Corticospinal Efficacy as a Prognostic Indicator for Walking Recovery Post-stroke

皮质脊髓功效作为中风后步行恢复的预后指标

基本信息

批准号：
10665005
负责人：
Carolynn Patten
金额：
--
依托单位：
VA NORTHERN CALIFORNIA HEALTH CARE SYS
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：
2015-06-01 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10665005
关键词：
Accounting Acute Address Adult Affect Ankle Articulation Biomechanics Characteristics Chronic Clinical Compensation Corticospinal Tracts Data Development Distal Flexor Functional disorder Gait Gait speed Generations Goals Healthcare Systems Heterogeneity Hip region structure Hospitalization Impairment Individual Intervention Joints Knowledge Leg Limb structure Link Locomotion Locomotor Recovery Lower Extremity Measures Metabolic Motor Motor Evoked Potentials Motor output Movement Muscle Neurologic Outcome Paresis Pattern Persons Physiological Physiological Adaptation Prediction of Response to Therapy Production Quality of life Recovery Rehabilitation therapy Research Residual state Role Spinal Stroke Therapeutic Intervention Training Transcranial magnetic stimulation Treatment outcome United States Vertebral column Veterans Walking Work ankle joint dorsiflexor behavioral outcome design disability efficacious intervention functional disability gait rehabilitation hemiparesis improved innovation insight neurological rehabilitation neurophysiology neuroregulation novel strategies physically handicapped post intervention post stroke predicting response preservation primary outcome prognostic indicator public health relevance recruit rehabilitation strategy remediation responders and non-responders response restoration spinal reflex stroke survivor walking rehabilitation walking speed

项目摘要

DESCRIPTION (provided by applicant): Stroke is the leading cause of serious, chronic disability in adults worldwide. Over 750,000 cases of first- ever stroke occur in the United States each year accounting for over half of all acute neurological hospital admissions. While two-thirds of persons who suffer a stroke regain the ability to walk, the resulting gait pattern is slow, asymmetrical and metabolically inefficient Walking dysfunction represents one of the greatest physical limitations post-stroke and improved walking is among the most frequently articulated goals of neurorehabilitation. To date, rehabilitation for walking dysfunction post-stroke has produced highly variable outcomes revealing minimal genuine change in walking function including walking speed or pattern. Our long-term goal is to improve walking post-stroke. The objective of this proposal is to investigate the neurophysiological mechanisms that underlie the capacity for locomotor recovery post-stroke. Specifically, our aim is to identify neurophysiologic measures differentiating stroke survivors who do or do not to a therapeutic intervention. We postulate that the efficacy of descending motor tracts to the distal leg muscles (plantar and dorsiflexors) is greatly reduced in low functioning stroke survivors, while this efficacy is at least partially preserved in higher functioning individuals. The first aim of this project seeks to differentiate high and low functioning stroke survivors based upon the proportion of distinguishable motor evoked potentials (MEPs) observed in the distal leg muscles during walking. We anticipate lower functioning individuals will have a smaller percentage of distinguishable MEPs compared to higher functioning individuals. In the second aim of this project we will evaluate the relationship between corticomotor function in the distal leg and biomechanical function during walking. Our preliminary data suggest a link between the corticospinal function and force production during walking. Specifically, we expect MEP modulation across the gait cycle correlates with ankle plantarflexor power generation during walking. In the third aim of the proposal we will evaluate whether corticospinal efficacy can predict post-intervention improvements in walking function. Using an efficacious intervention developed in our previous work, we will conduct a study of power training to pilot comparisons of pre-intervention measures of corticospinal efficacy with post-intervention gains in walking function. We anticipate that individuals with higher corticospinal efficacy will show the largest improvements in gait speed and locomotor function post-intervention. The results of this study will fill a gap in current knowledge by providing a prognostic indicator of an individual's capacity to recover walking function post-stroke. Furthermore, insights gained from this study can be used to develop targeted rehabilitation strategies to maximize neurorehabilitation.

描述（由申请人提供）：中风是全球成人严重，慢性残疾的主要原因。每年在美国发生了超过750,000例首次中风病例，占所有急性神经病医院入院的一半以上。尽管遭受中风的人中有三分之二仍然存在行走的能力，但最终的收集模式是缓慢，不对称和代谢效率低下的步行功能障碍，这代表了势头后的最大身体限制和改善的步行是最常见的神经疗养目标之一。迄今为止，冲程后恢复功能障碍的康复产生了高度可变的结果，揭示了步行功能（包括步行速度或图案）的真正变化最小。我们的长期目标是改善后击步行。该提案的目的是研究中风后运动能力的基础的神经生理机制。特别是，我们的目的是确定与治疗干预措施不同或不进行治疗干预的中风生存的神经生理测量。我们假设，在低功能的中风存活中，下降运动区向远端腿部肌肉（足底和背屈）的效率大大降低，而这种效率至少在较高功能的个体中得到了部分保留。该项目的第一个目标旨在根据步行过程中在不同的腿部肌肉中观察到的可区分运动诱发电位（MEP）的比例来区分高功能的中风存活。我们预计，与较高功能的个体相比，功能较低的个体的可区分MEP比例较小。在该项目的第二个目标中，我们将评估关系在步行过程中，在圆盘腿中的皮质运动功能与生物力学功能之间。我们的初步数据表明，步行过程中皮质脊髓功能与力产生之间的联系。具体而言，我们预计整个聚集周期的MEP调制与步行过程中的踝部plantarflexor发电相关。在该提案的第三个目标中，我们将评估皮质脊髓效率是否可以预测行走功能的干预后改善。利用先前工作中开发的有效干预措施，我们将对电力训练进行研究，以比较皮质脊髓效率的干预前测量与步行后干预后的增长。我们预计，皮质脊髓效率较高的个体将在干预后显示出速度和运动功能的最大改善。这项研究的结果将通过提供个人在击球后恢复行走功能的能力的预后指标，从而填补当前知识的空白。此外，从这项研究中获得的见解可用于制定有针对性的康复策略以最大化神经居住。