Acquisition and Retention of Locomotor Adaptations after Stroke

中风后运动适应的获得和保留

• 批准号: 8094408
• 负责人: Susanne M Morton
• 金额: $ 17.46万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8094408
• 关键词: Adult; Affect; Age; Behavior; Brain; Cerebellum; Chronic; Corticospinal Tracts; Development; Disinhibition; Effectiveness; Electromyography; Foundations; Frequencies; Gait; Gender; Handedness; Human; Individual; Intervention; Lead; Learning; Leg; Lesion; Limb structure; Location; Locomotor adaptation; Measures; Motion; Motor; Motor Cortex; Motor output; Movement; Output; Patients; Pattern; Phase; Physiologic pulse; Play; Process; Rehabilitation therapy; Research; Role; Side; Source; Stroke; Structure; Subgroup; System; Testing; Time; Transcranial magnetic stimulation; Walking; Work; base; chronic stroke; design; disability; improved; insight; limb movement; motor deficit; motor impairment; motor learning; nervous system disorder; novel; patient population; prevent; public health relevance; repetitive transcranial magnetic stimulation; success; visual feedback; visual motor

DESCRIPTION (provided by applicant): Motor learning forms a foundation for rehabilitation interventions to treat patients with debilitating neurological disorders such as stroke. It is now known that the cerebellum is required for motor adaptations and motor learning. The motor cortex is also involved in motor learning, but its specific role is less clear. Recent studies indicate that the motor cortex may be more involved in the consolidation and/or retention phases of motor learning than in the initial acquisition. It is not known whether individuals with stroke involving the motor cortex have deficits in retention of newly acquired motor adaptations. Broadly, the purpose of this research is to determine the effects of unilateral stroke involving the primary motor output system on retention of a newly learned visuomotor walking adaptation in humans. Motion capture, electromyography and transcranial magnetic stimulation (TMS) will be used to record limb movements and to measure and modulate corticospinal excitability, respectively. In Aim 1, visual feedback during walking will be altered to induce a novel gait pattern in healthy and stroke-affected adults that, in stroke subjects, is designed to improve symmetry of single limb support durations between the legs. Initial adaptation and retention of the new walking pattern will be measured and compared across groups at several time periods. Subject with stroke are expected to show reduced retention but relatively intact adaptation. In Aim 2, low frequency inhibitory repetitive TMS (rTMS) will be applied over the primary motor cortex (M1) of the non- lesioned hemisphere in individuals with stroke prior to walking. Effects of rTMS on the acquisition and retention of the visuomotor walking adaptation will be measured and compared to a group of stroke subjects receiving sham stimulation. Single pulse TMS will be used to measure changes in corticospinal excitability before and after rTMS. We predict that inhibitory rTMS to the non-lesioned M1 will improve retention of the walking adaptation in stroke subjects, and will be associated with disinhibition of the lesioned M1. We also expect to find that the level of benefit from rTMS varies with lesion location. Results from the proposed aims will help determine whether individuals with stroke involving the primary motor output system have deficits in acquisition and/or retention of newly adapted walking patterns and whether this deficit can be temporarily improved using rTMS. This work is particularly important because 1) it will help determine the role of the motor cortex in acquisition and/or retention of motor adaptations, 2) it will support or refute the proposed mechanism of overly strong transcallosal inhibition from the non-lesioned hemisphere as a source of motor impairment in patients with stroke, and 3) it may lead to the development of novel therapies to enhance motor learning and retention in patients with motor disability due to stroke. PUBLIC HEALTH RELEVANCE: Results from these studies will provide novel insights into brain mechanisms of impaired motor learning following stroke. Importantly, findings are expected to help lead to the development of new rehabilitation interventions to enhance motor learning of locomotor patterns in patients with stroke. Thus, this work will have broad impact on public heath, as stroke is a leading cause of long-term disability and leaves many of its victims unable to walk without assistance.

描述（由申请人提供）：运动学习为治疗患有衰弱神经系统疾病（例如中风）患者的康复干预措施的基础。现在已经知道，小脑适应和运动学习是必需的。运动皮层也参与运动学习，但其具体作用尚不清楚。最近的研究表明，运动皮层可能比最初的获取更多地参与运动学习的巩固和/或保留阶段。尚不清楚涉及运动皮层的中风的个体是否在保留新获得的运动适应性方面存在缺陷。从广义上讲，这项研究的目的是确定涉及主要运动输出系统的单侧中风对新知识的Visuomotor步行适应性的保留的影响。运动捕获，肌电图和经颅磁刺激（TMS）将分别用于记录肢体运动并分别测量和调节皮质脊髓兴奋性。在AIM 1中，步行过程中的视觉反馈将被改变，以诱导健康和中风影响的成年人中的新型步态模式，在中风受试者中，旨在改善腿之间的单肢支撑持续时间的对称性。在几个时间段内，将测量和比较新的步行模式的初始适应和保留。中风的受试者预计将显示保留率降低，但相对完整的适应性。在AIM 2中，低频抑制重复TMS（RTM）将在行走前具有中风的个体中未酸化半球的一级运动皮层（M1）上应用。将测量RTMS对视觉运动改编的获取和保留的影响，并将其与接受假刺激的一组中风受试者进行比较。单脉冲TMS将用于测量RTM前后皮质脊髓兴奋性的变化。我们预测，抑制不延伸的M1的RTM将改善中风受试者的行走适应性的保留，并将与病变的M1抑制有关。我们还希望发现，RTMS的收益水平随病变位置而变化。拟议的目标的结果将有助于确定涉及主要电动机输出系统的中风的个体在获取和/或保留新适应的步行模式方面是否存在缺陷，以及是否可以使用RTMS暂时改善这种赤字。这项工作尤其重要，因为1）它将有助于确定运动皮层在收购和/或保留运动适应性方面的作用，2）它将支持或反驳非静态半球过度强烈的透性抑制的拟议机制，从而使运动型的运动能力使运动型和运动性更高，并在运动过程中导致运动型的运动障碍，并在运动中促进运动，并在运动中延长了运动，并在运动中延长了运动。 公共卫生相关性：这些研究的结果将提供对中风后运动学习受损的大脑机制的新见解。重要的是，预计发现将有助于发展新的康复干预措施，从而增强中风患者运动模式的运动学习。因此，这项工作将对公共荒地产生广泛的影响，因为中风是长期残疾的主要原因，并使许多受害者无法在没有援助的情况下行走。