Evaluation of brain recovery of stroke patients using a novel magnetic resonance compatible hand induced robotic device combined with magnetic resonance imaging

使用新型磁共振兼容手诱导机器人装置结合磁共振成像评估中风患者的脑恢复

• 批准号: 9752683
• 负责人: A ARIA TZIKA
• 金额: $ 68.81万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9752683
• 关键词: Address; Affect; American; Animal Experiments; Area; Attention; Behavioral; Biological Markers; Brain; Brain Mapping; Brain imaging; Caring; Cause of Death; Clinical; Clinical assessments; Computers; Control Groups; Data; Deductibles; Devices; Diffusion Magnetic Resonance Imaging; Elderly; Evaluation; Feedback; Fiber; Functional Magnetic Resonance Imaging; Hand; Healthcare; Home environment; Image; Imagery; Individual; Insurance; Ischemic Stroke; Knowledge; Life; Longitudinal Studies; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Medicare; Meta-Analysis; Modeling; Modernization; Monitor; Morbidity - disease rate; Motor; Motor Cortex; Motor Skills; Movement; Outcome; Participant; Pathologic; Patient Selection; Patients; Perception; Performance; Phase; Physical therapy; Protocols documentation; Quality of life; Randomized; Recovery; Reporting; Research; Resolution; Robotics; Role; Societies; Stroke; Structure; Supervision; Testing; Thick; Time; Training; Treatment Efficacy; Variant; Work; arm; base; chronic stroke; cost; density; design; disability; effective intervention; expectation; experience; experimental group; human old age (65+); improved; in vivo; indexing; individualized medicine; inter-individual variation; ischemic lesion; light weight; magnetic resonance imaging biomarker; middle cerebral artery; motor deficit; motor recovery; neuroimaging; novel; novel marker; outcome forecast; patient population; personalized medicine; physical therapist; portability; post stroke; predict clinical outcome; relating to nervous system; restoration; robot therapy; robotic device; stroke event; stroke outcome; stroke patient; stroke recovery; stroke survivor; stroke victims; success; tractography; treatment planning; white matter

The broad, long-term objective of this study is to improve therapy efficacy for, and thus the quality of life (QoL) of, stroke patients. An increasing number of individuals suffer from stroke. Disabilities resulting from stroke were considered irreversible until very recently. Stroke recovery is an emerging field, still overcoming the longstanding view of functions lost to stroke being non-recoverable. We hypothesize that (a) robotic devices that stimulate brain recovery via motor training can support restoration of movement abilities compromised by stroke-induced pathological changes in the brain; and that (b) post-stroke neural changes can be monitored (and therefore later predicted) by in vivo state-of-the-art magnetic resonance imaging (MRI) via brain recovery biomarkers and behavioral motor performance improvements. To test this hypothesis, we propose to conduct a longitudinal study of our novel hand device in conjunction with 3-T brain MRI to monitor recovery in patients with chronic stroke via three Aims. Aim (1) is to perform state-of-the-art MRI with newly-developed phased-array coils and parallel imaging (to maximize sensitivity and resolution) to document quantifiable brain changes during training in 100 chronic stroke patients with confirmed middle cerebral artery (MCA) territory ischemic stroke and ischemic lesions affecting the motor strip. Patients will be assigned randomly to a training group and non-training control group. Participants will train for 30 min/d, 3 d/wk, to be conducted at home to facilitate participation. Volumetric MRI, functional MRI (fMRI), and diffusion tensor imaging (DTI) will be performed before the start of treatment (baseline) and then monthly over a 3-month training period. MRI measurements will focus on the motor cortex and its surrounding cortical areas and connecting tracts. Aim (2) is to evaluate motor performance in these chronic stroke patients with standard clinical indices and hand device measurements. Aim (3) is to demonstrate that brain mapping based on state-of-the art MRI in conjunction with hand device-assisted therapy can provide novel biomarkers for chronic stroke recovery while improving clinical outcome. We will perform a meta-analysis of structural, fMRI, DTI, and motor performance data using a general linear mixed-model (GLMM) approach, which handles heterogeneous data and facilitates deduction of useful results despite inter-individual variability. Impact: Success will facilitate selection of patients and personalized treatment planning optimized to yield improvements based on MRI metrics. Specifically, this study may identify biomarkers of brain recovery that can be monitored during therapy, inform therapy adjustments, and advance our ability to predict stroke recovery outcome. For chronic stroke patients, we anticipate demonstrating that recovery is possible for a longer period of time than previously thought, including motor skill improvements beyond 6 mos. after a stroke event, owing to the capacity for brain plasticity and functionally adaptive reorganization. If this research indicates continued improvement with physical therapy, then the limitations of Medicare and other insurances should be extended to assist in longer-term recovery of stroke victims, thus improving their QoL, especially in the geriatric patient population, where stroke is most prevalent.

这项研究的广泛、长期目标是提高治疗效果，从而提高治疗效果 中风患者的生活质量（QoL）。越来越多的人患有 中风。直到最近，中风造成的残疾还被认为是不可逆转的。 中风康复是一个新兴领域，仍然克服了长期以来对中风患者功能丧失的看法。 中风是不可恢复的。 我们假设（a）通过运动刺激大脑恢复的机器人设备 训练可以帮助恢复因中风而受损的运动能力 大脑的病理变化； (b) 中风后神经变化可以 通过体内最先进的磁共振监测（因此后来预测） 通过大脑恢复生物标志物和行为运动表现改善进行成像（MRI）。 为了检验这一假设，我们建议对我们的新型手持设备进行纵向研究 与 3-T 脑部 MRI 结合，通过三个目标监测慢性中风患者的康复情况。 目标 (1) 是利用新开发的相控阵线圈和并行线圈进行最先进的 MRI 成像（以最大限度地提高灵敏度和分辨率）以记录可量化的大脑变化 对 100 名确诊为大脑中动脉 (MCA) 的慢性中风患者进行培训 区域缺血性中风和影响运动带的缺血性病变。患者将被分配 随机分为训练组和非训练对照组。参加者每天训练30分钟， 每周 3 天，在家中进行以方便参与。体积 MRI、功能 MRI （fMRI）和弥散张量成像（DTI）将在开始之前进行 治疗（基线），然后在 3 个月的训练期内每月进行一次。核磁共振测量 将重点关注运动皮层及其周围的皮层区域和连接束。目标 (2) 的目的是通过标准临床评估这些慢性中风患者的运动表现 指数和手持设备测量。目标 (3) 是证明大脑图谱 基于最先进的 MRI 结合手持设备辅助治疗可以 为慢性中风恢复提供新的生物标志物，同时改善临床结果。我们将 使用以下方法对结构、fMRI、DTI 和运动表现数据进行荟萃分析 通用线性混合模型 (GLMM) 方法，可处理异构数据和 尽管个体间存在差异，但仍有助于推断有用的结果。 影响：成功将有助于患者的选择和个性化治疗计划 根据 MRI 指标进行优化以提高产量。具体而言，本研究可能 识别可在治疗期间监测的大脑恢复生物标志物，为治疗提供信息 调整，并提高我们预测中风恢复结果的能力。对于慢性中风 患者，我们预计证明康复的时间可能比 之前认为，包括运动技能的提高超过 6 个月。中风后 事件，由于大脑可塑性和功能适应性的能力 重组。如果这项研究表明物理治疗持续改善， 那么医疗保险和其他保险的限制应该扩大以帮助长期 中风患者的康复，从而提高他们的生活质量，尤其是老年患者 人口，其中中风最常见。