Mechanisms of Arm Recovery in Stroke Patients with Hand Paralysis

中风手麻痹患者手臂恢复机制

• 批准号: 9226537
• 负责人: Michelle Lynn Harris-Love
• 金额: $ 19.78万
• 依托单位: GEORGE MASON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-01 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9226537
• 关键词: Address; Affect; Area; Behavior; Behavioral; Brain; Characteristics; Corticospinal Tracts; Cost Savings; Data; Disabled Persons; Dorsal; Dose; Ensure; Equilibrium; Functional disorder; Goals; Hand; Hand functions; Human; Impairment; Individual; Intervention; Left; Lesion; Methods; Mission; Modeling; Motor; Motor Cortex; Movement; National Institute of Child Health and Human Development; National Institute of Neurological Disorders and Stroke; Paralysed; Patients; Pattern; Performance; Phase; Population; Process; Public Health; Recovery; Recruitment Activity; Rehabilitation therapy; Reporting; Research; Role; Severities; Stroke; System; Task Performances; Techniques; Testing; Time; Transcranial magnetic stimulation; United States National Institutes of Health; Work; arm; arm function; arm movement; burden of illness; disability; hand rehabilitation; improved; innovation; motor recovery; nervous system disorder; neuroregulation; phase III trial; post stroke; predictive modeling; prospective; relating to nervous system; stroke recovery; stroke survivor

Current treatments for severe post-stroke arm impairment, a major contributor to stroke-related disability, are of limited efficacy and patients are often permanently disabled. While mechanisms of arm and hand recovery have been extensively studied, patients with impaired reaching movements and no hand function are often ex- cluded from these studies due to the severity of their impairment. Thus there is little known about mechanisms of arm recovery in the large proportion of the stroke population that has sustained more severe damage to the corticomotor system and lacks hand function. The long-term goal is to gain the mechanistic information needed to develop interventions to improve reaching ability in patients with severe corticomotor system damage. The objective in this proposal is to identify the role of the unaffected hemisphere (UH) in affected arm movements in this population. While UH activation is often considered deleterious to recovery, new models suggest that in those with less "structural reserve", UH motor areas could contribute to motor recovery. Here, the central aim is to determine the extent to which UH motor areas can contribute to affected arm reaching movements in patients with severe corticomotor damage . The central aim will be achieved via 2 specific aims: 1) Compare the role of the unaffected vs. affected hemi- sphere in reaching movements of stroke patients with severe impairment, 2) Determine the effect of excitatory non-invasive brain stimulation to UH motor areas on practice-induced reaching improvements in patients with severe impairment. Under Aim 1, non-invasive brain stimulation will be used to momentarily interfere with pro- cessing in unaffected and affected hemisphere areas to see if it has any effect on movement of the affected arm. Under Aim 2, non-invasive brain stimulation will be used to induce a longer-lasting increase in excitability of the unaffected or affected hemisphere prior to a bout of reaching practice. We will compare the amount of improvement in reaching ability after stimulation of each targeted brain area. We will also test for any change in the role of the targeted brain areas in the movement. The approach is innovative because it addresses a little-studied topic (recovery mechanisms in severely im- paired patients) and targets brain areas that have been thought to be deleterious to recovery (UH). The pro- posed research is significant because, to develop interventions to improve post-stroke arm recovery, the mechanisms of impairment and recovery must be understood. Since a large portion of stroke-related disability is due to arm impairment, improvements in arm function could result in enormous benefits (and cost savings) when multiplied across this large and steeply growing population.

当前对严重的中风后手臂障碍的治疗方法，是中风相关残疾的主要贡献者，是 有限的功效和患者通常是永久残疾的。而手臂和手恢复机制 已经进行了广泛的研究，达到运动受损的患者通常没有手部功能 由于其损害的严重程度，这些研究源于这些研究。因此，关于机制鲜为人知 在大部分的中风人群中，手臂恢复的损害更为严重 皮质运动系统，缺乏手部功能。 长期目标是获取开发干预措施以改善覆盖范围所需的机械信息 严重皮质运动系统损伤患者的能力。该提案的目的是确定角色 在该人群中受影响的ARM运动中未受影​​响的半球（UH）。而UH激活通常是 被认为是恢复有害的，新型号表明，在“结构储备”较少的人中，嗯电机 区域可能有助于运动恢复。在这里，中心目的是确定电动机的程度 区域可以导致受影响的手臂到达严重皮质运动损伤的患者的运动。 将通过2个特定目的来实现中心目标：1）比较未受影响与受影响的半部的作用 在达到严重损害的中风患者运动运动时，2）确定兴奋的影响 对UH运动区域的非侵入性大脑刺激，以实践引起的患者的改善 严重的损害。在AIM 1下，非侵入性脑刺激将用于暂时干扰 在不受影响和受影响的半球区域中，查看它是否对受影响的运动有任何影响 手臂。在AIM 2下，非侵入性大脑刺激将用于诱导兴奋性持续更长的增加 在进行练习之前，未受影响或影响的半球。我们将比较 刺激每个靶向大脑区域后，达到能力的提高。我们还将测试任何更改 目标大脑区域在运动中的作用。 这种方法具有创新性，因为它解决了一个研究的话题（严重影响的恢复机制 配对的患者）和靶向被认为对恢复有害的大脑区域（UH）。专业人士 提出的研究很重要，因为为了制定干预措施以改善势头后的恢复， 必须理解损伤和恢复机制。由于很大一部分与中风有关的残疾 是由于手臂损伤，手臂功能的改善可能会带来巨大的好处（并节省成本） 当乘以这个庞大而陡峭的人口时。