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Advancing the delivery of aerobically intense walking training for walking recovery after stroke

Stroke survivors define the recovery of safe, efficient, and independent walking as a top research priority after stroke. Eighty percent of stroke survivors experience significant and lasting walking challenges with approximately 1/4 of survivors unable to achieve independent walking by three months after stroke. The heterogeneous nature of post stroke recovery presents a significant challenge in developing more targeted, personalized walking interventions after stroke.

The effectiveness of neurorehabilitation to facilitate motor recovery is predicated on the ability of the nervous system to reorganize and remodel (i.e., neuroplasticity) in response to an intervention. Aerobic exercise generates neuroplastic potential meaningful for motor learning; this is largely evidenced by improvements in motor skill acquisition, accuracy, and retention in neurologically-intact individuals following an acute bout of high intensity exercise. The beneficial priming effect of high intensity aerobic exercise suggested by these results is exciting, especially in the context of stroke motor recovery, yet the exact mechanisms contributing to the beneficial priming effect of exercise on learning are not well defined.

In contrast, it is well-recognized that, along with task-specificity and amount of practice, aerobic intensity is a critical training parameter for walking recovery interventions after stroke. Indeed, higher aerobic training intensities have generally contributed to greater improvements in walking function, as measured by improvements in functional measures of walking speed and endurance, in addition to cardiovascular fitness. Given the evidence, recent clinical practice guidelines for stroke gait rehabilitation emphasize training intensity to not only drive cardiovascular benefits but to also promote neuroplastic changes that maximize the potential for motor learning after stroke. That is, beyond the amount of practice, the intensity of practice is considered a critical component of the “dose” of training. However, strategies to optimize the dosage of training parameters for a given stroke survivor remain largely undefined.

Taken together, there is a recognized need to (i) expand the evidence-base of performance measures that may aid in optimizing training dose, including the (ii) use of biomarkers, and to (iii) explore promising interventions focused on optimizing the intensity of practice.

Study 1 of this dissertation is meant to expand the evidence-base of performance measures that may aid in optimizing training dose by improving the ability to monitor training intensity—a critical component of training dose—during walking after stroke. To that end, I developed and validated five equations that can be used by clinicians at point-of-care to more accurately and reliably measure training intensity compared to the current standard proxy measure, heart rate monitoring. Study 2 of this dissertation is meant to evaluate the effects of a novel soft robotic exosuit-assisted walking intervention focused on optimizing training intensity, as well as the value of an intensity-dependent molecule, brain-derived neurotrophic factor (BDNF), as a biomarker of treatment efficacy. Results suggest that exosuit-assistance may promote high intensity walking training, at a level that elicits an increase in serum BDNF levels, and in a manner that may reduce the reliance on propulsion-based compensatory walking mechanics that worsen peak propulsion symmetry. / 2024-01-17T00:00:00Z
Date17 January 2023
CreatorsCataldo, Anna Virginia Roto
ContributorsAwad, Louis N.
Source SetsBoston University
Detected LanguageEnglish
RightsAttribution-ShareAlike 4.0 International,

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