Mental Practice Clinical/Neural Effects/Subacute Stroke

心理实践临床/神经效应/亚急性中风

• 批准号: 7012694
• 负责人: STEPHEN J. PAGE
• 金额: $ 11.47万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-04-01 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7012694
• 关键词: alternative medicine; arm; clinical research; clinical trials; functional magnetic resonance imaging; human subject; human therapy evaluation; neuroimaging; neurologic manifestations; neurosciences; patient oriented research; psychomotor function; rehabilitation; stroke; stroke therapy

DESCRIPTION (provided by applicant): Stroke-induced hemiparesis is the most frequent impairment treated by therapists in the United States. Although millions of dollars are spent annually on stroke motor rehabilitation, conventional treatments for hemiparesis are ineffective, leaving patients with substantial motor disability and continued reliance on healthcare and others. The best approach to treat this disabling condition may be to combine promising elements from established disciplines in a new and alternative way. This training plan applies established principles from clinical trial design, neuroscience, and rehabilitation in a nontraditional way to better treat and understand stroke-induced hemiparesis. The immediate objective is to acquire formal, intensive training and experiences in stroke clinical trial design and neuroimaging, and to obtain additional complementary/alternative medicine (CAM) experiences. These activities will fulfill the long-term career objective, which is improving motor function after stroke by organizing trials examining mechanisms of action and efficacy of CAM interventions in stroke. The training plan provides exceptional mentoring from recognized leaders, and didactics in outstanding interdisciplinary environments. Mental practice (MP), a CAM mind-body technique in which physical skills are cognitively rehearsed, increases motor learning and performance in nondisabled individuals. Our pilot data suggest that MP significantly reduces hemiparesis in subacute stroke patients. However, MP efficacy using randomized controlled methods, and MP mechanisms of action, are unknown. Aims of the research study herein proposed are to: (1) measure the impact of MP on affected arm function in subacute stroke patients using stroke-specific, established, outcome measures; and (2) determine MP mechanisms of action using functional magnetic resonance imaging (fMRI). The central study hypothesis is that MP will significantly improve affected arm function in subacute stroke patients, and that these improved outcomes are accompanied by cortical reorganization. The central hypothesis will be tested and aims fulfilled using a multiple baseline, randomized controlled study, in which 30 subacute stroke patients receive either MP or a control intervention, both after affected arm therapy. Outcome measures include the FugI-Meyer Motor Assessment, the Action Research Arm Test, the Wolf Motor Function Test, and the Stroke Impact Scale. fMRI will examine possible MP-induced cortical reorganizations. As an outcome of the proposed study, MP efficacy and mechanisms in subacute stroke will be determined, producing a validated protocol that improves motor function. This study will also increase understanding of relationships among neural and functional outcomes in stroke, and provide pilot data for a RO1 submission. The proposed study meets NCCAM priorities, including: (1) study of mind-body interactions; (2) application of CAM to cardiovascular diseases, including stroke; and (3) elucidation of mechanisms of action of CAM. The study will propel the applicant toward fulfillment of his long-term goal of testing efficacy and mechanisms of CAM interventions in stroke.

描述（由申请人提供）：中风引起的偏瘫是美国治疗师治疗的最常见障碍。尽管每年花费数百万美元用于中风运动康复，但传统的偏瘫治疗方法无效，使大量运动障碍的患者持续依赖医疗保健和其他人。治疗这种残疾状况的最佳方法可能是以一种新的和替代的方式将有希望的要素结合在一起。该培训计划采用临床试验设计，神经科学和康复的既定原则，以非传统的方式更好地治疗和理解中风引起的偏瘫。直接目标是获得中风临床试验设计和神经影像学方面的正式，强化培训和经验，并获得其他补充/替代医学（CAM）经验。这些活动将实现长期的职业目标，该目标通过组织试验来检查动作机制和中风中CAM干预的功效，从而改善了运动功能。该培训计划提供了公认的领导者的卓越指导，并在出色的跨学科环境中提供教学法。 心理实践（MP）是一种凸轮身心技术，在其中进行了认知能力，可提高非构造个人的运动学习和表现。我们的试点数据表明，MP显着降低了亚急性中风患者的偏瘫。但是，使用随机控制方法和MP作用机理的MP功效尚不清楚。本文提出的研究的目的是：（1）使用中风特异性的，已建立的，结果指​​标来衡量MP对亚急性中风患者受影响的ARM功能的影响； （2）使用功能磁共振成像（fMRI）确定MP作用机理。中心研究假设是，MP将显着改善亚急性中风患者的影响，并且这些改善的预后以及皮质重组伴随着。中央假设将经过测试，并使用多个基线，随机对照研究实现，其中30名亚急性中风患者在影响手臂治疗后接受了MP或对照干预。结果指标包括Fugi-Meyer运动评估，动作研究组测试，狼运动功能测试和中风冲击量表。 FMRI将检查可能导致的MP诱导的皮质重组。作为拟议研究的结果，将确定亚急性中风中的MP功效和机制，从而产生改善运动功能的经过验证的方案。这项研究还将增加对中风中神经和功能结果之间关系的理解，并为RO1提交提供试验数据。拟议的研究符合NCCAM的优先级，包括：（1）心身相互作用的研究； （2）CAM应用于心血管疾病，包括中风； （3）阐明CAM的作用机理。这项研究将推动申请人实现他的长期目标，即测试中风中CAM干预措施的疗效和机制。