Neuroplasticity with Daily Use of a Sensorimotor Priming Vibration System to Improve Hand Function After Stroke

日常使用感觉运动启动振动系统改善中风后手部功能的神经可塑性

• 批准号: 9904719
• 负责人: Na Jin Seo
• 金额: $ 20.01万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-02 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9904719
• 关键词: Accelerometer; Action Research; Activities of Daily Living; Address; Affect; Back; Behavioral; Biomechanics; Centers of Research Excellence; Clinic Visits; Clinical; Conscious; Data Set; Device Designs; Devices; Dose; Double-Blind Method; Esthesia; Evaluation; Evoked Potentials; Feedback; Fingers; Forearm; Frequencies; Future; Hand; Hand functions; Healthcare Systems; Home environment; Hour; Impairment; Individual; Influenza; Intervention; Kinetics; Laboratories; Living Wills; Location; Measures; Methods; Motor; Motor Cortex; Neuronal Plasticity; Outcome; Paresis; Physiologic pulse; Posture; Protocols documentation; Quality of life; Randomized Controlled Trials; Recovery; Recovery of Function; Research; Research Design; Research Support; Risk; Sensory; Sensory Thresholds; Signal Transduction; Skin; Stroke; System; Task Performances; Testing; Therapeutic; Time; Touch sensation; Transcranial magnetic stimulation; Transcutaneous Electric Nerve Stimulation; Translations; Wolves; Wrist; arm; arm paresis; career development; chronic stroke; design; dexterity; disability; experience; follow-up; functional independence; grasp; hand dysfunction; hand rehabilitation; hand therapy; improved; innovation; kinematics; longitudinal analysis; median nerve; motor control; motor deficit; motor recovery; multidisciplinary; neuroregulation; novel; post stroke; randomized controlled study; response; secondary analysis; sedentary; sensory feedback; sensory input; stroke recovery; stroke survivor; treatment duration; vibration; wearable device

Current stroke hand rehabilitation overlooks sensory deficits, even though sensory deficits hinder motor recovery. Thus, we have developed a novel sensory stimulation, Therabracelet, in which a wristband applies imperceptible vibration to wrist skin to immediately enhance hand sensation and dexterity, facilitate plasticity, and enable home use to increase the treatment dose substantially beyond typical clinic visits. The objective of this proposal is to determine if continuous use of TheraBracelet in the home has a clinically meaningful effect. The career development objective is to build expertise in assessing neural plasticity underlying stroke recovery induced by sensory enhancement. In a double-blinded randomized controlled trial, chronic stroke survivors with moderate hand impairment will wear the TheraBracelet device on the paretic wrist for 8 hours/day every day during their normal daily activity for 1 month, coming to the laboratory for weekly evaluation and for 1- month follow-up evaluation. The device will deliver vibration (treatment) or no vibration (control). Double- blinding is possible because the treatment vibration is imperceptible (i.e., subthreshold). Aim 1: Determine the effect of in-home use of TheraBracelet on neural plasticity. Hypothesis: TheraBracelet induces neural plasticity. The primary measure is the extent that sensory input modulates the primary motor cortex, using the paired associative stimulation protocol with TMS immediately preceded by electrical median nerve stimulation. Secondary measures are cortical connectivity and grip-related spectral power change assessed using EEG. Secondary analyses will include individual factors associated with responsiveness to TheraBracelet and longitudinal analysis of outcomes to determine the way effects accumulate over time. Aim 2: Determine the effect of in-home use of TheraBracelet on hand function. Hypothesis: The immediate improvement in hand function with TheraBracelet leads to more use of the affected hand and arm in the home, resulting in functional recovery. The amount of the paretic arm use in daily living will be assessed using accelerometers. Clinical hand function will be assessed using the Wolf Motor Function, Box and Block, and Action Research Arm Tests. In addition, biomechanical hand grip control will be assessed by the ability to direct grip force, excess grip force used, and kinetic/kinematic response to perturbation of a gripped object to describe dynamic feedback control. Impact: This research will elucidate neural plasticity and behavioral effects induced by wearing a novel sensory stimulation device throughout daily living, along with determining likely responders and treatment duration effects. This research will guide the design of a future R01 to investigate the clinical utility of TheraBracelet for post-stroke hand motor recovery. This research is translational as stroke survivors can easily use this low-risk vibrating wristband. This research supports the COBRE major themes of neuromodulation, translation of an innovative treatment device, and using multidisciplinary datasets toward individualized intervention. Enhancing hand function should increase stroke survivors’ independence and quality of life.

当前的中风手部康复忽视了感觉缺陷，尽管感觉缺陷阻碍了运动 因此，我们开发了一种新颖的感官刺激 Therabracelet，其中应用了腕带。 对手腕皮肤产生难以察觉的振动，立即增强手部感觉和灵巧性，促进可塑性， 并使家庭使用的治疗剂量几乎超出了典型的诊所就诊的目标。 该提案旨在确定在家中持续使用 TheraBracelet 是否具有临床意义的效果。 职业发展目标是建立评估中风恢复背后的神经可塑性的专业知识 在一项双盲随机对照试验中，慢性中风幸存者通过感觉增强引起。 患有中度手部损伤的患者将每天在瘫痪手腕上佩戴 TheraBracelet 设备 8 小时 为期 1 个月的正常日常活动中的一天，每周到实验室进行评估，并进行 1- 一个月的后续评估。该设备将提供振动（治疗）或无振动（控制）。 致盲是可能的，因为治疗振动是不可察觉的（即亚阈值）。 家庭使用 TheraBracelet 对神经可塑性的影响 假设：TheraBracelet 诱导神经可塑性。 主要测量是感觉输入调节初级运动皮层的程度，使用成对的 在电正中神经刺激之前立即使用 TMS 进行关联刺激方案。 次要测量是使用脑电图评估皮质连接性和握力相关的光谱功率变化。 二次分析将包括与 TheraBracelet 反应相关的个体因素以及 对结果进行纵向分析，以确定效果随时间累积的方式。 目标 2：确定效果。 在家使用 TheraBracelet 对手部功能的影响 假设：立即改善手部功能。 TheraBracelet 的功能导致在家中更多地使用受影响的手和手臂，从而导致功能障碍 日常生活中瘫痪手臂的使用量将使用临床加速度计进行评估。 将使用 Wolf 运动功能、盒子和块以及动作研究手臂测试来评估手部功能。 此外，生物力学手握力控制将通过直接握力、过度握力的能力来评估 使用对抓取物体的扰动的动力学/运动学响应来描述动态反馈控制。 影响：这项研究将阐明佩戴新型感官所引起的神经可塑性和行为影响 整个日常生活中的刺激装置，以及确定可能的反应者和治疗持续时间 这项研究将指导未来 R01 的设计，以研究 TheraBracelet 的临床效用。 这项研究具有转化性，因为中风幸存者可以轻松使用这种低风险的方法。 这项研究支持 COBRE 的神经调节、翻译的主要主题。 创新的治疗设备，并使用多学科数据集来加强个性化干预。 手部功能应该可以提高中风幸存者的独立性和生活质量。