Translating Intensive Arm Rehabilitation in Stroke to a Telerehabilitation Format

将中风强化手臂康复转化为远程康复形式

• 批准号: 9264410
• 负责人: CHRISTOPHER T BEVER
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9264410
• 关键词: Activities of Daily Living; Adult; Affect; Aging; Auditory; Behavioral; Bilateral; Blinded; Caring; Chronic; Chronic Phase; Classification; Clinic; Comorbidity; Continuity of Patient Care; Coupling; Cues; Data Collection; Devices; Dose; Feedback; Foundations; Functional disorder; Funding; General Population; Goals; Hand; Hand functions; Home environment; Impairment; Improve Access; Incidence; Individual; International; Internet; Intervention; Investigation; Laboratories; Laboratory Finding; Lead; Mechanics; Methods; Modeling; Motor Cortex; Multiple Sclerosis; Neurologic; Neurorehabilitation; Outcome; Outcome Measure; Paresis; Participant; Patients; Periodicity; Population; Protocols documentation; Quality of life; Randomized; Recovery; Rehabilitation therapy; Residual state; Resources; Robot; Specialist; Specificity; Stroke; System; Testing; Time; Training; Translating; Translations; Traumatic Brain Injury; Upper Extremity; Veterans; Work; aging population; arm; arm function; base; chronic stroke; cost; design; disability; functional improvement; health related quality of life; improved; motor learning; patient oriented; post stroke; primary outcome; programs; prototype; psychosocial; public health relevance; robot assistance; robotic device; stroke survivor; telerehabilitation; treatment as usual; two-arm study

 DESCRIPTION (provided by applicant): Background: Stroke is the primary cause of adult long-term disability and its incidence is predicted to rise with our aging population. Residual arm deficits persist in 55% or more of stroke survivors six months post onset. The upper extremity (UE) is an important target for rehabilitation as it impacts independence in activities of daily living (ADL) and quality of life. ur investigations utilizing robot-assisted therapy for intense repetition and task specificity have resulted in positive effects on reducing UE impairment in Veterans with moderate to severe deficits ≥ six months post stroke. An expansion of our work suggests that intensive robot- assisted reaching combined with a brief period of task specific (Transition to Task Training (TTT)) leads to greater gains than robot training alone. Current robotic devices are large and expensive to deploy in large numbers. An alternative shown to have positive effect in this population is Bilateral Arm Training with Rhythmic Auditory Cueing (BATRAC). This is a low- cost mechanical device based on similar motor learning features. Unlike the robot, it does not have an assist mode and requires engagement of the less impaired arm to work in concert with the affected arm. This bilateral practice may enhance inter-hemispheric coupling of the damaged motor cortex to promote spatial and temporal interactions of the arms not seen in other forms of repetitive training. Objective: We propose to adapt the lab-based BATRAC training into a home-based model with a telerehabilitation platform. We will add TTT since it appears to be quite powerful in promoting paretic hand use based on the Stroke Impact Scale Hand Section. Our primary objective is to compare the effects of 6 weeks of UE neuro-rehabilitation using Home-based BATRAC telerehabilitation with TTT on arm function in patients with chronic stroke to the usual and customary care provided at this time point. Additional objectives are to determine whether Home-based BATRAC telerehabilitation + TTT will be at least as effective as lab-based and whether patient-centered telerehabilitation has an effect on behavioral-psychosocial outcomes. Methods: Participants with UE deficits ≥ 6 months duration due to stroke will be stratified by impairment and randomly assigned to immediate therapy or delayed-entry therapy. The immediate therapy group will be randomly assigned to one of two study arms: (1) lab-based BATRAC+TTT or (2) a home-based BATRAC telerehabilitation for repetitive, dose-matched reaching+TTT. Similarly, after serving as a usual care control for 6 weeks, the delayed-entry group will be randomized to either study arm 1 or 2. When the delayed entry individuals have completed their interventions, the two groups (1 and 2) will be compared (after 6 week training and after 8 week retention) to the immediate therapy study arms. The primary outcome measure is the WMFT conducted by the blinded assessment team at baseline, week 6, and week 14. All assessments for each group will occur in the clinic setting. Results: Expanding the continuum of stroke care with a home telerehabilitation format has the potential to increase opportunity for intensive UE practice and translation of gains to real world use. When we have completed these aims we expect the results to provide an objective basis for expansion of UE training in neurological populations such as traumatic brain injury, multiple sclerosis as well as design a program that can be disseminated more broadly through the "MyHealtheVet" web system.

 描述（由申请人提供）： 背景：中风是成人长期残疾的主要原因，预计其发病率会随着我们老龄化的人口而上升。出现后六个月，残留的臂定义了55％或更多的中风生存。上肢（UE）是康复的重要目标，因为它影响了日常生活（ADL）和生活质量的独立性。使用机器人辅助治疗进行强烈重复和任务特异性的UR研究对减少中风后中度至重度≥6个月的退伍军人的UE损害产生了积极影响。我们工作的扩展表明，密集的机器人辅助覆盖范围与短暂的特定任务（过渡到任务培训（TTT））相比，仅与仅机器人培训相比，提高了更大的收益。当前的机器人设备大量部署很大，而且昂贵。一种在该人群中具有积极作用的替代性是有节奏的听觉提示（BATRAC）的双边手臂训练。这是一种基于类似的运动学习功能的低成本机械设备。与机器人不同，它没有辅助模式，并且需要与受影响的手臂协同工作的较弱的手臂接合。这种双边练习可能会增强损坏的运动皮层的半球间耦合，以促进其他形式中未看到的武器的空间和临时相互作用：我们建议将基于实验室的BATRAC培训适应具有TeleHelibration平台的家庭模型。我们将添加TTT，因为它在基于Stroke Impact Scale Sectraws的促进手部使用方面似乎非常强大。我们的主要目的是比较使用基于家庭的BATRAC电信与TTT对慢性中风患者的ARM功能的6周UE神经护理的影响与在此时间点提供的常规和习惯护理的影响。其他对象是确定基于家庭的BATRAC电启动 + TTT是否至少与基于实验室一样有效，以及以患者为中心的远程校准是否会影响行为性心理社会成果。方法：UE的参与者定义了由于中风而导致的≥6个月的持续时间，将根据损害进行分层，并随机分配给立即治疗或延迟入境治疗。直接治疗组将随机分配给两个研究组之一：（1）基于实验室的BATRAC+TTT或（2）基于家庭的BATRAC电启动，用于重复，剂量匹配的达到+TTT。同样，在用作通常的护理控制6周后，将延迟入学组被随机分为研究组或2。主要结果指标是由盲人评估团队在基线，第6周和第14周进行的WMFT。每个组的所有评估都将在诊所环境中进行。结果：通过家庭电信格式扩大中风护理的连续性，有可能增加对UE实践的机会，并将收益转化为现实世界的使用。当我们完成这些目标后，我们希望结果为扩展神经系统培训（例如脑损伤，多发性硬化症以及设计可以通过“ MyHealthevet”网络系统更广泛地传播）的UE培训的客观基础。