Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke

治疗期间伴随感觉刺激以增强中风后手部功能恢复

• 批准号: 9884892
• 负责人: Na Jin Seo
• 金额: $ 48.05万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9884892
• 关键词: Accelerometer; Action Research; Activities of Daily Living; Address; Affect; American; Biomechanics; Brachial Paresis; Caregiver Burden; Clinical; Communication; Control Groups; Data; Devices; Digit structure; Dose; Double-Blind Method; Electric Stimulation; Electroencephalogram; Esthetics; Evaluation; Feedback; Fingers; Frequencies; Future; Hand; Hand functions; Leisures; Lifting; Literature; Location; Lower Extremity; Manuals; Measures; Mechanoreceptors; Methods; Modality; Motion; Motor; Motor Activity; Motor Cortex; Movement; Neurons; Outcome; Outcome Measure; Paresis; Participant; Patient-Focused Outcomes; Peripheral; Pilot Projects; Quality of life; Randomized; Randomized Controlled Trials; Recovery of Function; Research; Research Design; Rest; Risk; Self Care; Sensory; Skin; Standardization; Stroke; Testing; Therapeutic; Time; Translations; Treatment Efficacy; United States; Upper Extremity; Vocation; Wolves; Wrist; arm; base; chronic stroke; clinical practice; compliance behavior; cost; cost effective; dexterity; disability; finger movement; follow-up; functional independence; grasp; hand dysfunction; hand rehabilitation; improved; innovation; longitudinal analysis; motor impairment; new technology; novel; novel marker; post intervention; post stroke; programs; randomized controlled study; relating to nervous system; secondary analysis; smart watch; stroke survivor; treatment group; vibration

Project Summary: Post-stroke hand impairment is prevalent, persistent, and difficult to treat, with negative impact on functional ability and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. While promising, most modalities of sensory stimulation interfere with natural hand tasks. Thus they are administered prior to therapy, requiring additional time commitment and hindering patient adherence and implementation. Further, effects diminish after stimulation, weakening its potency during therapy. To address limitations of existing sensory stimulation and fully leverage the therapeutic benefits of sensory stimulation, a novel sensory stimulation `TheraBracelet' has been developed: A wristwatch applies imperceptible vibration during task practice to stimulate the sensorimotor cortex neurons for coherent firing during hand tasks, leading to enhanced neural communication and hand function recovery. The objective of this project is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone in an adequately powered study. The study design is a double-blinded randomized controlled trial. Chronic stroke survivors will undergo a standardized hand task-practice therapy program (3 days/week for 6 weeks) with the TheraBracelet device worn on the paretic wrist. The device will deliver vibration for the treatment group and no vibration for the control group. Double blinding is possible because the treatment vibration is imperceptible. Evaluation will be performed at baseline, 2, 4, and 6 weeks of therapy, and 1 month after. Aim 1: To determine clinical potential of TheraBracelet in improving hand functional recovery. Hypothesis: Improvement of hand motor function will be greater for the treatment than control. Hand function will be assessed using the Wolf Motor Function, Box and Block, and Action Research Arm Tests, along with the quantity/quality of the upper limb use in daily living, abilities for daily activities, and participant feedback. Aim 2: To determine the effects of TheraBracelet on sensorimotor grip control and neural communication. Hypothesis: The treatment will enhance sensorimotor grip control and neural communication for hand grip compared with control. Sensorimotor grip control will be assessed using the well-established biomechanical measure of digit force directional control and efficient scaling of grip force during grip-and-lift. Neural communication for hand grip will be quantified as increase in EEG coherence in the cortical sensorimotor network for grip compared to rest. Secondary analyses will include characterizing the time course of effects and responder analysis. Impact: This research will determine clinical utility and biomarkers of this novel stimulation to guide potential translation. This research is translational as this stimulation is implemented in an aesthetically appealing smartwatch, does not interfere with hand motion, and can be easily integrated in clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life, and reduce caregiver burden.

项目摘要：中风后手部损伤普遍存在、持续存在且难以治疗，且具有负面影响 对功能能力和独立性的影响。提高治疗效果的一种方法是加强治疗 与周围感觉刺激。虽然很有希望，但大多数感觉刺激方式都会干扰 自然的手工任务。因此，它们是在治疗前进行的，需要额外的时间投入和 阻碍患者的依从性和实施。此外，刺激后效果减弱，削弱了其 治疗期间的效力。解决现有感官刺激的局限性并充分利用治疗 感官刺激的好处，一种新颖的感官刺激“TheraBracelet”已经开发出来：手表 在任务练习过程中应用难以察觉的振动来刺激感觉运动皮层神经元以获得连贯性 在手部任务期间放电，从而增强神经通讯和手部功能恢复。目标 该项目的目的是确定 TheraBracelet 与手工任务练习相结合是否优于手工任务 在充分有力的研究中单独练习。该研究设计是双盲随机对照 审判。慢性中风幸存者将接受标准化的手部任务练习治疗计划（每周 3 天） 6 周），TheraBracelet 装置戴在瘫痪手腕上。该装置将为 治疗组为无振动对照组。双盲是可能的，因为治疗 振动是难以察觉的。评估将在基线、治疗第 2、4、6 周以及 1 个月时进行 后。目标 1：确定 TheraBracelet 在改善手部功能恢复方面的临床潜力。 假设：治疗组手部运动功能的改善效果优于对照组。手部功能 将使用 Wolf 运动功能、盒子和块以及行动研究手臂测试以及 日常生活中使用上肢的数量/质量、日常活动的能力以及参与者的反馈。 目标 2：确定 TheraBracelet 对感觉运动握力控制和神经通讯的影响。 假设：治疗将增强感觉运动握力控制和握力的神经通讯 与对照相比。感觉运动握力控制将使用成熟的生物力学进行评估 握力和举起过程中数字力方向控制和握力有效缩放的测量。神经 握力的交流将被量化为皮质感觉运动脑电图一致性的增加 与休息相比，网络的抓地力。二次分析将包括描述影响的时间过程 和响应者分析。影响：这项研究将确定该小说的临床实用性和生物标志物 刺激来指导潜在的翻译。这项研究是转化性的，因为这种刺激是在 美观的智能手表，不干扰手部运动，并且可以轻松集成到临床中 实践。增强手部功能应可大幅提高中风幸存者的独立性和生活质量 生活，减轻照顾者的负担。