Augmentation of Locomotor Adaptation Post-Stroke
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 85 |
| Updated: | 6/30/2018 |
| Start Date: | April 2013 |
| End Date: | March 31, 2018 |
This project will evaluate two different methods of normalizing the center of mass
acceleration (COMa) in individuals post-stroke, specifically focusing on rates and pattern of
recovery to analyze walking-specific adaptations as precursors to motor learning. In
addition, the proposed project seeks to establish the optimal configuration of electrodes to
activate neural circuits involved in post-stroke locomotion. Once the better method of
training COMa and optimal parameters of electrode placement for tDCS are identified, the
investigators will evaluate the effects of tDCS on locomotor adaptations during single
sessions and over a five-day training period.
acceleration (COMa) in individuals post-stroke, specifically focusing on rates and pattern of
recovery to analyze walking-specific adaptations as precursors to motor learning. In
addition, the proposed project seeks to establish the optimal configuration of electrodes to
activate neural circuits involved in post-stroke locomotion. Once the better method of
training COMa and optimal parameters of electrode placement for tDCS are identified, the
investigators will evaluate the effects of tDCS on locomotor adaptations during single
sessions and over a five-day training period.
The project seeks to establish the optimal configuration of electrodes to change the
excitability of neural circuits involved in post-stroke locomotion, identify effective
strategies for training a specific locomotor adaptation, and improve adaptations via
adjunctive non-invasive brain stimulation. Tools to improve neural excitability may increase
potential for locomotor skill learning, thereby improving rehabilitation outcomes.
Non-invasive brain stimulation with transcranial direct current stimulation (tDCS) has
recently emerged as a simple to administer, low-cost, and low-risk option for stimulating
brain tissue. Cortical excitability is increased after application and preliminary results
imply a relationship to increases in motor activity in those post-stroke. However, inhibition
of the contralesional hemisphere is also shown to improve paretic motor output through
inhibition of excessive maladaptive strategies, and combining the two electrode
configurations may provide additional benefit for locomotor tasks requiring interlimb
coordination. Furthermore, the effects of tDCS on walking function in conjunction with
physical intervention strategies aimed at improving locomotor ability post-stroke are yet
unstudied.
excitability of neural circuits involved in post-stroke locomotion, identify effective
strategies for training a specific locomotor adaptation, and improve adaptations via
adjunctive non-invasive brain stimulation. Tools to improve neural excitability may increase
potential for locomotor skill learning, thereby improving rehabilitation outcomes.
Non-invasive brain stimulation with transcranial direct current stimulation (tDCS) has
recently emerged as a simple to administer, low-cost, and low-risk option for stimulating
brain tissue. Cortical excitability is increased after application and preliminary results
imply a relationship to increases in motor activity in those post-stroke. However, inhibition
of the contralesional hemisphere is also shown to improve paretic motor output through
inhibition of excessive maladaptive strategies, and combining the two electrode
configurations may provide additional benefit for locomotor tasks requiring interlimb
coordination. Furthermore, the effects of tDCS on walking function in conjunction with
physical intervention strategies aimed at improving locomotor ability post-stroke are yet
unstudied.
Inclusion Criteria: Chronic Stroke
1. age 18-70
2. at least six month post-stroke
3. residual paresis in the lower extremity (Fugl-Meyer LE motor score <34)
4. ability to sit unsupported for ≥ 30 sec
5. ability to walk at least 10 ft.
6. self-selected 10 meter gait speed < 0.8 m/s
7. provision of informed consent.
Exclusion Criteria: Acute Stroke
1. Unable to ambulate at least 150 feet prior to stroke, or experienced intermittent
claudication while walking < 200 meters
2. history of congestive heart failure, unstable cardiac arrhythmias, hypertrophic
cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during activities
of daily living
3. History of COPD or oxygen dependence
4. Preexisting neurological disorders, dementia or previous stroke
5. History of major head trauma
6. Legal blindness or severe visual impairment
7. history of significant psychiatric illness
8. Life expectancy <1 yr
9. Severe arthritis or orthopedic problems that limit passive ROM
10. post-stroke depression (PHQ-9 ≥10)
11. History of DVT or pulmonary embolism within 6 months
12. Uncontrolled diabetes with recent weight loss, diabetic coma, or frequent insulin
reactions
13. Severe hypertension with systolic >200 mmHg and diastolic >110 mmHg at rest
14. presence of cerebellar stroke.
We found this trial at
1
site
86 Jonathan Lucas Street
Charleston, South Carolina 29425
Charleston, South Carolina 29425
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