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: 10728384
• 负责人: Na Jin Seo
• 金额: $ 0.12万
• 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 2023-08-13
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10728384
• 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; Electroencephalography; Esthesia; Esthetics; Evaluation; Feedback; Fingers; Frequencies; Future; Hand; Hand functions; Intervention; Leisures; Lifting; Literature; Location; Lower Extremity; Manipulative Therapies; 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; Wrist; arm; 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; neural; new technology; novel; novel marker; post intervention; post stroke; programs; randomized, controlled study; secondary analysis; smart watch; stroke survivor; translational potential; 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：冲程后手损伤很普遍，持久且难以治疗，负面影响 对功能能力和独立性的影响。提高治疗功效的一种方法是增加治疗 带有周围感觉刺激。在有希望的同时，大多数感觉刺激的方式都会干扰 自然的手工任务。因此，它们是在治疗之前对其进行管理的，需要额外的时间承诺和 阻碍患者的依从性和实施。此外，刺激后的影响减弱，削弱了其 治疗期间的效力。解决现有感觉刺激的局限性并充分利用治疗 感官刺激的好处，一种新型的感觉刺激“ therabracelet”：手表 在任务练习过程中应用不可察觉的振动，以刺激连贯的感觉运动皮质神经元 在手部任务期间发射，从而增强了神经通信和手部功能恢复。目标 这个项目的是确定将Therabracelet与手部任务练习相结合是否优于手工任务 在一项足够的动力研究中独自练习。研究设计是双盲随机控制 审判。慢性中风幸存者将接受标准化的手工实践治疗计划（每周3天/周 6周）戴在副手腕上的Therabracelet设备。该设备将为 治疗组和对照组无振动。双眼是可能的，因为治疗 振动是无法察觉的。评估将在基线，2、4和6周的治疗和1个月进行。 后。目的1：确定治疗剂在改善手部功能恢复方面的临床潜力。 假设：治疗的手机功能的改善要大于对照。手功能 将使用狼运动功能，盒子和块以及动作研究臂测试以及 上肢使用的数量/质量在日常生活中使用，日常活动的能力和参与者的反馈。 目的2：确定治疗脑对感觉运动控制和神经通信的影响。 假设：治疗将增强手持握把的感觉运动控制和神经通信 与对照相比。感觉运动控制控制将使用良好的生物力学评估 握把和握力期间的数字力方向控制和握力的有效尺度的度量。神经 手动握把的通信将被量化为皮质感觉运动中的脑电图相干性的增加 与休息相比，抓地力网络。次要分析将包括表征时间效果的表征 和响应者分析。影响：这项研究将确定这项小说的临床效用和生物标志物 刺激以指导潜在的翻译。这项研究是转化的，因为这种刺激是在 美学上吸引人的智能手表，不会干扰手动运动，并且可以轻松地集成到临床上 实践。增强手功能应大大提高中风幸存者的独立性和质量 生活，减轻照顾者负担。