Moderating Post-Stroke Hemiparesis with the Cross Education Phenomenon

通过交叉教育现象缓解中风后偏瘫

• 批准号: 8778982
• 负责人: Michael A. Urbin
• 金额: $ 5.6万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8778982
• 关键词: Accounting; Action Research; Activities of Daily Living; Address; Affect; Articular Range of Motion; Behavioral; Chronic; Clinical; Consensus; Contralateral; Development; Education; Educational Status; Exercise; Exposure to; Force of Gravity; Foundations; Frequencies; Functional disorder; Goals; Individual; Intervention; Ipsilateral; Learning; Limb structure; Literature; Measurement; Measures; Motor; Motor Neurons; Movement; Muscle; Neurorehabilitation; Outcome; Outcomes Research; Paresis; Participant; Patients; Persons; Population; Prevalence; Production; Qualifying; Recovery; Research; Residual state; Science; Scientist; Severities; Spinal; Stroke; Survivors; Techniques; Testing; Time; Training; Upper Extremity; Wrist; arm; career; cohort; constraint induced movement therapy; design; disability; effective intervention; evidence base; experience; extensor digitorum; hemiparesis; hemiparetic stroke; insight; neuroadaptation; neurobehavioral; novel; post intervention; post stroke; programs; prospective; public health relevance; relating to nervous system; restoration; skills; strength training

DESCRIPTION (provided by applicant): The disability brought about by post-stroke hemiparesis has negative consequences for the stroke survivor and the U.S. economy. There are evidence-based motor retraining programs that have been shown to promote movement recovery. If paresis in the affected upper extremity is too severe, however, individuals are not able to participate. The goal of the proposed project is to investigate the potential of an intervention that addresses the neural dysfunction underlying severe hemiparesis. The cross education effect is an established phenomenon in the exercise science literature that accounts for strength gains high-intensity, unilateral resistance training evokes in the contralateral, untrained limb. Though no definitive conclusions have been reached, the current consensus is that chronic interhemispheric and corticospinal adaptations underlie the strength gains observed in the untrained limb. These adaptations are the inverse of what is typically observed following hemiparetic stroke, inviting the possibility that high-intensity, unilateral resistance training ofthe non-paretic limb may drive the neural adaptations needed for movement restoration in the paretic limb. Using a prospective cohort, repeated-measures design, subjects will undergo 16 sessions of high-intensity, unilateral resistance training of the non-paretic wrist extensors. Sessions will take place at a frequency of four times per week over four weeks. The proposed project will take a multilevel approach to investigate changes in neural and behavioral function. The primary aim will test whether the intervention alters corticospinal excitability. It is hypothesized that there will be enhanced excitability of corticospinal projections to the paretic extensor digitorum communis. The secondary aim will examine whether the intervention elicits a hypothesized increase in active range of motion in the untrained, paretic wrist extensors. The third aim will evaluate whether the intervention leads to a hypothesized increase in functional capacity of the paretic upper extremity. The expected outcome of this project is an intervention that enhances paretic upper extremity movement production in persons with severe post-stroke hemiparesis. The ultimate goal is for this intervention to moderate paresis sufficiently for severely affected patients to participate in empirically-supported motor retraining programs. This project also will facilitate the experiences needed to achieve the training and career goals of Dr. Urbin.

描述（由申请人提供）：中风后偏瘫带来的残疾对中风幸存者和美国经济产生了负面影响。有证据基于循证的运动再培训计划可以促进运动恢复。但是，如果受影响的上肢中的麻痹太严重，那么个体将无法参加。拟议项目的目的是研究解决严重偏瘫基础神经功能障碍的干预措施的潜力。跨教育效应是运动科学文献中既定的现象，它在对侧未经训练的肢体中引起了高度强度，单方面抵抗训练的高度增强。尽管尚未得出明确的结论，但目前的共识是慢性半球和皮质脊髓适应的适应性是未经训练的肢体中观察到的强度增长。这些适应性是偏瘫中风后通常观察到的倒数的，邀请了非肢体肢体的高强度，单方面的耐药性训练可能会驱动paretic肢体运动恢复所需的神经适应性。使用前瞻性队列，重复测量设计，受试者将接受16次对非预腕伸肌的高强度，单方面耐药性训练。会议将在四个星期内以每周四次的频率进行。拟议的项目将采用多级方法来研究神经和行为功能的变化。主要目的将测试干预措施是否改变皮层脊髓兴奋性。假设皮质脊柱投影将增强对偏伸肌的兴奋性。次要目的将检查干预措施是否在未经训练的，paretic腕伸肌中假设有效运动范围增加。第三个目标将评估干预措施是否导致偏长端功能能力的假设增加。该项目的预期结果是一种干预措施，可增强势力后偏瘫患者的偏式上肢运动的产生。最终的目标是使这种干预措施充分适度，以使受到严重影响的患者参与经验支持的运动再培训计划。该项目还将促进实现博士培训和职业目标所需的经验。 厄本。