Achieving functional ambulation post stroke continues to be a challenge for stroke survivors, clinicians and researchers. The proposed study builds on our earlier R01 where we successfully examined the feasibility of a clinically implementable walking program which involves high intensity speed-based treadmill training (HIISTT) in combination with cortical priming to improve walking speed of individuals with stroke. Cortical priming has emerged as a promising adjuvant to enhance the outcomes of motor training. Our research team has pioneered and successfully developed neuromodulation techniques for the lower limb motor cortex using non-invasive transcranial direct current stimulation (tDCS) and ankle motor skill training. In this renewal application, our goal is to quantify the effectiveness of 36 sessions of cortical priming plus HIISTT intervention in comparison to sham priming plus HIISTT. Outcome measures will include gait variables, balance, aerobic capacity, quality of life, neurophysiological measures of descending and interhemispheric corticomotor excitability measured with transcranial magnetic stimulation (TMS), and changes in serum BDNF before, immediately after and 3-months post training. There has been a growing interest in understanding responsiveness to training to personalize stroke rehabilitation.
We aim to understand variability in responsiveness to training using patient-specific parameters such as participant demographics, neurophysiological measures and the presence of genetic variations such as brain derived neurotrophic factor (BDNF) polymorphism. With our innovative mechanistic approach to enhance walking recovery, we seek to optimize gait rehabilitation post stroke and characterize relationships between neural mechanisms, motor function and genetic variations. Improved gait will enable stroke survivors to be more independent in the community and advance their quality of life, which is highly relevant to the mission of the NIH.

Public Health Relevance

Over four million stroke survivors currently living in the United States are unable to walk independently in the community. To increase the effectiveness of gait rehabilitation, it is critical we develop therapies that are based on an understanding of brain adaptations that occur after stroke. This project will be an important step towards the development of a promising therapeutic approach that utilizes brain stimulation and high intensity treadmill training to increase neural drive and walking capacity in stroke survivors and further understand patient- specific responses to prescribe custom walking treatments.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
2R01HD075777-06A1
Application #
10049462
Study Section
Motor Function, Speech and Rehabilitation Study Section (MFSR)
Program Officer
Nitkin, Ralph M
Project Start
2014-01-10
Project End
2025-07-31
Budget Start
2020-08-17
Budget End
2021-07-31
Support Year
6
Fiscal Year
2020
Total Cost
Indirect Cost
Name
University of Illinois at Chicago
Department
Other Health Professions
Type
Sch Allied Health Professions
DUNS #
098987217
City
Chicago
State
IL
Country
United States
Zip Code
60612
David, Fabian J; Goelz, Lisa C; Tangonan, Ruth Z et al. (2018) Bilateral deep brain stimulation of the subthalamic nucleus increases pointing error during memory-guided sequential reaching. Exp Brain Res 236:1053-1065
Sivaramakrishnan, Anjali; Madhavan, Sangeetha (2018) Absence of a Transcranial Magnetic Stimulation-Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors. Stroke 49:2004-2007
Madhavan, Sangeetha; Stoykov, Mary Ellen (2017) Editorial: Motor Priming for Motor Recovery: Neural Mechanisms and Clinical Perspectives. Front Neurol 8:448
Stoykov, Mary Ellen; Corcos, Daniel Montie; Madhavan, Sangeetha (2017) Movement-Based Priming: Clinical Applications and Neural Mechanisms. J Mot Behav 49:88-97
Madhavan, Sangeetha; Bishnoi, Alka (2017) Comparison of the Mini-Balance Evaluations Systems Test with the Berg Balance Scale in relationship to walking speed and motor recovery post stroke. Top Stroke Rehabil 24:579-584
Devanathan, Daya; Madhavan, Sangeetha (2016) Effects of anodal tDCS of the lower limb M1 on ankle reaction time in young adults. Exp Brain Res 234:377-85
Madhavan, Sangeetha; Sriraman, Aishwarya; Freels, Sally (2016) Reliability and Variability of tDCS Induced Changes in the Lower Limb Motor Cortex. Brain Sci 6:
Madhavan, Sangeetha; Stinear, James W; Kanekar, Neeta (2016) Effects of a Single Session of High Intensity Interval Treadmill Training on Corticomotor Excitability following Stroke: Implications for Therapy. Neural Plast 2016:1686414
Sivaramakrishnan, Anjali; Tahara-Eckl, Lenore; Madhavan, Sangeetha (2016) Spatial localization and distribution of the TMS-related 'hotspot' of the tibialis anterior muscle representation in the healthy and post-stroke motor cortex. Neurosci Lett 627:30-5
Nguyen, Tai Tri; Ugwu, John; Madhavan, Sangeetha (2015) Anodal tDCS of the lower limb M1 does not acutely affect clinical blood pressure and heart rate in healthy and post stroke individuals. SOJ Neurol 2:

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