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）：尽管中风的发生率和流行率增加，但常规受影响的手臂康复可忽略不计。较新的方法强调了受影响的手臂重复的，特定于任务的实践（RTP）。尽管这些方法是有希望的，但它们通常需要特定的设备来管理，对患者和治疗师可能是密集型和/或征税，并且/或可能具有侵入性。上述许多方法中固有的策略也不由保险计划偿还。因此，仍然需要易于实施，易于实施，不创，无创的RTP方法。心理实践（MP）是一种补充/替代药物（CAM）思维技术，可以以廉价，重复的方式进行体育技能。该实验室第一个表明在RTP中添加MP的实验室产生的ARM运动结果明显大于中风中的常规运动疗法。 PI随后的研究证实，MP改善了受影响的ARM运动学，并增加了受影响的ARM使用和功能，这项工作最终在阳性MP试验中达到了最终影响。 PI最近的工作还确定了最佳的MP持续时间，在该持续时间内显示了最大的电动机变化。下一个逻辑步骤是确定IIB期多中心试验中的MP功效。这项两中心的研究将随机[100]慢性中风患者进行：（a）MP会议与RTP训练相结合；或（b）RTP培训。这将解决该应用程序的目标，即确定RTP方案在慢性中风中的影响。结果包括功能限制（主要端点），障碍，实验室和社区的活动限制，生活质量和fMRI。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特定目的来检验中心假设并实现目标：（1）与RTP相比，确定MP + RTP的功效； （2）确定MP + RTP对受影响的ARM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，导致运动障碍损害损害有价值的活动的表现。偏瘫特别是残疾，是与中风相关的残疾的主要损害，也是美国治疗师治疗的最常见障碍。这项研究将测试一种有希望的技术在减少残疾和增加功能方面的功效，从而改善结果和健康状况，并降低患有中风引起的偏瘫的社区居住患者。