Novel spatial-motor approaches targeting post-stroke spatial neglect and gait deficits

针对中风后空间忽视和步态缺陷的新型空间运动方法

• 批准号: 10606908
• 负责人: Olufisayo O Aloba
• 金额: $ 5.02万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-17 至 2026-03-16
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606908
• 关键词: Address; Affect; Attention; Attentional deficit; Behavior; Biomechanics; Combined Modality Therapy; Data; Detection; Diagnosis; Electric Stimulation; Electric Stimulation Therapy; Electrodes; Evidence based treatment; Failure; Functional disorder; Future; Gait; Goals; Hypokinesia; Impairment; Individual; Knowledge; Left; Length of Stay; Lower Extremity; Measures; Mentors; Motor; Movement; National Research Service Awards; Neurologist; Output; Paresis; Pathologic; Performance; Persons; Physical Rehabilitation; Production; Protocols documentation; Quality of life; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Research Personnel; Research Proposals; Sampling; Scientist; Side; Spatial Behavior; Stimulus; Stroke; Surface; System; Testing; Therapeutic; Therapeutic Effect; Training; Treatment Protocols; Upper Extremity; Walking; Weight-Bearing state; Work; behavior measurement; clinical training; cognitive function; combinatorial; common symptom; design; disability; effective therapy; evidence base; fall risk; gait rehabilitation; improved; inattention; motor learning; neglect; neuroimaging marker; neuromuscular stimulation; novel; physical therapist; post stroke; rehabilitation paradigm; simulation; spatial neglect; stroke rehabilitation; stroke survivor; targeted treatment; treatment response

PROJECT SUMMARY/ABSTRACT Aiming spatial neglect (SN) is a sub-type of SN that is a dysfunction in initiation/execution of motor–intentional behavior. SN components such as directional hypokinesia, turning behavior, weight-bearing asymmetry, and veering with straight-walking path adversely affect walking. However, there is a paucity of treatments targeting gait dysfunction caused by SN. Dr. Barrett (sponsor) is a leading rehabilitation researcher who has characterized Aiming SN and has established prism adaptation therapy (PAT) as an effective treatment to reduce pathological Aiming SN and improve upper extremity function post-stroke. However, while traditional PAT remains effective for targeting the upper extremity, its generalization to walking has only been studied in able-bodied people. In parallel, other studies have shown that electrical stimulation applied to the affected side improves SN deficits in stroke survivors, but the additive effects of electrical stimulation and PAT are largely unknown. Dr. Kesar (co- sponsor) has expertise in post-stroke gait biomechanics and gait rehabilitation treatments incorporating electrical stimulation. Dr. Kesar has shown that adding electrical stimulation during gait training enhances motor learning, augments force production, restores gait deficits, and improves walking function. Importantly, the feasibility and effects of adding electrical stimulation to augment the effects of PAT and gait training in stroke survivors with SN are not well-studied. Thus, this F31 research proposal seeks to generate data supporting novel motor spatial retraining approaches that can enhance the rehabilitation of SN and gait performance in individuals post-stroke. I will evaluate novel combinations of PAT, electrical stimulation, and gait training, which are effective rehabilitation paradigms previously studied in isolation, as well as their effects on Aiming SN and gait post-stroke. Specifically, this F31 proposal will evaluate the effects of combining PAT and electrical stimulation (Aim 1), as well as PAT and gait training (Aim 2), on Aiming SN and gait performance in post-stroke Aiming SN. I hypothesize that adding stimulation to the neglected upper limb during PAT will induce larger improvements in Aiming SN versus PAT without electrical stimulation and that PAT with electrical stimulation will induce greater generalization to gait performance. In addition, I hypothesize that gait training with stimulation to the left lower limb preceded by PAT will induce larger improvements in gait performance than gait training with stimulation alone. This F31 proposal will capitalize on the PI’s clinical training and mentoring team’s expertise in post-stroke Aiming SN (sponsor Barrett) and gait (co-sponsor Kesar) rehabilitation to address SN and gait deficits in individuals with SN post-stroke. This work will generate novel information that will inform future design of new and targeted treatment protocols for evidence-based rehabilitation of spatial neglect and gait dysfunctions post- stroke, to improve gait function and quality of life in stroke survivors.

项目摘要/摘要 瞄准空间忽略（SN）是SN的子类型，是运动与执行的功能障碍 行为。 SN组件，例如定向性低下，转弯行为，体重不对称和 通过直行的路径转向行走。但是，靶向的治疗很少 步态功能障碍是由SN引起的。 Barrett博士（赞助商）是一位领先的康复研究人员 瞄准SN并已建立棱镜适应疗法（PAT）作为减少病理的有效疗法 瞄准SN并改善上肢功能。但是，尽管传统的PAT仍然有效 为了瞄准上肢，其对步行的概括仅是在健全的人中研究的。 其他研究表明，应用于受影响侧的电气模拟改善了SN的定义 中风存活，但是电刺激和PAT的附加作用在很大程度上是未知的。凯萨尔博士（共同 赞助商）具有势后步态生物力学和步态康复治疗方面的专业知识，以减少电气 刺激。 Kesar博士表明，在收集训练中添加电刺激可以增强运动学习， 增强力量产生，恢复步态定义并改善步行功能。重要的是，可行性和 添加电刺激以增强sn中风存活中PAT和收集训练的影响的影响 没有得到充分研究。这是F31研究建议旨在生成支持新型运动空间的数据 重新训练方法可以增强SN的康复并在中风后收集个人表现。 我将评估PAT，电刺激和聚集训练的新型组合，这是有效的 康复范式以前曾孤立地研究，及其对瞄准后冲程后的瞄准。 具体而言，该F31提案将评估合并PAT和电刺激的影响（AIM 1），因为 以及拍拍和收集培训（AIM 2），瞄准SN并以射击后的瞄准SN进行训练。我假设 在PAT期间，增加被忽视的上肢的刺激将引起更大的改善。 与没有电刺激的PAT相对于PAT，并且用电刺激PAT会引起更大的 对步态性能的概括。此外，我假设 步态训练 向左刺激 肢 在PAT之前，与接受刺激的培训相比，PAT会引起更大的提高性能 独自的。该F31提案将利用PI的临床培训和心理团队的中风专业知识 瞄准SN（赞助商Barrett）和步态（共同赞助者Kesar）康复，以解决SN和步态定义 中风后的个人。这项工作将产生新的信息，这些信息将为新的新设计提供信息 以及针对性的治疗方案，用于基于证据的恢复空间忽视和GYIT功能障碍 中风，以改善中风冲浪者的步态功能和生活质量。