A TREATMENT FOR EXCESS MOTOR DISABILITY IN THE AGED

老年人过度运动障碍的治疗

• 批准号: 6625273
• 负责人: Edward Taub
• 金额: $ 4.37万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-12-09 至 2003-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6625273
• 关键词: aging; behavioral /social science research tag; chronic brain damage; clinical research; clinical trials; disease /therapy duration; functional ability; human subject; human therapy evaluation; immobilization of body part; limb movement; longitudinal human study; magnetic resonance imaging; mesencephalon; outcomes research; person with disability; physical therapy; psychomotor function; rehabilitation; restricted physical activity; social psychology; stroke

Stroke afflicts over 700,000 persons in America every year. There is thus an urgent need to translate unique behavioral techniques shown to have an impact on plasticity of the nervous system into practical evidence-based therapeutic interventions, especially at a time when the duration of treatments has shortened. In this laboratory we have developed on such set of techniques derived from basic research with an8mal and human subjects. Randomized, controlled studies indicate that it can substantially reduce the motor deficit of patients with mild to moderate chronic strokes from the upper two quartiles of motor functioning and can increase their independence over a period of years. The techniques, termed Constrain- Induced (CI) Movement Therapy, involve motor restriction of the less affected upper extremity for a period of two or three weeks while at the same time training the more affected upper limb. This gives rise to massed or repetitive use of the more affected extremity and to a large increase in use-dependent cortical reorganization involving the recruitment of substantial new regions of the brain in the innervation of more-affected extremity movement. One of the main aims of the proposed research is to determine if Cl Therapy can be used with therapeutic success for increasing the amount of real work extremity use in patients with chronic stroke who have a greater level of motor impairment than those previously worked with in this laboratory (i.e., patients who are approximately in the next to lowest quartile of motor functioning). Another aim is to ascertain whether the locus of the lesion and its size as determined by MRI, are factors influencing the extent to which motor function can be recovered through the use of CI Therapy. This prospective, 4-year randomized trial, including 18-month follow-up will use a crossover design. Eight patients with chronic stroke from the next to lowest quartile of motor functioning will be randomly assigned to receive either Cl therapy (40 subjects) or a General Fitness placebo control intervention (40 subjects). Two years after intake the control patients will be crossed over to receive Cl Therapy. Primary outcome measures will be a laboratory motor function test and amount of extremity use in the real world setting. Changes in psychosocial functioning will also be measured.

每年，中风会困扰着70万人。因此，迫切需要将证明对神经系统的可塑性产生影响的独特行为技术转化为实用的基于证据的治疗干预措施，尤其是在治疗持续时间缩短的时候。在这个实验室中，我们已经开发了从AN8MAL和人类受试者的基础研究中得出的一系列技术。随机，对照研究表明，它可以大大减少从运动功能的上两个四分位数中轻度至中度慢性中风的患者的运动不足，并且可以在几年内提高其独立性。该技术称为约束（CI）运动治疗，涉及在两到三周的上肢受影响较小的上肢的运动限制，同时训练受影响的上肢受影响较大。这引起了较大影响的肢体的大规模或重复使用，并大大增加了使用依赖性的皮质重组，涉及在受影响更大的肢体运动的神经支配中募集大脑的大量新区域。拟议研究的主要目的之一是确定是否可以将CL疗法用于治疗成功，以增加慢性中风患者的实际工作肢体使用量，而慢性中风患者的运动障碍水平比以前在该实验室工作的患者更高（即，在下一至低四分位于运动功能的四分位数中大约是运动功能的患者）。另一个目的是确定病变的轨迹及其大小是否由MRI确定，是影响通过使用CI治疗可以恢复运动功能的程度的因素。这项预期的4年随机试验（包括18个月的随访）将使用跨界设计。从下一到最低的运动功能的慢性中风患者将随机分配接受CL治疗（40名受试者）或一般的健身安慰剂控制干预措施（40名受试者）。摄入两年后，将越过对照患者接受CL疗法。主要结果指标将是实验室运动功能测试和现实世界中的极端使用量。也将测量社会心理功能的变化。