责人: JESSE C. DEAN
• 金额: $ 18.46万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-08 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9317366
• 关键词: Address; Behavior; Clinical; Complex; Development; Elements; Environment; Equilibrium; Failure; Fall prevention; Foundations; Gait; Goals; Human; Incidence; Individual; Intervention; Investigation; Knowledge; Learning; Link; Location; Locomotor training; Mechanics; Methods; Motion; Motor; Movement; Nature; Neurologic; Neuromechanics; Participant; Patients; Pattern; Population; Positioning Attribute; Quality of life; Rehabilitation therapy; Research; Robot; Shapes; Stroke; Techniques; Testing; Therapeutic Intervention; Time; Training; Walking; Work; base; design; fall risk; falls; fear of falling; foot; improved; individual patient; kinematics; motor control; new technology; novel; post stroke; prevent; rehabilitation paradigm; restoration; stroke intervention; stroke survivor; treadmill; walking speed

Project Summary / Abstract Independent mobility, the ability of an individual to successfully navigate through their environment, is a primary contributor to quality of life. Unfortunately, mobility often decreases following a stroke, preventing many people with stroke from returning to typical levels of activity participation. A major contributor to reduced mobility is gait instability, which can limit function either by increasing the risk of falls or by decreasing an individual's confidence in their balance. Existing rehabilitation techniques have been shown to improve certain aspects of post-stroke gait function, such as increasing self-selected walking speed. However, these interventions have generally failed to address gait instability, as evidenced by a lack of improvement in fall risk. The long term objective of this line of research is to develop a toolbox of interventions for improving post-stroke gait instability, allowing clinicians to select the most appropriate option for individual patients. This project will focus on a potential mechanistic cause of instability, which has been suggested by preliminary work that identified a consistent neuromechanical gait stabilization strategy among controls. The present approach contrasts with typical investigations of gait instability, which largely focus on quantifying non-causal indicators of stability rather than understanding the underlying mechanism. The central hypothesis is that post-stroke gait instability is commonly caused by a lack of mechanically- appropriate adjustments in foot placement. Individuals with stable gait patterns consistently use a strategy of actively controlling their mediolateral foot placement based on the mechanical state of their center of mass. However, this evidence of active stabilization is lacking in a sub-population of stroke survivors with an increased fall risk. The proposed work will investigate the effects of a novel force-field designed to allow the real-time manipulation of mediolateral foot placement without interfering with gait progression. The first Specific Aim is to determine whether foot placement assistance promotes use of the typical gait stabilization strategy. The force-field will be used to encourage mechanically-appropriate foot placement while stroke survivors walk, which may drive restoration of gait stability by allowing participants to practice the desired movement pattern in an appropriately challenging environment. The second Specific Aim is to determine whether foot placement perturbation promotes use of the typical gait stabilization strategy. The force-field will be used to perturb foot placement away from mechanically-appropriate target locations, potentially causing error-driven adaptation toward the desired gait pattern as participants seek to cancel out these errors. The proposed project is based on a quantitative understanding of human gait mechanics, and takes advantage of a recently developed force-field designed to allow gait manipulations that were previously not feasible. The resultant knowledge has the potential to make an important contribution to the development of a larger-scale rehabilitation paradigm in which therapeutic interventions are targeted to a patient's specific limitations.

项目摘要 /摘要 独立流动性，个人成功地浏览环境的能力是 生活质量的主要贡献者。不幸的是，中风后的流动性通常会降低，阻止了许多 从返回典型的活动参与水平的人。减少的主要贡献者 移动性是步态不稳定性，它可以通过增加跌倒风险或减少一个来限制功能 个人对平衡的信心。现有的康复技术已被证明可以改善某些 冲程后步态功能的各个方面，例如提高自我选择的步行速度。但是，这些 干预措施通常无法解决步态不稳定性，这是由于缺乏跌倒风险的改善所证明的。 这一研究的长期目标是开发一种干预措施的工具箱，以改善势头 步态不稳定性，使临床医生可以为个别患者选择最合适的选择。这个项目将 专注于潜在的不稳定性原因，初步工作已经提出了这一点 确定了对照之间的一致神经力学步态稳定策略。目前的方法 与步态不稳定性的典型研究形成鲜明对比，步态不稳定性主要集中于量化非因果指标 稳定而不是理解基本机制。 中心假设是，势后步态不稳定性通常是由于缺乏机械性的 - 脚步安排适当调整。步态模式稳定的人一贯使用 根据其质量中心的机械状态积极控制其中外侧的位置。 但是，这种主动稳定的证据缺乏 跌落风险增加。拟议的工作将研究一个新型力场的影响，旨在允许 实时操纵中外侧脚的位置，而不会干扰步态进展。第一个特定 目的是确定脚步辅助是否促进了典型的步态稳定策略的使用。 在中风幸存者步行时，将使用力场来鼓励机械适合的脚部放置， 通过允许参与者练习所需的运动模式，这可能会推动步态稳定性的恢复 一个充满挑战的环境。第二个具体目的是确定是否放置 扰动促进使用典型的步态稳定策略。力场将用于驱动脚 远离机械适合目标位置的位置，可能导​​致错误驱动的适应 随着参与者寻求取消这些错误，朝着所需的步态模式迈进。 拟议的项目是基于对人步态力学的定量理解，并利用了优势 最近开发的力场旨在允许步态操纵以前不可行。这 结果知识有可能为发展大规模的发展做出重要贡献 治疗干预措施针对患者的特定局限性的康复范式。