Clinical Trial: Rehabilitating Corticospinal Control of Walking

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Rehabilitation of Corticospinal Control of Walking Following Stroke

Brief Summary: The VHA estimates that over 15,000 Veterans incur a stroke each year. As the population of older Veterans grows, stroke will become an increasingly important problem to the VHA. Recovery of walking function is the most common goal of stroke survivors. The proposed study will test whether training with accurate walking tasks to engage the damaged supraspinal motor pathways is more effective than training with steady state walking. The investigators expect that training accurate tasks will be more effective, thereby improving walking function of Veteran stroke survivors and reducing the burden of care placed on families and on the VHA. Furthermore, this rehabilitation approach can be accomplished at comparable cost to existing rehabilitation approaches, which is important given that the VHA invests $88 million per year toward outpatient care, including physical rehabilitation, in the first six months after stroke. This research also has implications for rehabilitation of other neurologically injured populations, including traumatic brain injury and incomplete spinal cord injury.

Detailed Summary:

Current approaches for rehabilitation of walking following stroke do not sufficiently restore mobility function. For instance, fewer than 50% of individuals with stroke-induced walking dysfunction recover the ability to walk independently in the community. New breakthroughs in rehabilitation are needed that will target the motor impairments responsible for poor walking function in individuals post-stroke. Functional recovery can occur in response to task-specific neuroplasticity of damaged brain circuitry. The corticospinal tract is an important target for neuroplasticity because it plays an important role for control of walking in humans. Research has shown that, compared to steady state walking, accurate gait modification (ACC) tasks are a potent behavioral stimulus for activating the corticospinal tract. Therefore, the investigators propose that training with ACC tasks (e.g., obstacle crossing/avoidance, accurate foot placement, etc.) may be superior to training with steady state walking (SS) for eliciting corticospinal neuroplasticity and recovery of walking function. Most rehabilitation paradigms have previously focused on SS training. This is largely because therapists consider it premature to progress to ACC tasks when persistent deficits of steady state walking still remain. However, this reasoning might be counter-productive, because training only steady state walking may not sufficiently stimulate neuro-plasticity of the damaged corticospinal pathway. In contrast, ACC training is specifically designed to stimulate corticospinal neuroplasticity. Importantly, since ACC training targets a central mechanism, its benefits are expected to generalize across walking conditions. Furthermore, it is expected to benefit most stroke survivors who possess at least a minimal residual capability to activate the corticospinal tract. ACC training also provides an opportunity to practice tasks that are analogous to challenges enc
Sponsor: VA Office of Research and Development

Current Primary Outcome: Change in Walking Speed [ Time Frame: assessed pre-intervention (0 months), post-intervention (3 months) and follow up (six months) ]

Original Primary Outcome: Same as current

Current Secondary Outcome:

Original Secondary Outcome:

• Change in Intermuscular Coordination [ Time Frame: assessed pre-intervention (0 months), post-intervention (3 months) and follow up (six months) ]
  Timing of electromyography from leg muscles
• Change in Synchrony of EMG in Piper frequency band [ Time Frame: assessed pre-intervention (0 months), post-intervention (3 months) and follow up (six months) ]
  EMG frequency analysis to determine if EMG signal content is consistent with recovery of corticospinal drive

Information By: VA Office of Research and Development

Dates:
Date Received: April 23, 2014
Date Started: June 2, 2014
Date Completion: June 2018
Last Updated: April 19, 2017
Last Verified: April 2017