Can rTMS enhance somatosensory recovery after stroke?

rTMS 能否增强中风后体感恢复？

• 批准号: 8925411
• 负责人: SVETLANA PUNDIK
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8925411
• 关键词: Admission activity; Affect; American; Area; Bilateral; Brain; Brain region; Characteristics; Complex; Development; Discrimination; Education; Enrollment; Environment; Esthesia; Foundations; Impairment; Individual; Intervention; Investigation; Joints; Lead; Lesion; Life; Limb structure; Measures; Methods; Motor; Motor Pathways; Movement; Muscle; Nature; Neuronal Plasticity; Numbness; Outcome; Outcome Measure; Pain; Pathway interactions; Patients; Perception; Peripheral; Personal Satisfaction; Pilot Projects; Process; Proprioception; Quality of life; Recovery; Recovery of Function; Rehabilitation therapy; Research Design; Role; Sensory; Sensory Process; Signal Transduction; Skin; Somatosensory Evoked Potentials; Stimulus; Stroke; Survivors; Tactile; Techniques; Temperature; Testing; Time; Touch sensation; Training; United States; Veterans; Work; base; chronic stroke; disability; efficacy testing; functional improvement; functional restoration; improved; limb movement; median nerve; motor control; motor deficit; motor learning; neurological recovery; neurophysiology; novel; novel strategies; post stroke; primary outcome; public health relevance; repetitive transcranial magnetic stimulation; response; restoration; secondary outcome; sensory stimulus; somatosensory; stimulus processing; stroke rehabilitation

 DESCRIPTION (provided by applicant): Problem: Stroke is a leading cause of disability in the United States. Sensory deficits are present in the majority of stroke survivors. Inability to feel movement, touch or pain impairs our ability to interact with environment and diminished the quality of life. These sensory deficits significantly impair functional activity and slow down recovery during rehabilitation. Currently available sensory rehabilitation techniques can only partially restore sensory function. The main objective of this study is to test a novel approach to improve sensory function after stroke using non-invasive brain stimulation. Rationale: Sensory deficits can be partially recovered with peripheral manipulation of skin, muscles and joints using sensory re-education-based rehabilitation. Sensory re-education is associated with adaptive functional and structural alterations in the brain, called neuroplasticity. Despite reorganization, sensory recovery is usually slow and incomplete. There is a non-invasive method of brain modulation, called repetitive Transcranial Magnetic Stimulation (rTMS) that can potentially drive the adaptive functional and structural brain changes that lead to functional improvements. Although rTMS of motor control regions has been shown to enhance motor rehabilitation after stroke, evidence in support of rTMS to improve sensory function is lacking. In our preliminary studies, we discovered that rTMS of the contralesional primary sensory region (S1) is feasible and promising as an intervention for sensory treatment. The proposed study will test this novel approach. Study Design: We will enroll 30 individuals with sensory deficits after first ever stroke (stroke onset > 6 months prior). There will be two baseline sessions followed by three different rTMS interventions targeting contralesional S1 (facilitatory 5Hz, inhibitory 1 Hz and sham) randomly ordered and administered at least one week apart. Hypothesis 1a: Facilitatory rTMS of contralesional S1 produces a greater response versus sham rTMS, according to a measure of tactile discrimination. Hypothesis 1b Facilitatory rTMS of contralesional S1 produces a greater response versus inhibitory rTMS in improving tactile discrimination. We will test these hypotheses by comparing response to rTMS interventions according to 2-point discrimination (primary outcome measure). Secondary outcome measures will include grating orientation test, proprioception, monofilament discrimination, vibratory perception and Jebsen Taylor test. Hypothesis 2: Facilitatory rTMS at contralesional S1 can increase excitability of bilateral sensory networks and enhance sensory motor connectivity. We will test this hypothesis by measuring functional brain changes using somatosensory evoked potential (SSEP) induced by median nerve stimulation (primary outcome measure) and short-latency afferent inhibition (secondary outcome measure). Significance: This study will provide information about a novel brain stimulation approach for sensory rehabilitation, characterize the functional role of the contralesional S1 regions in sensory processing after stroke and open opportunities for development of new interventions for sensory rehabilitation. This study will be a first step in determining if rTMS stimulation of contralesional S1 can improve sensory function of a stroke-affected limb. If the concept is demonstrated in this pilot study, then following the lead of other investigations of this type, this pilot will provide the foundation to test the efficacy of a long-erm multi-session intervention of combined rTMS and peripherally directed therapy.

 描述（由申请人提供）： 问题：中风是美国残疾的主要原因。在大多数中风存活中存在感官定义。无法感受到运动，触摸或痛苦会损害我们与环境互动并降低生活质量的能力。这些感觉不足会严重损害功能活性，并减慢康复过程中的恢复速度。当前可用的感官康复技术只能部分恢复感官功能。这项研究的主要目的是测试一种使用非侵入性脑刺激后改善中风后感觉功能的新方法。理由：使用基于感觉再教育的康复对皮肤，肌肉和关节的外围操纵，可以部分恢复感觉不足。感觉重新教育与大脑的自适应功能和结构改变有关，称为神经成形术。尽管进行了重组，但感觉恢复通常是缓慢且不完整的。有一种非侵入性的大脑调节方法，称为重复的经颅磁刺激（RTMS），可以潜在地驱动自适应功能和结构性大脑变化，从而导致功能改善。尽管已经显示出运动控制区的RTMS可在中风后增强运动康复，但缺乏支持RTMS以改善感觉功能的证据。在我们的初步研究中，我们发现对比度原发感觉区域（S1）的RTM是可行的，并且有望作为对感觉治疗的干预。拟议的研究将测试这种新方法。研究设计：我们将在第一次中风后注册30名感官缺陷的人 （中风发作>前6个月）。将有两个基线会话，然后进行三种不同的RTMS干预措施，靶向对比度S1（促进性5Hz，抑制1 Hz和假手术），然后随机排序并相隔至少一周。假设1a：根据触觉歧视的量度，对比度S1的功能RTM与假RTM相比产生更大的响应。假设1B对侧S1的促进性RTM在改善触觉歧视方面产生更大的响应与抑制性RTM。我们将根据2分歧视（主要结果测量）比较对RTMS干预措施的反应来检验这些假设。次要结局指标将包括光栅方向测试，前置检查，单丝歧视，振动感知和Jebsen Taylor检验。假设2：对比S1时的促进性RTM可以增加双侧感觉的兴奋性 网络并增强感觉电动机连接。我们将使用中位神经刺激（主要结局测量）和短期传入抑制（次级结局测量）引起的体感诱发电位（SSEP）来测量功能性大脑变化（SSEP）。意义：这项研究将提供有关一种新型大脑刺激方法进行感觉康复的信息，这是对比度S1区域在中风后的感觉处理中的功能作用，并开放了开发新的感觉康复干预措施的机会。这项研究将是确定对比度S1的RTMS模拟是否可以改善受中风影响肢体的感觉功能的第一步。如果在这项试验研究中证明了这一概念，那么遵循其他概念 对这种类型的调查，该飞行员将为测试RTMS组合和横向定向治疗的遗体多课程干预的效率提供基础。