Functional implications of stroke and Botulinum Neurotoxin on ankle stiffness and viscosity during gait

中风和肉毒杆菌神经毒素对步态过程中踝关节僵硬和粘度的功能影响

基本信息

批准号：
10633500
负责人：
CHANDRAMOULI KRISHNAN
金额：
$ 61.98万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-05-01 至 2028-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10633500
关键词：
Address Affect Age Ankle Bilateral Biomechanics Botulinum Toxins Clinic Clinical Data Equipment Evaluation Exhibits Fostering Foundations Functional disorder Funding Gait Goals Grant Impairment Individual Injection of therapeutic agent Injections Intervention Investigation Joints Knowledge Leg Locomotion Manuals Measurement Measures Mechanics Motion Movement Muscle Nervous System Trauma Orthotic Devices Outcome Patient Care Patients Persons Pharmaceutical Preparations Phase Process Property Qualifying Quality of life Research Resistance Rest Side Social Interaction Stroke Symptoms System Techniques Testing Time Torque Viscosity Visual Walking Work ankle joint botulinum neurotoxin injection botulinum toxin treatment clinical decision-making experience functional outcomes improved improved mobility innovation insight joint stiffness mechanical properties negative affect novel post stroke response spasticity statistics stem stroke rehabilitation stroke survivor stroke therapy tool

项目摘要

PROJECT SUMMARY Gait impairments are ubiquitous after stroke, leading to persistent mobility deficits in most stroke survivors. Assessment of these impairments guides patient care and the use of clinical interventions, yet obtaining a complete picture of the factors that underlie these deficits remains an ongoing challenge. Clinicians currently assess patients post-stroke with coarse, qualitative metrics obtained at rest, combined with functional evaluations and visual inspection of walking. However, these tools only enable assessment of the external changes that underlie patient symptoms and cannot provide insight into internal changes that may cause these symptoms. These internal properties—including how joint stiffness and viscosity vary throughout locomotion— are fundamental mechanical descriptions that govern the movement of the body. Joint stiffness is a key factor in energy storage and forward movement, while joint viscosity describes resistance during gait, and yet these concepts are currently unaccounted for or misjudged in clinical decision making. For example, ankle joint stiffness and viscosity, which clinicians believe to be increased post-stroke, were surprisingly found to be reduced or unchanged when compared to the less-affected side. Additionally, Botulinum Neurotoxin (BoNT) injections—a commonly-used medication for lowering joint stiffness—may cause further reduction in these properties, which could be detrimental to mobility. These initial results highlight the need for treatment that accounts for how joint stiffness and viscosity are affected after stroke and injection therapy. In the proposed work, we go beyond traditional descriptions of gait using quick displacements of the ankle while measuring its mechanical response. We use these data to measure how joint stiffness and viscosity vary during walking. In previous work, we pioneered this approach to quantify joint stiffness and viscosity during motion. In this project, we will extend our approach to determine how stroke and BoNT injection treatment affect these properties. In this project, three aims lay the foundation to transform treatment post-stroke by both investigating new assessments techniques for ankle stiffness and viscosity, and also quantifying how anti-spastic treatment (i.e. BoNT therapy) affects these properties. In our first Aim, we extend the results from our R21 to assess how ankle stiffness and viscosity change post-stroke. In our second Aim, we quantify the effect of Botulinum Neurotoxin to understand how this treatment affects ankle stiffness and viscosity, gait biomechanics, and functional outcomes. This aim is also supported by our preliminary data that demonstrates BoNT reduces joint stiffness. Finally, in our third Aim, we investigate a simpler, surrogate measure for joint stiffness, namely the slope of the joint's torque-angle curve, which could improve the clinical feasibility of our approach. While this research builds upon our previous work, the proposed studies will provide a clear picture of the internal changes that drive gait deficits which can be used to guide treatment, such as injections and orthoses.

项目概要中风后步态障碍普遍存在，导致大多数中风幸存者出现持续的活动能力缺陷。对这些损伤的评估可以指导患者护理和临床干预措施的使用，同时获得目前，全面了解这些缺陷背后的因素仍然是一个持续的挑战。使用在休息时获得的粗略定性指标并结合功能来评估中风后患者然而，这些工具只能对外部进行评估。患者症状背后的变化，无法深入了解可能导致这些症状的内部变化这些内部特性——包括关节刚度和粘度在运动过程中如何变化—— 是控制身体运动的基本力学描述，关节刚度是控制身体运动的关键因素。能量储存和向前运动，而关节粘度描述了步态过程中的阻力，然而这些目前临床决策中的一些概念未被解释或误判，例如踝关节。刚度和粘度被认为在中风后会增加，但令人惊讶地发现与受影响较小的一侧相比，肉毒杆菌神经毒素（BoNT）减少或不变。注射——一种用于降低关节僵硬的常用药物——可能会进一步减少这些症状这些初步结果强调了治疗的必要性。解释了中风和注射治疗后关节僵硬和粘度如何受到影响。在拟议的工作中，我们超越了传统的步态描述，使用脚踝的快速位移，同时我们使用这些数据来测量关节刚度和粘度在过程中的变化。在之前的工作中，我们开创了这种方法来量化运动过程中的关节刚度和粘度。在这个项目中，我们将扩展我们的方法来确定中风和 BoNT 注射治疗如何影响这些在该项目中，三个目标通过调查为改变中风后治疗奠定了基础。踝关节僵硬和粘度的新评估技术，以及量化抗痉挛治疗的效果（即 BoNT 疗法）影响这些特性在我们的第一个目标中，我们扩展了 R21 的结果来评估如何影响这些特性。在我们的第二个目标中，我们量化了肉毒杆菌的作用。神经毒素，以了解这种治疗如何影响踝关节僵硬和粘度、步态生物力学以及我们的初步数据也支持了这一目标，该数据表明 BoNT 可以减少关节疼痛。最后，在我们的第三个目标中，我们研究了一种更简单的关节刚度替代测量方法，即关节刚度。关节扭矩-角度曲线的斜率，这可以提高我们方法的临床可行性。研究建立在我们之前的工作基础上，拟议的研究将提供内部变化的清晰图景导致步态缺陷，可用于指导治疗，例如注射和矫形器。