CUped: An Approach to Motor Recovery Post-Stroke, not Compensation

CUped：中风后运动恢复的方法，而不是补偿

• 批准号: 10667869
• 负责人: SHEILA M SCHINDLER-IVENS
• 金额: $ 23.14万
• 依托单位: MARQUETTE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-05 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667869
• 关键词: Address; Adoption; Adverse event; Bilateral; Clinical; Communities; Coupled; Data; Development; Dose; Exercise; Funding Opportunities; Future; Goals; Home; Intervention; Laboratories; Left; Limb structure; Lower Extremity; Measures; Mechanics; Modeling; Motor; Movement; Muscle; Nature; Outcome; Output; Paresis; Participant; Performance; Phase; Physiological; Protocols documentation; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Research; Rewards; Risk; Robotics; Running; Safety; Specific qualifier value; Stroke; Target Populations; Technology; Testing; Therapeutic Effect; Therapeutic exercise; Training; United States National Institutes of Health; Walking; Work; design; effective intervention; effective therapy; exercise intervention; gait rehabilitation; improved; limb movement; motor impairment; motor recovery; novel; novel therapeutics; patient tolerability; post stroke; response; restoration; standard care; stroke rehabilitation; stroke survivor; therapy design; treatment response

Project Summary The goal of lower limb rehabilitation after stroke is recovery of independent walking at home and in the community. Few stroke survivors achieve this goal. Suboptimal outcomes are due to the serious and intransigent nature of movement impairments caused by stroke and the scarcity of feasible and effective therapies that restore movement lost to stroke. Our team has developed a novel exercise intervention called CUped (pronounced cupid, like the Roman god) to address barriers to recovery and improve walking after stroke. CUped is so called because it compels use of the paretic limb during a movement that resembles pedaling. This project will examine safety, acceptability, and tolerance to CUped, characterize its therapeutic effects, and identify dose-response relationships. Results will provide preliminary data for an R01 to support a randomized controlled trial (RCT). CUped is designed to help stroke survivors recover lower limb movement lost to stroke, thereby improving walking. It is intended to be used as an adjunct to gait training. CUped uses a robotic technology that eliminates compensatory movements that interfere with recovery, compels use of the paretic lower limb, and targets 3 key movement impairments caused by stroke: decreased muscle output from the paretic limb, inappropriate paretic muscle timing, and abnormal interlimb coordination. Exercise is done in sitting which enables high repetition practice. Like walking, CUped requires continuous, reciprocal use of both lower limbs; effects are likely to transfer to walking. The risk-reward profile of this proposal is ideal for an R21, which is an NIH funding opportunity intended to encourage exploratory/developmental research by providing support for the early and conceptual stages of project development. CUped is a novel therapy grounded in a physiologic premise and based on prior observations from our laboratory. We have pilot data suggesting that CUped fulfills its design specifications, and this study will be the first to test its therapeutic effects. In this Stage 1 rehabilitation trial, we will support or quickly refute the hypothesis that CUped is safe, acceptable, and capable of eliciting a therapeutic response in stroke survivors. We will also examine tolerance to CUped and dose-response effects. If our hypotheses are supported, we will be poised to run an RCT to isolate the effects of CUped and compare them to standard care. Future work will investigate physiologic mechanisms underlying the effects of CUped.

项目概要 中风后下肢康复的目标是恢复在家中和在户外的独立行走 社区。很少有中风幸存者能够实现这一目标。次优结果是由于严重和 中风引起的运动障碍具有顽固性，并且缺乏可行和有效的治疗方法 恢复因中风而丧失的运动能力的疗法。 我们的团队开发了一种新颖的运动干预措施，称为 CUped（发音为丘比特，就像罗马神） 解决中风后康复的障碍并改善步行。 CUped 之所以如此命名是因为它强制使用 类似踩踏板的运动期间的瘫痪肢体。该项目将检查安全性、可接受性、 和对 CUped 的耐受性，表征其治疗效果，并确定剂量反应关系。结果 将为 R01 提供初步数据以支持随机对照试验 (RCT)。 CUped 旨在帮助中风幸存者恢复因中风而丧失的下肢运动能力，从而改善 步行。它旨在用作步态训练的辅助手段。 CUped 使用机器人技术 消除干扰恢复、迫使使用瘫痪下肢的代偿性运动，以及 针对中风引起的 3 种主要运动障碍：瘫痪肢体的肌肉输出减少， 麻痹肌肉时序不适当，肢体间协调异常。锻炼是在坐着的情况下进行的 实现高重复练习。与步行一样，CUped 需要双下肢持续、相互使用； 影响可能会转移到步行上。 该提案的风险回报概况对于 R21 来说是理想的选择，R21 是 NIH 的一项资助机会，旨在 通过为早期和概念阶段提供支持来鼓励探索性/发展性研究 项目开发。 CUped 是一种以生理学为前提并基于先前研究的新型疗法 我们实验室的观察结果。我们的试点数据表明 CUped 满足其设计规范， 这项研究将是第一个测试其治疗效果的研究。在第一阶段康复试验中，我们将支持或 快速反驳 CUped 安全、可接受且能够引发治疗反应的假设 中风幸存者。我们还将检查对 CUped 的耐受性和剂量反应效应。如果我们的假设是 支持，我们将准备运行随机对照试验来隔离 CUped 的影响并将其与标准进行比较 关心。未来的工作将研究 CUped 影响的生理机制。