Neural Mechanisms Mediating Interlimb Transfer Following Stroke

中风后介导肢体间转移的神经机制

• 批准号: 8925314
• 负责人: Carolynn Patten
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2017-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8925314
• 关键词: Accounting; Activities of Daily Living; Acute; Address; Admission activity; Adult; Affect; Age; Behavioral; Behavioral inhibition; Boxing; Chronic; Clinical; Data; Data Element; Development; Exercise; Failure; Future; Goals; Hand; Health; Healthcare; Hospitals; Hour; Impairment; Intervention; Knowledge; Lead; Life; Limb structure; Measures; Mediating; Mission; Monitor; Motor; Motor Cortex; Neurobiology; Neurologic; Neuronal Plasticity; Outcome; Paresis; Persons; Physiological; Pilot Projects; Prevalence; Production; Proxy; Recovery; Rehabilitation therapy; Research; Rest; Sample Size; Stroke; Survivors; Testing; Therapeutic; Time; Transcranial magnetic stimulation; Translations; Treatment Efficacy; United States; Upper Extremity; Veterans; Veterans Hospitals; Work; arm; base; behavior test; behavioral response; clinical investigation; critical period; dexterity; disability; experience; grasp; hemiparesis; improved; insight; interhemispheric transfer; motor disorder; motor impairment; motor recovery; neuromechanism; neurophysiology; post stroke; prevent; relating to nervous system; response; stroke hemiparesis; stroke recovery; therapy development

 DESCRIPTION (provided by applicant): Stroke is the leading cause of serious, chronic disability in adults worldwide. Over 750,000 new strokes occur in the United States each year accounting for over half of all acute neurological hospital admissions in both civilian and Veterans' hospitals. The most persistent stroke-related motor impairments affect the upper- extremity (UE)14. Among survivors, 73-88% present with sensorimotor impairments affecting upper-extremity function and 55-75% experience difficulty using the arm for activities of daily living activities. To date, upper- extremity rehabilitation fr post-stroke hemiparesis has produced highly variable outcomes revealing minimal genuine change in motor impairment or functional use of the affected arm. Our long-term goal is to restore UE motor function following stroke. The overall objective of this proposal is to improve our understanding of neural mechanisms contributing to inter-limb and inter-hemispheric transfer following non-paretic limb exercise to task failure. We will use transcranial magnetic stimulation to probe acute adaptations in cortical excitability, intracortical and inter-hemispheri circuits that accompany behavioral facilitation of the paretic hand. The work proposed in the current application will enable us to obtain three data elements that are critical to our current working hypothesis. We will: 1) investigate changes in intracortical and interhemispheric inhibition in both hemispheres following non-paretic limb exercise to task failure; 2) test behavioral effects on paretic limb function using a motor task involving manipulation and dexterity; 3) determine the persistence (i.e., time course) of acute neural and behavioral facilitation and its consistency over repeated sessions. Our results will inform regarding the mechanisms of inter-limb and inter-hemispheric transfer post-stroke and contribute development of a clinical intervention to be tested in future studies. The data obtained in this small study wil prevent failure of a larger, clinical investigation by enabling us to develop appropriately focused mechanistic hypotheses, understand the effects elicited and therefore project a sample size to afford appropriate statistical power in our future study. Ultimately, the work conducted in this small project and future studies will advance our knowledge regarding the neurobiology of motor recovery following stroke, providing insight regarding the phenomenon of interlimb transfer and the associated mechanisms of neural plasticity. Keywords: stroke, recovery, neurophysiology, rehabilitation, upper-extremity

 描述（由申请人提供）： 中风是全球成人严重，慢性残疾的主要原因。每年在美国发生了超过75万新的中风，占平民和退伍军人医院的所有急性神经病医院入院的一半以上。与中风相关的最持续性运动障碍会影响上限（UE）14。在生存中，有73-88％的感觉运动障碍会影响上流功能，而55-75％的人使用手臂在日常活动活动中经历了难度。迄今为止，中风后半瘫痪后，高级康复产生了高度可变的结果，揭示了运动障碍的真正变化或受影响的手臂的功能使用最小。我们的长期目标是恢复中风后的UE运动功能。该提案的总体目的是提高我们对非肢体肢体运动后促成limb间和半球间转移的神经机制的理解。我们将使用经颅磁刺激在皮质兴奋性，心脏内和半球间电路中探测急性适应，这些电路适合可容纳偏心手的行为设施。当前应用程序中提出的工作将使我们能够获得三个对当前工作假设至关重要的数据元素。我们将：1）研究非肢体锻炼后两个半球的心脏内和半球间抑制的变化； 2）使用涉及操纵和敏捷性的运动任务对侧肢功能的行为影响； 3）确定急性神经元和行为设施的持久性（即时间过程）及其对重复会议的一致性。我们的结果将告知中风间和中风间转移的机制，并在未来的研究中进行临床干预的发展。这项小型研究中获得的数据将通过使我们能够发展出适当的机械假设，了解引起的效果并因此投射样本量以提供适当的统计能力，从而防止更大的临床研究失败。最终，在这个小项目和未来的研究中进行的工作将提高我们关于中风后运动恢复神经生物学的知识，从而提供了有关相互转移现象的见解以及神经可塑性的相关机制。关键词：中风，恢复，神经生理学，康复，高级