# Brain Networks of Turning Performance with Aging and Stroke

> **NIH VA IK1** · VETERANS HEALTH ADMINISTRATION · 2023 · —

## Abstract

The objective of this CDA-1 proposal is to launch my independent research career in the area of mobility function
and rehabilitation in Veterans with neurological impairments. Specifically, I am interested in the neural control of
turning while walking, which is often impaired for older adults and people who have had a stroke. Leveraging my
prior training and experience in assessing and analyzing turning performance, I am proposing to expand my
skillset by adding training in clinical trials, neuroimaging, and neuromodulation. I have assembled a mentoring
team of experts in these particular fields who hold faculty appointments at Malcom Randall VA Medical Center
and the University of Florida. This CDA-1 proposal is supported by the infrastructure of Dr. David Clark’s (primary
mentor) ongoing Merit Review study that aims to determine the effects of prefrontal transcranial direct current
stimulation (tDCS) in augmenting complex locomotor learning in older adults with mobility impairment. Recent
research from Clark and colleagues indicates that the prefrontal cortical networks play a critical role in the control
of complex walking tasks and the acquisition and consolidation of new motor skills (as suggested by
neuroimaging and neuromodulation studies). These findings provide the scientific basis for the parent Merit
Review study and supports the innovative use of tDCS as an adjuvant to enhance training for complex walking
tasks. Dr. Clark’s novel complex locomotor learning protocol trains study participants to practice complex walking
tasks such as walking over obstacles, over compliant (soft) terrain, and turning. While assessing a variety of
functional gait measures, the parent Merit Review study does NOT include turning as an outcome measure.
Turning assessments proposed in this CDA-1 will be a novel addition to the study. Notably, turning is a complex
movement requiring neural control, movement planning, dynamic balance, and coordination. From the moment
we wake up, to when we fall asleep, nearly half of our steps incorporate some degree of a turn, which can result
in serious injury if performed poorly. For instance, a fall while turning is eight times more likely to result in a hip
fracture compared to a fall while walking straight ahead. Additionally, prolonged 360˚ turn duration in older adults
is strongly associated with increased fall risk, loss of independence, and reduced walking speed. However, our
understanding of the specific characteristics and mechanisms of declines in turning function remain poorly
understood, and the potential for restoration of turning function is uncertain. The proposed CDA-1 will study
whether tDCS combined with a complex walking intervention can specifically enhance turning performance.
Therefore, the objective of this proposal is to elucidate whether tDCS and complex locomotor learning can
enhance turning performance and furthermore, identify associations between gains in turning performance and
baseline measur...

## Key facts

- **NIH application ID:** 10536898
- **Project number:** 1IK1RX003954-01A1
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Clayton Swanson
- **Activity code:** IK1 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2023
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-11-01 → 2024-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10536898

## Citation

> US National Institutes of Health, RePORTER application 10536898, Brain Networks of Turning Performance with Aging and Stroke (1IK1RX003954-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10536898. Licensed CC0.

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