Mental Practice in Chronic, Stroke-Induced Hemiparesis

慢性中风引起的偏瘫的心理实践

• 批准号: 8331350
• 负责人: STEPHEN J. PAGE
• 金额: $ 71.19万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8331350
• 关键词: Action Research; Activities of Daily Living; Address; Affect; Aftercare; Age; Area; Behavioral; Biology; Blinded; Brain; California; Caring; Clinic; Clinical; Clinical Research; Clinical Trials Cooperative Group; Collaborations; Communities; Complementary and alternative medicine; Country; Data; Devices; Disabled Persons; Environment; Equipment; Exercise; Exhibits; Functional Magnetic Resonance Imaging; Funding; Goals; Grant; Group Practice; Health; Home environment; Imagery; Impairment; Incidence; Institution; Insurance; Intervention; Magnetic Resonance Imaging; Measures; Mediating; Mind-Body Intervention; Motor; Motor Activity; Motor Cortex; Movement; Multicenter Trials; National Institute of Neurological Disorders and Stroke; Neurology; Neurosciences; Outcome; Outcome Measure; Outcome Study; Patients; Pattern; Performance; Phase; Positioning Attribute; Predictive Value; Prevalence; Progress Review Group; Public Health; Quality of life; Randomized; Recommendation; Recording of previous events; Recovery; Regimen; Rehabilitation therapy; Relative (related person); Reporting; Research; Research Design; Research Personnel; Resources; Robotics; Sampling; Site; Stroke; Structure; Survivors; Taxes; Techniques; Testing; Training; United States; United States National Institutes of Health; Universities; Upper Extremity; Work; acute stroke; arm; base; chronic stroke; cost; disability; efficacy testing; experience; functional disability; hemiparesis; implantable device; improved; interest; kinematics; mental practice; mortality; motor impairment; motor learning; neuroimaging; neuromechanism; novel strategies; post stroke; primary outcome; programs; rehabilitation strategy; relating to nervous system; repaired; repetitive task practice; response; skills; stroke recovery; stroke rehabilitation; therapy duration

DESCRIPTION (provided by applicant): Despite increasing stroke incidence and prevalence, conventional affected arm rehabilitation offers negligible efficacy. Newer approaches emphasize repetitive, task-specific practice (RTP) with the affected arm. While these approaches are promising, they often require particular equipment to administer, can be intensive and/or taxing for the patient and therapist, and/or can be invasive. Strategies inherent in many of the above approaches are also not reimbursed by insurance plans. Thus, there remains a need for easily implemented, inexpensive, non-invasive RTP approaches for hemiparesis. Mental practice (MP) is a complementary/alternative medicine (CAM) mind-body technique in which physical skills can be rehearsed in an inexpensive, repetitive manner. This lab was the first to show that addition of MP to RTP yields significantly larger affected arm motor outcomes than conventional motor therapy in stroke. The PI's subsequent research confirmed that MP improves affected arm kinematics, and increases affected arm use and function, with this work culminating in a positive MP trial. The PI's recent work has also determined optimal MP duration at which the largest motor changes are exhibited. The next logical step is to determine MP efficacy in a Phase IIb, multicenter trial. This two-center study will randomize [100] chronic stroke patients to either: (a) MP sessions combined with RTP training; or (b) RTP training only. This will address the objective of this application, which is to determine the impact of a RTP regimen including MP in chronic stroke. Outcomes include functional limitation (primary endpoint), impairment, activity restriction in the lab and community, quality of life, and fMRI. The central hypothesis is that participation in MP + RTP will reduce functional limitation. We will test our central hypothesis and accomplish our objective by pursuing the following specific aims: (1) Determine efficacy of MP + RTP as compared to RTP on affected arm functional limitation; (2) Determine the impact of MP + RTP on affected arm outcomes; (3) Determin MP + RTP effects on cortical organization using fMRI. PUBLIC HEALTH RELEVANCE Stroke is the leading cause of disability in the United States, producing motor impairments that compromise performance of valued activities. Hemiparesis is particularly disabling, is the primary impairment underlying stroke-related disability, and the most frequent impairment treated by therapists in the United States. This study will test efficacy of a promising technique in reducing disability and increasing function, thereby improving outcomes and health, and reducing care costs, for community dwelling patients with stroke-induced hemiparesis.

描述（由申请人提供）：尽管中风发病率和患病率不断增加，但传统的受影响手臂康复治疗的效果可以忽略不计。较新的方法强调对受影响的手臂进行重复的、特定任务的练习 (RTP)。虽然这些方法很有希望，但它们通常需要特定的设备来管理，对患者和治疗师来说可能是密集的和/或繁重的，和/或可能是侵入性的。上述许多方法中固有的策略也不由保险计划报销。因此，仍然需要易于实施、廉价、非侵入性的偏瘫 RTP 方法。心理练习 (MP) 是一种补充/替代医学 (CAM) 身心技术，可以以廉价、重复的方式排练身体技能。该实验室首次证明，与传统的中风运动疗法相比，在 RTP 中添加 MP 会产生显着更大的手臂运动结果影响。 PI 随后的研究证实，MP 可以改善受影响手臂的运动学，并增加受影响手臂的使用和功能，这项工作最终以积极的 MP 试验告终。 PI 最近的工作还确定了表现出最大运动变化的最佳 MP 持续时间。下一个合乎逻辑的步骤是确定 IIb 期多中心试验中 MP 的疗效。这项双中心研究将 [100] 名慢性中风患者随机分配至以下任一组： (a) MP 课程与 RTP 训练相结合；或 (b) 仅 RTP 培训。这将解决本申请的目标，即确定包括 MP 在内的 RTP 方案对慢性中风的影响。结果包括功能限制（主要终点）、损伤、实验室和社区活动限制、生活质量和功能磁共振成像。中心假设是参与 MP + RTP 将减少功能限制。我们将通过追求以下具体目标来检验我们的中心假设并实现我们的目标： (1) 确定 MP + RTP 与 RTP 相比对受影响手臂功能限制的疗效； (2) 确定 MP + RTP 对受影响手臂结果的影响； (3) 使用 fMRI 确定 MP + RTP 对皮质组织的影响。公共卫生相关性 中风是美国残疾的主要原因，它会造成运动障碍，影响重要活动的表现。偏瘫尤其会造成残疾，是中风相关残疾的主要损伤，也是美国治疗师最常治疗的损伤。这项研究将测试一种有前途的技术在减少残疾和增强功能方面的功效，从而改善社区居住的中风引起的偏瘫患者的预后和健康，并降低护理成本。