University of California, Los Angeles (UCLA)

Recovery of Walking in Older Persons After Stroke

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We propose to better understand the optimal intensity and duration of a technique for retraining walking in older patients with stroke, who no longer qualify for ongoing therapy. The technique, body weight-supported treadmill training (BWSTT), offers a highly reproducible type and quantifiable intensity of rehabilitation, unlike more conventional interventions for walking. Thus, we can use the intervention to probe for the optimal intensity and duration of therapy. Our study will determine the amount of BWSTT that maximizes gains in independence, walking speed, and the distance a patient can walk.

At the same time, we will monitor the effects of practice during the reacquisition of the motor skill of walking on the organization of the brain’s control of leg movement, using a noninvasive technique called functional magnetic resonance imaging (fMRI). The changes in brain reorganization may serve as a physiologic marker for the potential efficacy of training. In addition, we are comparing the effects of intensive training alone, versus training under the influence of approved medications. We hope to learn if the rate or overall success of retraining can be augmented by pharmacotherapy.

The overall goal is to develop a model that can predict whether the hemiplegic patient is likely to improve walking skills based on clinical features in early and subsequent stages, and in response to a drug agent.