Elucidating the role of the contralesional corticoreticulospinal tract for lower limb function after stroke.

阐明对侧皮质脊髓束对中风后下肢功能的作用。

• 批准号: 10667897
• 负责人: Sangeetha Madhavan
• 金额: $ 23.99万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667897
• 关键词: Address; Affect; Ankle; Area; Bilateral; Brain; Cerebral hemisphere; Chronic; Corticospinal Tracts; Data; Development; Diffusion Magnetic Resonance Imaging; Dimensions; Fiber; Functional Magnetic Resonance Imaging; Goals; Health Care Costs; Healthcare; Impairment; Individual; Ipsilateral; Knowledge; Lesion; Limb structure; Lower Extremity; Measurement; Measures; Methodology; Modeling; Motor; Motor Pathways; Movement; Neural Pathways; Paresis; Participant; Pathway interactions; Performance; Phase; Physical activity; Quality of life; Recovery; Rehabilitation therapy; Reporting; Research; Role; Severities; Side; Stroke; Testing; Transcranial magnetic stimulation; Walking; Work; blood oxygen level dependent; brain pathway; care burden; chronic stroke; community involvement; disability; gait rehabilitation; imaging study; improved; innovation; insight; motor control; neuroregulation; novel; post stroke; response; reticulospinal tract; societal costs; stroke recovery; stroke rehabilitation; tool; walking rehabilitation; walking speed; Address; Affect; Ankle; Area; Bilateral; Brain; Cerebral hemisphere; Chronic; Corticospinal Tracts; Data; Development; Diffusion Magnetic Resonance Imaging; Dimensions; Fiber; Functional Magnetic Resonance Imaging; Goals; Health Care Costs; Healthcare; Impairment; Individual; Ipsilateral; Knowledge; Lesion; Limb structure; Lower Extremity; Measurement; Measures; Methodology; Modeling; Motor; Motor Pathways; Movement; Neural Pathways; Paresis; Participant; Pathway interactions; Performance; Phase; Physical activity; Quality of life; Recovery; Rehabilitation therapy; Reporting; Research; Role; Severities; Side; Stroke; Testing; Transcranial magnetic stimulation; Walking; Work; blood oxygen level dependent; brain pathway; care burden; chronic stroke; community involvement; disability; gait rehabilitation; imaging study; improved; innovation; insight; motor control; neuroregulation; novel; post stroke; response; reticulospinal tract; societal costs; stroke recovery; stroke rehabilitation; tool; walking rehabilitation; walking speed

Project Summary/Abstract Chronic walking impairments such as decreased walking speed, endurance, and independence are common after stroke and limit physical activity, quality of life, and community involvement. These walking impairments contribute to high healthcare costs and the development of secondary disabilities. Walking impairments tend to persist despite gait rehabilitation, partly because we lack a comprehensive understanding of which brain pathways contribute to lower limb and walking recovery after stroke. Emerging evidence suggests that ipsilaterally-descending motor pathways from the non-lesioned hemisphere to the stroke-affected limb, specifically the corticoreticulospinal tract, may be enhanced. However, the measurement tools used in prior work, when considered in isolation, provide limited insight into whether this pathway is functional enhanced and contributes to improved lower limb function. The primary objective of this proposal is to address this question with the long-term goal of improving gait rehabilitation after stroke by identifying recovery-related motor pathways that can be targeted. Our central hypothesis is that the corticoreticulospinal tract from the non-lesioned brain hemisphere to the more affected limb will be enhanced after stroke. The secondary objective of this proposal is to determine whether the strength of the corticoreticulospinal tract from the non-lesioned brain hemisphere influences lower limb motor control. To achieve the objectives of this proposal, two specific aims will be tested in individuals with chronic stroke with a range of impairment. In Aim 1, we will develop a multi-dimensional estimate of whether the corticoreticulospinal tract is enhanced after stroke by combining three measures used in prior research: functional magnetic resonance imaging (non-lesioned brain activation), diffusion tensor imaging (structural integrity), and transcranial magnetic stimulation (functional excitability). In Aim 2, the association between the strength of the corticoreticulospinal tract from the non-lesioned hemisphere and lower limb motor control will be assessed. This analysis will account for measures of stroke severity (lesion load and lower limb impairment). The proposed work would be the first to use a multifaceted approach to comprehensively and rigorously assess whether brain pathways from the non-lesioned hemisphere to the stroke-affected lower limb are enhanced after stroke. Results from this work will improve our understanding of the brain pathways that contribute to walking recovery after stroke, essential information for improving walking rehabilitation. The proposed work will also provide insight into how stroke impairment influences the mechanisms of recovery and the optimal rehabilitative strategy. Support for the central hypothesis will be a major breakthrough that supports the potential for neuromodulation applied to non-lesioned brain pathways pathways to lead to improvements in walking recovery after stroke. Improvements in walking rehabilitation that result from the proposed work could lead to substantial reductions in chronic walking impairment, disability, and societal cost of stroke.

项目摘要/摘要 慢性步行障碍（例如步行速度，耐力和独立性）很常见 中风并限制体育锻炼，生活质量和社区参与。这些行走障碍 促进高医疗保健成本和继发性残疾的发展。步行障碍往往 尽管步态康复，但仍坚持不懈，部分是因为我们对哪种大脑缺乏全面的理解 途径有助于下肢和中风后的步行恢复。新兴证据表明 从非静态半球到中风影响的肢体，同侧降级的电路途径， 具体的皮质肺导脊髓道可能会得到增强。但是，在先前工作中使用的测量工具， 当孤立地考虑时，就可以有限地了解该途径是否具有功能性增强和 有助于改善下肢功能。该提议的主要目的是解决这个问题 通过确定与恢复相关的电路通路，以改善中风后步态康复的长期目标 可以针对目标。我们的中心假设是来自非仪器的大脑的皮质孔脊髓道 中风后，半球到受影响更大的肢体。该提议的次要目标是 确定是否是从非损坏的脑半球的皮质肺脊髓道的强度 影响下肢电动机控制。为了实现该提案的目标，将测试两个具体目标 在患有一系列损害的慢性中风的个体中。在AIM 1中，我们将开发多维 通过组合使用三种措施，估计中风后皮质肺导脊髓段是否会增强 在先前的研究中：功能性磁共振成像（非损坏的大脑激活），扩散张量成像 （结构完整性）和经颅磁刺激（功能兴奋性）。在AIM 2中，协会 在非静态半球和下肢运动的皮质孔脊髓段的强度之间 控制将被评估。该分析将解释中风严重程度的度量（病变负荷和下肢 损害）。拟议的工作将是第一个使用多方面的方法进行全面和 严格评估从未延节的半球到中风影响下肢的脑道路是否 中风后增强。这项工作的结果将提高我们对大脑通路的理解 促进中风后的步行恢复，这是改善步行康复的重要信息。这 拟议的工作还将提供有关中风障碍如何影响恢复机制和 最佳的康复策略。支持中央假设将是支持的重大突破 神经调节的潜力应用于未延伸的大脑途径，导致改善 中风后步行恢复。拟议工作导致的步行康复的改善可能 导致慢性步行障碍，残疾和中风的社会成本大大减少。