Bilateral Priming Plus Task Specific Training for Severe Upper Limb Hemiparesis

针对严重上肢偏瘫的双侧启动加任务特定训练

• 批准号: 9979933
• 负责人: Daniel M. Corcos
• 金额: $ 29.33万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979933
• 关键词: Aerobic; Affect; Aftercare; Aging; Articular Range of Motion; Bilateral; Caregiver Burden; Caregivers; Chronic; Clinic; Clinical; Clinical Research; Combined Modality Therapy; Communities; Data; Devices; Dose; Effectiveness; Equilibrium; Evaluation; Frequencies; Goals; Hand; Hour; Impairment; Incidence; Individual; Intervention; Intervention Studies; Limb structure; Measures; Mechanics; Medical; Motor; Motor Cortex; Movement; Movement Disorders; Neuronal Plasticity; Outcome; Outcome Measure; Paralysed; Participant; Patients; Pattern; Periodicity; Population; Protocols documentation; Public Health; Publishing; Quality of life; Randomized; Rehabilitation therapy; Research; Residual state; Resources; Safety; Schedule; Science; Scientist; Stroke; Techniques; Testing; Therapeutic; Therapeutic procedure; Time; Training; Transcranial magnetic stimulation; Upper Extremity; Withholding Treatment; Work; Wrist; alternative treatment; arm; arm function; arm movement; baby boomer; base; behavior measurement; chronic stroke; clinical practice; constraint induced movement therapy; cost; cost effective; design; disability; effective intervention; effective therapy; efficacy study; follow-up; hemiparesis; improved; indexing; mortality; motor recovery; neuroregulation; novel; outcome forecast; post intervention; post stroke; primary outcome; programs; rehabilitation research; relating to nervous system; secondary outcome; stroke rehabilitation; stroke survivor; upper limb hemiparesis

Priming techniques to enhance use dependent plasticity have been examined in stroke rehabilitation research. Priming can upregulate ipsilesional cortex and/or down regulate contralesional cortex to improve effectiveness of subsequent therapy. Most priming techniques are costly and approved only for research. Here, we describe a priming technique that is cost-effective and has the potential to significantly change clinical practice. Bilateral motor priming (BMP) uses bilateral, symmetrical, rhythmic movement to ready the motor cortex for functional limb training. A "rocker" is used so that the less affected limb can drive the more affected one in symmetrical wrist flexion and extension. Active range of motion of the affected wrist is not necessary, and, thus, BMP can be used in severely impaired participants. Beneficial aspects of bilateral motor priming (compared to priming using rTMS and tDCS) include the fact that BMP is: 1) cost-effective; 2) available to a larger pool of individuals due to a paucity of safety concerns; (3) does not require a skilled operator; and (4) can be used the clinic. Previous studies comparing bilateral priming plus therapy found the priming and therapy combination to be more effective than therapy alone. However, previous BMP studies have not used dose matched designs. This project compares two groups of randomly assigned participants receiving task specific training (TST). Seventy-six participants will be randomized to receive either fifteen 2-hour sessions (30 hours) of BMP + TST or the same dose matched 30 hours of TST alone. Participants will attend sessions 3 times per week for 5 weeks with possible missed sessions scheduled at week 6. Outcome measures will be collected at pre-intervention, post-intervention, and follow-up (6 weeks post discharge). Aim 1 will determine the magnitude of change in upper limb impairment and function in chronic stroke survivors who have undergone 5 weeks of BMP+TST. The primary outcome measure is the Fugl-Meyer Test of Upper Extremity Function (FMUE). The secondary outcome is the Chedoke Arm and Hand Activity Index, an assessment of bimanual functional tasks. We expect both groups to improve on behavioral measures from pre-to post-intervention. However, the BMP+TST group is expected to have larger improvements than the TST alone group. We also expect these measures to persist at follow-up (6 weeks post cessation of treatment) in the BMP+TST group but not in TST alone. Aim 2 will determine the effects of bilateral priming on cortical mechanisms as measured by transcranial magnetic stimulation (TMS). We expect to find changes in TMS parameters that reflect a greater balance of hemispheric excitability in the BMP+TST group only. We further hypothesize that increases in hemispheric excitability will be associated with improvements in the FMUE. Currently, there is no clinically demonstrated long-term effective treatment for individuals with severe chronic upper limb hemiparesis. It is important to identify treatments for this underserved and under-investigated population.

增强使用依赖性可塑性的启动技术已在中风康复中得到检验 研究。启动可以上调同侧皮层和/或下调对侧皮层以改善 后续治疗的有效性。大多数启动技术都很昂贵并且仅被批准用于研究。这里， 我们描述了一种具有成本效益且有可能显着改变临床的启动技术 实践。双边运动启动 (BMP) 使用双边、对称、有节奏的运动来准备运动 皮质进行肢体功能训练。使用“摇杆”，以便受影响较小的肢体可以驱动受影响较大的肢体 一种是对称的手腕屈曲和伸展。受影响手腕的主动运动范围是不必要的， 因此，BMP 可用于严重受损的参与者。双侧运动启动的好处 （与使用 rTMS 和 tDCS 启动相比）包括 BMP 的事实： 1) 成本效益高； 2）可用于 由于缺乏安全考虑，人员数量较多； (3)不需要熟练的操作人员；和（4） 可以到诊所使用。先前比较双侧启动加治疗的研究发现启动和治疗 联合治疗比单独治疗更有效。然而，之前的 BMP 研究并未使用剂量 匹配的设计。该项目比较了两组随机分配的参与者接受特定任务的情况 培训（TST）。 76 名参与者将被随机分配接受 15 场 2 小时课程（30 小时） BMP + TST 或相同剂量与单独 TST 30 小时相匹配。参加者每场参加3次 每周 5 周，可能错过第 6 周安排的课程。结果测量将在 干预前、干预后和随访（出院后 6 周）。目标 1 将确定大小 经过 5 周的慢性中风幸存者上肢损伤和功能的变化 BMP+TST。主要结果指标是上肢功能 Fugl-Meyer 测试 (FMUE)。这 次要结果是 Chedoke 手臂和手部活动指数，这是对双手功能任务的评估。 我们预计这两个群体从干预前到干预后的行为测量都会有所改善。然而， BMP+TST 组预计比单独 TST 组有更大的改善。我们也期待这些 BMP+TST 组在随访（停止治疗后 6 周）时坚持采取的措施，但 TST 组则不然 独自的。目标 2 将确定双侧启动对皮质机制的影响（通过经颅测量） 磁刺激（TMS）。我们期望发现 TMS 参数的变化，以反映更大的平衡 仅 BMP+TST 组的半球兴奋性。我们进一步假设半球的增加 兴奋性将与 FMUE 的改善相关。目前，尚无临床证明 对患有严重慢性上肢偏瘫的个体进行长期有效的治疗。重要的是 确定针对这一服务不足和调查不足的人群的治疗方法。