Home-based mirror therapy for treating hemiparesis in stroke patients

家庭镜像疗法治疗中风患者偏瘫

• 批准号: 8827831
• 负责人: Steven Jax
• 金额: $ 31.07万
• 依托单位: ALBERT EINSTEIN HEALTHCARE NETWORK
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8827831
• 关键词: Address; Affect; Behavioral; Brain; Case Study; Clinical; Controlled Clinical Trials; Data; Dose; Elbow; Enrollment; Equipment; Feedback; Future; Genetic Crossing Over; Goals; Hand; Hemispatial Neglect; Home environment; Illusions; Imagery; Individual; Individual Differences; Insurance Coverage; Lead; Lesion; Limb structure; Literature; Location; Maps; Measures; Medical; Motor; Movement; Outcome; Pain management; Patients; Performance; Placebo Control; Placebos; Process; Production; Proprioception; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation Research; Relative (related person); Reporting; Sampling; Selection for Treatments; Sensory; Source; Stroke; Survivors; Symptoms; Testing; Therapeutic; Time; Touch sensation; United States; Upper Extremity; Visual; Wrist; alternative treatment; arm; base; behavior measurement; chronic stroke; clinical decision-making; clinically significant; constraint induced movement therapy; cost; cost effectiveness; effective therapy; experience; follow-up; functional disability; hemiparesis; improved; innovation; relating to nervous system; robotic training; stem; stroke hemiparesis; success; theories

DESCRIPTION (provided by applicant): Each year in the United States 550,000 people develop upper-extremity movement deficits after stroke (hemiparesis). The recent success of mirror therapy (MT) is notable because it is a simple treatment for hemiparesis, and may be feasible for home use. MT uses a standard mirror to create a compelling illusion in which movements of the unimpaired limb appear as if they are being made by the impaired limb. We propose to complete a randomized placebo-controlled clinical trial of MT with a target enrollment of 100 chronic stroke patients. The therapy will consist of a standardized set of hand, wrist, and elbow movements completed in two daily 30-minute sessions, 5 times per week for 4 weeks. Patients assigned to the placebo treatment (identical therapy with an opaque divider rather than a mirror) will be crossed over to receive MT after a three month follow-up. The first goal of the study will be to determine whether a home-based form of MT is an effective treatment of hemiparesis. Providing evidence that mirror therapy could be administered at home would have enormous implications for the cost of treating hemiparesis, especially relative to alternative treatments that require a significant amount of therapist time (constraint-induced movement therapy) or expensive equipment (robotic training). Pilot data suggest that home-based mirror therapy could lead to clinically significant improvements in functioning. The second goal will be to determine the optimal dosing of MT by including weekly measures of improvement. The third goal will be to understand individual differences in the efficacy of mirror therapy. Previous MT studies have not reported, or lacked the power to test, why some patients benefit from MT and others do not, even though significant individual differences have been reported. Our use of a large sample of patients will allow us to assess predictors of therapeutic benefit. Being able to predict beneficial clinical outcomes would be quite innovative because this issue is rarely addressed in rehabilitation research more generally and is crucial to the real world task of treatment selection for individual patients.

描述（由申请人提供）：每年在美国，有55万人会在中风后出现高级运动缺陷（偏瘫）。镜像疗法（MT）的最新成功之所以值得注意，是因为它是偏瘫的简单疗法，并且对于家庭使用可能是可行的。 MT使用标准镜子来产生引人注目的幻觉，其中未受损的肢体的动作似乎是由肢体受损而制造的。我们建议完成100例慢性中风患者的目标入学率的MT随机安慰剂对照试验。该疗法将包括一组标准化的手，腕部和肘部运动，分别为每天30分钟的课程完成，每周5次，持续4周。分配给安慰剂治疗的患者（用不透明的分隔器而不是镜子的相同疗法）将在三个月后进行随访后接受MT。该研究的第一个目标是确定基于家庭形式的MT是否是对偏瘫的有效治疗方法。提供证据表明可以在家中进行镜像治疗的证据对治疗偏瘫的成本具有巨大影响，尤其是相对于需要大量治疗师时间（约束诱导的运动疗法）或昂贵的设备（机器人培训）的替代治疗。试点数据表明，基于家庭的镜像疗法可能会导致临床上显着改善功能。第二个目标是通过包括每周的改进度量来确定MT的最佳剂量。第三个目标是了解镜像治疗功效的个体差异。以前的MT研究尚未报告或缺乏测试能力，为什么有些患者从MT中受益而其他患者则没有受益，即使已经报告了重大的个体差异。我们使用大量患者的使用将使我们能够评估治疗益处的预测因子。能够预测有益的临床结果将是相当创新的，因为在康复研究中很少解决此问题，并且对于个人患者的治疗选择的现实世界任务至关重要。