Fatigue and mobility in stroke: a Biomechanical and Neurophysiological Investigation

中风时的疲劳和活动能力：生物力学和神经生理学研究

• 批准号: 9982097
• 负责人: John Harvey Kindred
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982097
• 关键词: Adult; Affect; Ankle; Area; Award; Back; Behavioral; Bioenergetics; Biomechanics; Brain; Caring; Characteristics; Clinical; Clinical Research; Colorado; Contract Services; Development; Doctor of Philosophy; Elements; Environment; Equilibrium; Esthesia; Etiology; Exertion; Fasting; Fatigue; Functional disorder; Future; Gait; Gait speed; Goals; Health; High Prevalence; Hip region structure; Human; Impairment; Individual; Intervention; Investigation; Ischemic Stroke; Journals; K-Series Research Career Programs; Kinetics; Knee; Knowledge; Laboratories; Laboratory Research; Lead; Lesion; Link; Lower Extremity; Magnetism; Manuscripts; Medical center; Mentors; Mentorship; Motor; Motor Evoked Potentials; Multiple Sclerosis; Muscle; Musculoskeletal System; Nervous system structure; Neuraxis; Neurologic; Neurologic Symptoms; Outcome; Output; Paper; Paresis; Participant; Pattern; Peer Review; Perception; Performance; Peripheral; Persons; Physical Function; Physical Rehabilitation; Physiological; Population; Positioning Attribute; Postdoctoral Fellow; Property; Psyche structure; Publishing; Quality of life; Rehabilitation therapy; Reporting; Research; Risk; Severities; Skeletal Muscle; Soleus Muscle; Stroke; System; Task Performances; Techniques; Time; Training; Transcranial magnetic stimulation; Traumatic Brain Injury; United States; Universities; Veterans; Walking; care outcomes; cognitive function; college; design; effective therapy; experience; experimental study; expiration; improved; insight; interdisciplinary approach; interest; kinematics; negative affect; neuroimaging; neurophysiology; neuroregulation; post stroke; programs; psychologic; recruit; reduce symptoms; rehabilitation strategy; research facility; response; skills; social; stem; stroke recovery; therapeutic target; tibialis anterior muscle; tool; walking speed

The long-term goal of this proposed career development award (CDA-1) is to accelerate the training and development of the PI, allowing him to establish and independent line of research into the etiology and consequences of post-stroke fatigue and dysfunctions of gait and balance. Prior to his collegiate studies the PI served on active duty in the United States Marine Corps for nine years, receiving an Honorable Discharge upon the expiration of his service contract. The PI completed his PhD in Human Bioenergetics at Colorado State University and published 15 manuscripts in peer-reviewed journals during his time there. Since graduating has had another paper accepted and has two manuscripts under review. Currently he is training under the tutelage of Dr. Mark G. Bowden, PT, PhD, at the Ralph H. Johnson VA Medical Center. This proposal will allow the PI to gain the necessary skills needed in neurophysiological assessment and analysis, biomechanical assessment and analysis, and neuroimaging analysis to establish and independent VA backed research program focusing on reducing the impact of fatigue, and gait and balance dysfunctions in healthy and neurologically impaired Veterans. The assembled mentorship team is composed of experts in each of the skillsets the PI is hoping to obtain. Up to 92% of people post-stroke experience fatigue and fatigue negatively affects physical and mental performance and leads to a lower quality of life. Fatigue also affects many other neurological populations of interest to the VA, such as traumatic brain injury and multiple sclerosis. Advances in the knowledge and understanding of post-stroke fatigue may also lead to similar advances in other VA clinical populations. The first aim is to characterize the corticomotor response in Veterans with post-stroke fatigue. The response will be assessed using transcranial magnetic stimulation delivered to the cortical representations of lower extremity muscles, e.g., tibialis anterior and soleus. Fatigue severity and corticomotor response variables will be correlated to establish the link between altered neurophysiology and post-stroke fatigue. We expect to see longer, Lower MEP amplitudes, stimulation latency, and corticosilent periods in participants with high levels of fatigue, signifying a central mechanism of fatigue that can be targeted in future brain stimulation therapies. The second aim of this study is to determine if participants with high levels of fatigue display unique gait biomechanical characteristics. Differences between self-selected and fasted comfortable walking speeds will be calculated for kinetic and kinematic properties of gait. These differences, i.e., walking capacity/reserve, represent a possible behavioral adaptation to post-stroke fatigue to minimize effort due to high perceived fatigue. We expect that Veteran’s with higher reported post-stroke fatigue will walk at a lower percentage (self-selected) of their maximal capacity (fastest comfortable). This aim is expected to identify behavioral consequences of post-stroke fatigue that may exacerbate health outcomes related to poor mobility and physical/social activity participation.

该拟议职业发展奖（CDA-1）的长期目标是加速培训和 PI 的发展，使他能够建立独立的病因学和研究路线 在他的大学学习 PI 之前，他研究了中风后疲劳以及步态和平衡功能障碍的后果。 在美国海军陆战队现役九年，获得光荣退伍 PI 在科罗拉多州立大学完成了人类生物能量学博士学位。 大学期间，他在同行评审期刊上发表了 15 篇手稿。 另一篇论文已被接受，并且有两篇手稿正在审阅中，目前他正在接受培训。 Ralph H. Johnson VA 医疗中心的 Mark G. Bowden 博士（PT、PhD） 该提案将使 PI 能够： 获得神经生理学评估和分析、生物力学评估所需的必要技能 和分析，以及神经影像分析，以建立和独立的 VA 支持的研究计划重点 减少健康人和神经受损者的疲劳、步态和平衡功能障碍的影响 经验丰富的导师团队由 PI 希望获得的各个技能领域的专家组成。 高达 92% 的中风后患者会感到疲劳，而疲劳会对身心产生负面影响。 疲劳还会影响许多其他神经系统人群。 VA 的兴趣，例如创伤性脑损伤和多发性硬化症的知识和进展。 对中风后疲劳的理解也可能导致其他 VA 临床人群的类似进展。 目的是表征中风后疲劳退伍军人的皮质运动反应。 使用传递至下肢皮质表征的经颅磁刺激进行评估 肌肉，例如胫骨前肌和比目鱼肌，疲劳严重程度和皮质运动反应变量将相关。 以确定神经生理学改变与中风后疲劳之间的联系，我们期望看到更长、更低的结果。 高度疲劳参与者的 MEP 振幅、刺激潜伏期和皮质沉默期， 表明疲劳的一个核心机制可以作为未来大脑刺激疗法的目标。 这项研究的目的是确定高度疲劳的参与者是否表现出独特的步态生物力学 将计算自我选择的舒适步行速度和空腹舒适步行速度之间的差异。 步态的动力学和运动学特性，即行走能力/储备，代表了可能的差异。 对中风后疲劳的行为适应，以最大限度地减少由于高度感知疲劳而产生的努力。 中风后疲劳报告较高的退伍军人将以较低的百分比（自行选择）步行 最大能力（最快舒适）预计该目标可确定中风后的行为后果。 疲劳可能会加剧与行动不便和身体/社会活动参与不良相关的健康结果。