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: 7382535
• 负责人: STEPHEN J. PAGE
• 金额: $ 11.96万
• 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/7382535
• 关键词: Action Research; Activities of Daily Living; Affect; Area; Biological; Brain Mapping; Cardiovascular Diseases; Clinical; Clinical Protocols; Clinical Trials Design; Communities; Complementary and alternative medicine; Condition; Data; Development; Discipline; Elements; Environment; Functional Magnetic Resonance Imaging; Future; Goals; Healthcare; Imagery; Impairment; Individual; Injury; Intervention; Left; Living Wills; Magnetic Resonance Imaging; Measures; Mentors; Methods; Mind-Body Intervention; Modality; Motor; Motor Skills; National Center for Complementary and Alternative Medicine; Neurologic; Neurosciences; Outcome; Outcome Measure; Patients; Performance; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Recovery of Function; Rehabilitation therapy; Reliance; Research; Resource Sharing; Resources; Sample Size; Stroke; Structure; Testing; Training; United States; Upper arm; Wolves; Work; base; career; cost; disability; experience; functional outcomes; hemiparesis; improved; information gathering; insight; member; mental practice; mind body interaction; motor deficit; motor impairment; motor learning; motor skill learning; neuroimaging; post stroke; relating to nervous system; research study; skills; 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的损伤。尽管每年花费数百万美元用于中风运动康复，但偏瘫的传统治疗方法无效，导致患者出现严重的运动障碍，并持续依赖医疗保健和其他方面。治疗这种致残状况的最佳方法可能是以一种新的替代方式结合现有学科中的有希望的元素。该培训计划以非传统方式应用临床试验设计、神经科学和康复的既定原则，以更好地治疗和理解中风引起的偏瘫。近期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，并获得额外的补充/替代医学 (CAM) 经验。这些活动将实现长期职业目标，即通过组织试验检查 CAM 干预中风的作用机制和功效，改善中风后的运动功能。该培训计划提供来自知名领导者的卓越指导，以及出色的跨学科环境中的教学。 心理练习 (MP) 是一种 CAM 身心技术，通过认知排练身体技能，可以提高非残疾人的运动学习和表现。我们的试验数据表明 MP 显着减少亚急性中风患者的偏瘫。然而，使用随机对照方法的 MP 功效以及 MP 作用机制尚不清楚。本文提出的研究目的是：（1）使用针对中风的特定、已建立的结果测量方法来测量 MP 对亚急性中风患者受影响手臂功能的影响； (2) 使用功能磁共振成像 (fMRI) 确定 MP 的作用机制。研究的中心假设是 MP 将显着改善亚急性中风患者受影响的手臂功能，并且这些改善的结果伴随着皮质重组。将使用多基线、随机对照研究来测试中心假设并实现目标，其中 30 名亚急性中风患者在受影响的手臂治疗后接受 MP 或对照干预。结果测量包括 FugI-Meyer 运动评估、行动研究手臂测试、Wolf 运动功能测试和中风影响量表。功能磁共振成像将检查可能由 MP 引起的皮质重组。作为拟议研究的结果，将确定 MP 在亚急性中风中的功效和机制，从而产生改善运动功能的经过验证的方案。这项研究还将增进对中风神经和功能结果之间关系的理解，并为 RO1 提交提供试点数据。拟议的研究符合 NCCAM 的优先事项，包括：（1）身心相互作用的研究； （2）CAM在心血管疾病（包括脑卒中）中的应用； (3)阐明CAM的作用机制。该研究将推动申请人实现测试 CAM 干预中风的功效和机制的长期目标。