The objective of this project is to identify the trajectory of neurological and locomotor recovery in patients early post-stroke and the biomechanical strategies used by patients to accomplish independent locomotion. These patterns of recovery and underlying movement strategies used to accomplish independent ambulation will be assessed during both conventional rehabilitation strategies, and following application of physical interventions, specifically high intensity training (HIT) of stepping tasks, that have been shown to strongly influence multiple measures of neurological and locomotor recovery. Our previous work suggests consistent relationships between the amount of intensity of stepping practice and locomotor recovery (walking gains) following training. However, these findings contrast directly with research that indicates a relative consistent pattern of neurological recovery (measured using specific assessments of movement capability, fractionation of individual joints, or reflex activity), irrespective of the types of interventions provided. These discrepancies may be due to differences in definitions utilized for neurological vs locomotor recovery, but also highlight the potential use of alternative movement patterns post-stroke, during which full restitution of neurological function may not occur in most patients. Rather, compensatory movement strategies must be utilized to accomplish locomotor tasks. The present project will attempt to delineate changes in neurological and locomotor recovery and the underlying strategies used to perform walking tasks (Aim 1). We will subsequently evaluate alterations in specific patterns of neurological and functional recovery in response HIT applied in the later stages post-stroke to ascertain the relative plasticity of these patterns (Aim 2). In a separate cohort, we will apply such training early post-stroke and identify alterations in movement capability and neuromuscular strategies through the recovery phases post-stroke (Aim 3). If neurological recovery is indeed predictable and deterministic, we believe patterns of locomotor recovery and compensation are also deterministic and can be categorized by the amount of movement capability and compensations observed. We further postulate that these patterns are likely malleable with specific interventions and can provide greater insight into long-term functional and neuromuscular outcomes in patients early post-stroke.
The proposed research will characterize of the time course of neurological and locomotor recovery as well as development of compensatory strategies throughout sub-acute and chronic phases post stroke. In addition, we will also investigate the extent to which measures of recovery and compensation are malleable and can be altered with specific interventions in both the early and late stages post-stroke. Delineation of the time course of development and magnitude of patterns of recovery and compensation should result in alternative predictive ?rules? regarding how patients early post-stroke could recovery functional and neurological function.
