Home-Based Automated Therapy of Arm Function After Stroke Via Tele-Rehabilitation

通过远程康复对中风后手臂功能进行家庭自动治疗

基本信息

批准号：
8249006
负责人：
GITENDRA USWATTE
金额：
$ 8.89万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-04-01 至 2014-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8249006
关键词：
Accounting Activities of Daily Living Affect Automation Bathing Behavioral Caregivers Chronic Clinic Clinical Clinical Trials Collaborations Computer software Contracts Control Groups Controlled Study Cost Analysis Data Devices Disabled Persons Doctor of Philosophy Dose Electronics Equipment Family Feedback Graph Hand Health Health Care Costs Healthcare Systems Home environment Hour Human Individual Internet Joints Laboratories Life Limb structure Link Measures Monitor Motivation Motor Names Occupations Outcome Participant Patient Education Patients Performance Persons Procedures Protocols documentation Published Comment Publishing Randomized Randomized Controlled Trials Rehabilitation therapy Reporting Research Residual state Resources Rest Running Self Care Shapes Signal Transduction Simulate Sterile coverings Stroke Supervision Survivors Techniques Testing Text Time Training Travel Treatment Cost Treatment outcome Upper Extremity Visual arm base chronic stroke constraint induced movement therapy cost design disability distraction efficacy testing feeding handicapping condition health disparity hemiparesis in vivo motor deficit programs prototype sensor standard care telerehabilitation transmission process virtual reality

项目摘要

DESCRIPTION (provided by applicant): Constraint-Induced Movement therapy (CIMT) is one of few techniques that has been shown in controlled studies to produce large improvements in real-world arm function in stroke survivors with mild to moderate hemiparesis. The standard treatment involves one-on-one training of paretic arm use in the clinic for 3 hr/day for 10 consecutive weekdays and placing a mitt on the other hand to discourage its use. The considerable cost of CIMT, due to the demand on therapist time and requirement that patients travel daily to a clinic for 2 weeks, imposes substantial limits on those who might access the therapy. Our lab, with Peter Lum, Ph.D., has developed a device for automating the delivery of CIMT named AutoCITE; it permits practice of 8 upper- extremity tasks and provides frequent graphical performance feedback. Two reports indicate that AutoCITE is as efficacious as standard CIMT even with therapist effort reduced by 75%. A third report suggests that AutoCITE under simulated telerehabilitation conditions (i.e., patient and therapist were in different rooms in the lab) is also just as efficacious. We propose to modify AutoCITE so that it is more appropriate for use in patients' homes and evaluate its efficacy for providing CIMT on a telerehab basis. We will also specifically test whether making the AutoCITE software more interactive helps patients to comply with training at home, where there are more distractions. To this end, we will randomize 87 chronic stroke survivors to: 1. AutoCITE training in the home with two patients supervised concurrently by one therapist remotely via an Internet-based audio- visual link, 2. the same procedures except that the more interactive software will be run on AutoCITE, and 3. dose-matched, standard CIMT in the home. Motor outcomes and costs from the home-based, two-on-one, tele-AutoCITE groups will be compared to those from the home-based, one-on-one, in vivo CIMT group and to those from laboratory-based AutoCITE and standard CIMT groups run previously. If successful, AutoCITE, which involves simply automating task practice with actual objects and is much less expensive than prevailing virtual reality based approaches, might serve as a platform for delivering other upper-extremity therapies, in addition to CIMT, via telerehab. With about 300,000 new stroke survivors suffering motor disability annually, cutting the cost of and increasing access to efficacious upper-extremity rehabilitation has the potential to reduce disability significantly. PUBLIC HEALTH RELEVANCE Our laboratory, in collaboration with Peter Lum, Ph.D., has developed a device for automating the delivery of Constraint-Induced Movement therapy (CI therapy) named AutoCITE; it permits practice of 8 upper-extremity tasks and provides frequent graphical performance feedback. Two recently published studies suggest that AutoCITE is as efficacious as one-one-one CI therapy. Our proposed study will test the efficacy of the AutoCITE device to provide CI therapy on a tele-rehabilitation basis in patients' home. There are approximately 300,000 new strokes survivors with residual motor disability annually. Reducing the cost of and increasing access to efficacious upper-extremity rehabilitation has the potential to significantly reduce the burden of stroke on patients, their families and the healthcare system.

描述（由申请人提供）：约束诱导运动疗法（CIMT）是对照研究中显示的少数技术之一，可对患有轻度至中度偏瘫的中风幸存者的现实世界手臂功能产生巨大改善。标准治疗包括在诊所进行一对一的麻痹手臂使用训练，每天 3 小时，连续 10 个工作日，并在另一只手上戴上手套以阻止其使用。由于对治疗师时间的要求以及患者每天前往诊所为期两周的要求，CIMT 的成本相当高，这对可能接受治疗的人造成了很大的限制。我们的实验室与 Peter Lum 博士一起开发了一种用于自动化交付 CIMT 的设备，名为 AutoCITE；它允许练习 8 项上肢任务，并提供频繁的图形表现反馈。两份报告表明，AutoCITE 与标准 CIMT 一样有效，即使治疗师的工作量减少了 75%。第三份报告表明，AutoCITE 在模拟远程康复条件下（即患者和治疗师位于实验室的不同房间）也同样有效。我们建议修改 AutoCITE，使其更适合在患者家中使用，并评估其在远程康复基础上提供 CIMT 的功效。我们还将专门测试 AutoCITE 软件更具交互性是否有助于患者在家中遵守训练，因为家中干扰较多。为此，我们将 87 名慢性中风幸存者随机分配到： 1. 在家中对两名患者进行 AutoCITE 培训，由一名治疗师通过基于互联网的视听链接进行远程监督， 2. 相同的程序，只是交互性更强的软件将在 AutoCITE 上运行，并且 3. 在家中进行剂量匹配的标准 CIMT。家庭、二对一、远程 AutoCITE 小组的运动结果和成本将与家庭、一对一、体内 CIMT 小组以及实验室 AutoCITE 和小组的运动结果和成本进行比较。标准 CIMT 组之前运行。如果成功，AutoCITE 只涉及使用实际对象实现任务练习的自动化，并且比流行的基于虚拟现实的方法便宜得多，它可以作为除 CIMT 之外通过远程康复提供其他上肢治疗的平台。每年约有 300,000 名新的中风幸存者患有运动残疾，降低有效上肢康复的成本并增加获得有效上肢康复的机会有可能显着减少残疾。公共健康相关性我们的实验室与 Peter Lum 博士合作，开发了一种自动实施约束诱导运动疗法（CI 疗法）的设备，名为 AutoCITE；它允许练习 8 项上肢任务，并提供频繁的图形表现反馈。最近发表的两项研究表明 AutoCITE 与一对一 CI 疗法一样有效。我们提出的研究将测试 AutoCITE 设备在患者家中提供远程康复 CI 治疗的功效。每年大约有 300,000 名新的中风幸存者患有残余运动障碍。降低上肢康复的成本并增加获得有效上肢康复的机会有可能显着减轻中风患者及其家人和医疗保健系统的负担。