Optimizing the Dose of Rehabilitation After Stroke

优化中风后康复的剂量

• 批准号: 8727795
• 负责人: Nicolas Schweighofer
• 金额: $ 18.68万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-10 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8727795
• 关键词: Accounting; Address; Affect; Behavioral; Brain imaging; Characteristics; Chronic Phase; Clinical Data; Clinical Trials; Computer Simulation; Confidence Intervals; Data; Dose; Encapsulated; Exhibits; Funding; Future; Goals; Hand; Hand functions; Hour; Impairment; Individual; Intervention; Lead; Lesion; Limb structure; Link; Location; Measures; Methods; Middle Cerebral Artery Infarction; Modeling; Motor; Motor Activity; Neurologic; Neurosciences; Outcome; Participant; Patients; Persons; Phase; Policies; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Recovery of Function; Rehabilitation therapy; Research; Research Personnel; Resources; Statistical Models; Stroke; Survivors; Testing; Time; Training; Treatment Efficacy; Upper Extremity; Wolves; Work; arm; base; cost; data modeling; design; disability; dosage; effective therapy; eligible participant; evidence base; experience; improved; improved functioning; insight; instrument; motor function recovery; motor impairment; novel; partial recovery; post stroke; predictive modeling; programs; relating to nervous system; response; skill acquisition; spinal tract; stroke recovery; stroke rehabilitation

DESCRIPTION (provided by applicant): Because each patient post stroke has unique impairments and function, it is important to depart from a "one size fits all" approach to rehabilitation. Although there is now evidence that motor therapy can improve function and use of the more affected limb for patients with moderate to mild impairments, change in use in the months following therapy is variable: for some patients there is an increase in use, but for others a decrease in use. Our long-term goal is to determine prospectively the dose of therapy that leads to further improvements of use after therapy for individual patients while keeping cost at reasonable levels - we call this dose critical dose. Our objective here is to investigate long-term predictions of use as a function of the dose of therapy and of the patient's neurological and behavioral characteristics. Our general hypothesis is that, for a subset of patients, there is a threshold level for arm and hand function to be achieved after therapy, such that if therapy brings function above this threshold, spontaneous use and function will reinforce each other in a virtuous circle. We formulated our hypothesis based on computational models that demonstrate such a threshold and account for existing data. We will address our general hypothesis and accomplish our objective with two aims. Aim 1. Determine the effect of a distributed dose of therapy on immediate and long-term gains in upper extremity use. Aim 2: Develop a means to compute the critical dose for individual patients. With the first aim, we will test our general hypothesis and generate relevant clinical data of function and use. The data will then be used in the second aim to develop a predictive model, based on the Extended Kalman Filter, of long-term arm and hand use as a function of the dose of therapy as well as behavioral and neurological data. Our proposed work is significant because such a predictive model of stroke recovery, once subjected under future funding to clinical trials, can be used to influence policy regarding the necessary dosage of effective treatments at a reasonable cost for the growing number of persons who have survived stroke. This work will also make an important neuro- scientific contribution as we will model, and test behaviorally, the causal and adaptive linkages between the decisions to use the affected arm and recovery of motor function.

描述（由申请人提供）：由于每位中风后患者都有独特的损伤和功能，因此远离“一刀切”的康复方法非常重要。尽管现在有证据表明运动疗法可以改善中度至轻度损伤患者受影响较大肢体的功能和使用，但治疗后几个月的使用变化是可变的：对于某些患者来说，使用量有所增加，但对于其他患者来说，使用量有所增加使用量减少。我们的长期目标是前瞻性地确定治疗剂量，以进一步改善个体患者治疗后的使用，同时将成本保持在合理水平 - 我们称之为剂量临界剂量。我们的目标是研究使用的长期预测，作为治疗剂量以及患者神经和行为特征的函数。我们的一般假设是，对于一部分患者来说，治疗后手臂和手的功能要达到一个阈值水平，这样，如果治疗使功能高于这个阈值，自发使用和功能将在良性循环中相互加强。我们根据计算模型制定了我们的假设，该模型证明了这样的阈值并解释了现有数据。我们将提出我们的一般假设并通过两个目标来实现我们的目标。目标 1. 确定分布式治疗剂量对上肢使用的近期和长期收益的影响。目标 2：开发一种计算个体患者临界剂量的方法。出于第一个目标，我们将测试我们的一般假设并生成功能和使用的相关临床数据。然后，这些数据将用于第二个目标，即开发基于扩展卡尔曼滤波器的预测模型，该模型将长期手臂和手的使用作为治疗剂量以及行为和神经学数据的函数。我们提出的工作意义重大，因为这种中风恢复的预测模型一旦在未来的资助下进行临床试验，就可以用来影响政策，以合理的成本为越来越多的中风幸存者提供有效治疗的必要剂量。这项工作还将做出重要的神经科学贡献，因为我们将对使用受影响手臂的决定与运动功能恢复之间的因果关系和适应性联系进行建模和行为测试。