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Proactive and reactive perturbation training to reduce falls and improve gait stability in people with chronic stroke

Award Number: R01HD103923
ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 04/01/2021
PERIOD OF PERFORMANCE END DATE: 03/31/2026

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Proactive and reactive perturbation training to reduce falls and improve gait stability in people with chronic stroke - PROJECT SUMMARY / ABSTRACT Following a stroke, deficits in independent mobility are a primary contributor to decreased quality of life, as many people with chronic stroke (PwCS) are prevented from returning to their prior levels of activity participation or involvement in the community. A major cause of mobility deficits is gait instability, which can increase the risk of falls and limit independent function. While several common rehabilitation methods (e.g. locomotor training, traditional balance training, strengthening) can improve some aspects of function, they have failed to address fall incidence among PwCS. In part, this lack of success is likely due to current interventions not being targeted toward the specific mechanisms causing post-stroke gait instability. A long-term goal of this research is to develop a toolbox of mechanism-based interventions to improve various aspects of post-stroke function. As a step toward this goal, the objective of the present proposal is to determine whether targeted perturbation training can reduce falls in PwCS by improving gait stability. While perturbation training has previously been used to reduce fall risk in other clinical populations, it has thus far been unsuccessful at doing so among PwCS. This lack of success may be due to the nature of the applied perturbations, which are traditionally designed to elicit discrete Reactive responses to avoid a loss of balance. In contrast, the present proposal will apply mechanical perturbations designed to elicit Proactive adjustments in the neuromechanical strategies used to ensure walking stability with every step. Such Proactive perturbations may be better suited to prevent the intrinsic movement errors that are a primary contributor to losses of balance and falls among PwCS. The central hypothesis of this work is that that unlike Reactive methods, Proactive perturbation training will retrain generalized gait stabilization strategies, reducing the risk of falls. This hypothesis will be addressed through three Specific Aims. The first Specific Aim is to determine whether fall rate in PwCS is reduced by Proactive or Reactive training, with immediate clinical implications for the development of interventions that can be applied in the real world. The second Specific Aim is to characterize the neuromechanical mechanisms that underlie gait changes with perturbation training, revealing whether the stabilization strategies normally used to ensure walking balance can be strengthened with appropriately targeted perturbations. Finally, the third Specific Aim is to determine whether Proactive or Reactive training produces generalized gait stabilization, as an ideal intervention would improve resilience even to untrained perturbations that may be experienced in real world walking. The proposed project is based on a neuromechanical framework of bipedal walking control, and thus allows investigation of both clinically relevant outcomes (fall rate) and mechanistic measures of the strategies used to ensure stability. The knowledge resulting from this project has the potential to contribute to the development of a larger-scale rehabilitation paradigm addressing the important problem of post-stroke falls.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $321,843 )
2025	2025	THE MEDICAL UNIVERSITY OF SOUTH CAROLINA	179 ASHLEY AVE	CHARLESTON	SC	29425	CHARLESTON	USA	Child Health and Human Development Extramural Research	000	5	4/21/2025	NON-COMPETING CONTINUATION	$321,843
														Subtotal = $321,843

Issue Date FY: 2024 ( Subtotal = $318,625 )
2024	2024	THE MEDICAL UNIVERSITY OF SOUTH CAROLINA	179 ASHLEY AVE	CHARLESTON	SC	29425	CHARLESTON	USA	Child Health and Human Development Extramural Research	000	4	3/27/2024	NON-COMPETING CONTINUATION	$289,658
2024	2024	THE MEDICAL UNIVERSITY OF SOUTH CAROLINA	179 ASHLEY AVE	CHARLESTON	SC	29425	CHARLESTON	USA	Child Health and Human Development Extramural Research	001	4	5/3/2024	NON-COMPETING CONTINUATION	$28,967
														Subtotal = $318,625

Issue Date FY: 2023 ( Subtotal = $321,843 )
2023	2023	MEDICAL UNIVERSITY OF SOUTH CAROLINA THE	179 ASHLEY AVE	CHARLESTON	SC	29425	CHARLESTON	USA	Child Health and Human Development Extramural Research	000	3	3/13/2023	NON-COMPETING CONTINUATION	$321,843
														Subtotal = $321,843

Issue Date FY: 2022 ( Subtotal = $321,581 )
2022	2022	MEDICAL UNIVERSITY OF SOUTH CAROLINA THE	179 ASHLEY AVE	CHARLESTON	SC	29425	CHARLESTON	USA	Child Health and Human Development Extramural Research	000	2	4/28/2022	NON-COMPETING CONTINUATION	$321,581
2022	2022	MEDICAL UNIVERSITY OF SOUTH CAROLINA THE	179 ASHLEY AVE	CHARLESTON	SC	29425	CHARLESTON	USA	Child Health and Human Development Extramural Research	001	2	5/11/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $321,581

Issue Date FY: 2021 ( Subtotal = $320,795 )
2021	2021	MEDICAL UNIVERSITY OF SOUTH CAROLINA THE	179 ASHLEY AVE	CHARLESTON	SC	29425	CHARLESTON	USA	Child Health and Human Development Extramural Research	000	1	3/31/2021	NEW	$320,795
														Subtotal = $320,795

Grand Total All Awards = $1,604,687

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Proactive and reactive perturbation training to reduce falls and improve gait stability in people with chronic stroke

Award Number: R01HD103923

ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 04/01/2021

PERIOD OF PERFORMANCE END DATE: 03/31/2026

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