Movement Amplification Training to Enhance Walking Balance Post-Stroke

运动放大训练以增强中风后的行走平衡

基本信息

批准号：
10725856
负责人：
Keith Edward Gordon
金额：
$ 42.61万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
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：
2023-08-01 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10725856
关键词：
Acceleration Address Affect Behavior Biomechanics Clinical Clinical Practice Guideline Clinical Trials Cross-Sectional Studies Custom Development Educational Intervention Elements Environment Equilibrium Exhibits Exploratory/Developmental Grant Exposure to Feedback Functional disorder Future Gait Goals Impairment Individual Intervention Lateral Learning Locomotor adaptation Measures Methodology Methods Mission Motion Motor Movement National Institute of Mental Health National Institute of Neurological Disorders and Stroke Neurosciences Research Outcome Participant Pattern Pelvis Perception Persons Physical activity Quality of life Randomized, Controlled Trials Recommendation Rehabilitation therapy Research Design Research Project Grants Robot Robotics Spinal cord injury Stroke Time Training United States Walking biomechanical test chronic stroke clinical outcome measures clinically significant disability effective intervention efficacy evaluation equilibration disorder experimental study foot functional independence gait rehabilitation improved innovation insight kinematics motor learning nervous system disorder novel post stroke response robotic device tool treadmill visual feedback

项目摘要

Project Summary People with chronic stroke (PwCS) have substantial walking balance dysfunctions that limit independence and participation in walking activities. There is a pressing need to develop effective methods to enhance walking balance in PwCS. Interventions that amplify self-generated movements may accelerate motor learning by enhancing an individual’s perception of movement errors. This method could potentially be applied to help PwCS improve walking balance. To this end, we have developed a cable-driven robot to create a Movement Amplification Environment (MAE) during treadmill walking. The MAE challenges walking balance by applying lateral forces to the pelvis that are proportional in magnitude to real-time lateral center of mass (COM) velocity. Here we propose to evaluate the effects of gait training in a MAE on walking balance in PwCS. Aim 1 will quantify locomotor adaptations that PwCS make to maintain walking balance in a MAE and evaluate the impact of MAE strength, a key gait training variable. We will also examine short-term changes in the ability of PwCS to control their lateral COM excursion during walking (a quantifiable walking balance measure) immediately after MAE training. Aim 2 will evaluate long-term changes in walking balance and daily walking following a 5-week high- intensity gait training intervention performed in a MAE. For Aim 1, we will conduct a single-session cross sectional study wherein twenty PwCS will each participate in two experiments evaluating gait biomechanics (whole body center of mass dynamics and stepping patterns) during and immediately following MAE training. Locomotor adaptations during walking in a MAE and the effect of MAE strength (low, medium, and high) will be examined. We will measure changes in the ability of PwCS to control their lateral COM excursion during walking immediately before and after walking in a MAE. Outcomes will assess if short-term walking balance is enhanced immediately following MAE exposure. For Aim 2, we will employ a pre-post study design wherein ten PwCS will participate in 10-sessions of high intensity gait training performed in a MAE. We will assess pre- to post- changes in walking balance using clinical gait and balance measures, biomechanical assessments, and participation in daily walking (steps/day). Outcomes will assess if long-term walking balance is enhanced following MAE gait training. Our innovative training paradigm, amplifying individuals own self-generated movements, is a radical departure from current practice and could substantially enhance walking balance in PwCS. This study will provide valuable insights about the mechanisms employed by PwCS to maintain their walking balance in a MAE and if beneficial behaviors persist following MAE training. Successful outcomes will motivate a randomized controlled trial to assess efficacy of MAE training on walking balance in PwCS. The broad aim of our proposal aligns closely with the mission of NINDS/NIMH Exploratory Neuroscience Research Grant R21 program to support early-stage projects that seek to develop novel methodology to reduce the burden of neurological disease.

项目概要慢性中风患者 (PwCS) 存在严重的行走平衡功能障碍，限制了独立性和迫切需要开发有效的方法来增强步行活动的参与度。 PwCS 中的平衡，放大自发运动的干预措施可以通过以下方式加速运动学习。增强个人对运动错误的感知，这种方法可能有助于普华永道 (PwCS) 的帮助。为此，我们开发了一种缆绳驱动的机器人来创造运动。跑步机行走期间的放大环境 (MAE) MAE 通过应用来挑战行走平衡。骨盆侧向力的大小与实时侧向质心 (COM) 速度成正比。在这里，我们建议评估 MAE 中的步态训练对 PwCS 中步行平衡的影响，目标 1 将量化。 PwCS 为保持 MAE 中的行走平衡而进行的运动适应并评估 MAE 的影响力量，一个关键的步态训练变量，我们还将检查 PwCS 控制能力的短期变化。 MAE 后立即步行期间的横向 COM 偏移（可量化的步行平衡测量）训练目标 2 将评估 5 周高强度训练后步行平衡和日常步行的长期变化。在 MAE 中进行强度步态训练干预对于目标 1，我们将进行单次横断面训练。研究中，二十名 PwCS 将每人参加两项评估步态生物力学（全身 MAE 训练期间和之后立即进行质心动力学和步进模式）。将检查在 MAE 中行走时的适应情况以及 MAE 强度（低、中和高）的影响。我们将立即测量 PwCS 在行走过程中控制横向 COM 偏移的能力的变化在 MAE 中行走之前和之后，结果将评估短期行走平衡是否立即得到增强。在 MAE 暴露之后，我们将采用事前研究设计，因此 10 名 PwCS 将参与其中。在 MAE 中进行 10 次高强度步态训练，我们将评估步行前后的变化。使用临床步态和平衡测量、生物力学评估以及参与日常步行来保持平衡（步数/天）。结果将评估 MAE 步态训练后长期步行平衡是否得到增强。创新的训练模式，放大个人自己产生的运动，与传统的训练模式截然不同。这项研究将提供有价值的信息。关于 PwCS 在 MAE 中维持步行平衡所采用的机制的见解以及是否有益 MAE 培训后行为持续存在，成功的结果将激发随机对照试验的开展。评估 PwCS 中 MAE 步行平衡训练的效果我们提案的总体目标与此密切相关。 NINDS/NIMH 探索性神经科学研究资助 R21 计划的使命是支持早期阶段旨在开发新方法来减轻神经系统疾病负担的项目。