Locomotor Recovery and Compensation Post-stroke

中风后的运动恢复和代偿

基本信息

批准号：
10357603
负责人：
Thomas George Hornby
金额：
$ 38.85万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-02-15 至 2026-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10357603
关键词：
Acute Address Aerobic Algorithms Biomechanics Chronic Chronic Phase Classification Clinical Conflict (Psychology)Data Decision Making Development Devices Equilibrium Financial compensation Fractionation Future Goals Heart Rate Hip region structure Impairment Individual Intervention Joints Locomotion Locomotor Recovery Longitudinal cohort Lower Extremity Measures Methodology Morbidity - disease rate Movement Nervous System Physiology Neurologic Outcome Patients Pattern Persons Phase Posture Publishing Recovery Recovery of Function Reflex action Regression Analysis Rehabilitation therapy Research Speed Subgroup Terminology Therapeutic Intervention Time Training Upper Extremity Walking Work base cohort course development dosage improved independent ambulation insight locomotor tasks mortality motor deficit neurological recovery neuromuscular patient prognosis patient subsets post stroke prediction algorithm rehabilitation strategy response

项目摘要

Project Summary The objective of this project is to identify the trajectory of neurological and locomotor recovery in patients early post-stroke and the biomechanical strategies used by patients to accomplish independent locomotion. These patterns of recovery and underlying movement strategies used to accomplish independent ambulation will be assessed during both conventional rehabilitation strategies, and following application of physical interventions, specifically high intensity training (HIT) of stepping tasks, that have been shown to strongly influence multiple measures of neurological and locomotor recovery. Our previous work suggests consistent relationships between the amount of intensity of stepping practice and locomotor recovery (walking gains) following training. However, these findings contrast directly with research that indicates a relative consistent pattern of neurological recovery (measured using specific assessments of movement capability, fractionation of individual joints, or reflex activity), irrespective of the types of interventions provided. These discrepancies may be due to differences in definitions utilized for neurological vs locomotor recovery, but also highlight the potential use of alternative movement patterns post-stroke, during which full restitution of neurological function may not occur in most patients. Rather, compensatory movement strategies must be utilized to accomplish locomotor tasks. The present project will attempt to delineate changes in neurological and locomotor recovery and the underlying strategies used to perform walking tasks (Aim 1). We will subsequently evaluate alterations in specific patterns of neurological and functional recovery in response HIT applied in the later stages post-stroke to ascertain the relative plasticity of these patterns (Aim 2). In a separate cohort, we will apply such training early post-stroke and identify alterations in movement capability and neuromuscular strategies through the recovery phases post-stroke (Aim 3). If neurological recovery is indeed predictable and deterministic, we believe patterns of locomotor recovery and compensation are also deterministic and can be categorized by the amount of movement capability and compensations observed. We further postulate that these patterns are likely malleable with specific interventions and can provide greater insight into long-term functional and neuromuscular outcomes in patients early post-stroke.

项目概要该项目的目标是尽早确定患者神经和运动恢复的轨迹中风后以及患者用于完成独立运动的生物力学策略。这些用于实现独立行走的恢复模式和基本运动策略将在传统康复策略期间以及应用物理干预措施后进行评估，特别是步进任务的高强度训练（HIT），已被证明对多种因素有强烈影响神经和运动恢复的测量。我们之前的工作表明了一致的关系踏步练习的强度与训练后的运动恢复（步行增益）之间的关系。然而，这些发现与表明相对一致模式的研究形成鲜明对比。神经系统恢复（通过对运动能力的具体评估、个体的分级来测量关节或反射活动），无论提供何种干预措施。这些差异可能是由于用于神经恢复与运动恢复的定义存在差异，但也强调了潜在用途中风后的替代运动模式，在此期间神经功能可能不会完全恢复在大多数患者中。相反，必须利用补偿性运动策略来完成运动任务。本项目将尝试描绘神经和运动恢复的变化以及用于执行步行任务的基本策略（目标 1）。我们随后将评估变更中风后后期 HIT 反应中神经和功能恢复的具体模式确定这些模式的相对可塑性（目标 2）。在一个单独的队列中，我们将应用此类培训中风后早期并通过以下方式识别运动能力和神经肌肉策略的变化中风后的恢复阶段（目标 3）。如果神经系统恢复确实是可预测和确定的，我们相信运动恢复和补偿的模式也是确定性的，可以按观察到的运动能力和补偿量。我们进一步假设这些模式是可能通过特定的干预措施进行延展，并且可以提供对长期功能和功能的更深入的了解中风后早期患者的神经肌肉结局。