Effect of Constraint-Induced Gaming Therapy in an Acute Care Setting

约束诱导游戏疗法在急性护理环境中的效果

• 批准号: 10177968
• 负责人: Andrew H. Hansen
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10177968
• 关键词: Activities of Daily Living; Acute; Address; Adverse effects; Affect; Animal Experimentation; Applications Grants; Appointment; Artificial Intelligence; Behavioral; Brain; Caring; Chronic; Clinic; Clinical effectiveness; Communities; Continuity of Patient Care; Disabled Persons; Equilibrium; Health; Hemiplegia; Home environment; Hospitals; Hour; Impairment; Inpatients; Intervention; Ischemic Stroke; Journals; Learning; Length of Stay; Life; Limb structure; Literature; Logistics; Maintenance Therapy; Medical; Modeling; Motor; Movement; Occupational Therapist; Outcome; Outcome Measure; Patients; Peer Review; Persons; Play; Policies; Protocols documentation; Quality of life; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Research; Site; Stroke; Structure; System; Techniques; Technology; Testing; Therapeutic; Therapeutic Intervention; Time; Training; Translating; Transportation; Travel; Treatment Protocols; Upper Extremity; Veterans; Video Games; Work; acute care; acute stroke; arm; base; care costs; community based participatory research; comparative; constraint induced movement therapy; constraint induced therapy; cost; experience; follow-up; functional decline; functional gain; functional outcomes; gaming environment; healing; improved; medical specialties; motor function improvement; motor learning; portability; post stroke; preference; programs; recruit; relative effectiveness; rural area; rural setting; standard care; standard of care; stroke patient; stroke recovery; stroke rehabilitation; stroke survivor; stroke therapy; symposium; therapy duration; treatment group; treatment program; virtual

More than 6000 Veterans each year have an ischemic stroke that often results in some level of hemiplegia. Poor outcomes in stroke therapy leave the Veteran less able to participate in follow- up therapy post-discharge, reduces ability to complete activities of daily living, and contributes to an average cost of care three times the typical Veteran. Current protocols for therapy on a rehabilitation unit call for intensive rehabilitation composed of high intensity, long duration therapy. Evidence from brain healing and animal research, along with motor learning principles suggest that a treatment program composed of short duration therapy sessions distributed throughout the day may provide better rehabilitation outcomes for stroke patients. Such a program can be implemented using constraint-induced therapy in which the Veteran is provided with opportunities to use the affected limb while participating in a video game and completing complementary tasks in therapy. Additionally, rehabilitation outcomes may improve if Veterans are provided with regular opportunities to participate in gaming therapy at home after discharge from the hospital rather than having to travel to a clinic or receive limited or no follow-up in rural areas. This project will develop a therapeutic model for applying constraint-induced therapy via a video gaming environment that has movements paired with motor retraining performed in therapy sessions. A small group of patients will participate in a question and answer session about preferences for activities which make up transfer tasks. Transfer tasks are paired with movement performed while playing the video game. Patients will also receive automated reminders to use the impaired arm throughout the day. Ten Veterans will be recruited annually from the inpatient Stroke Specialty Program. Five patients will be assigned to the Treatment group and receive the intervention. The remaining five will receive the current standard of care. Outcome measures will include motor function tests that evaluate upper extremity function. Preliminary results will be presented at a major conference with project results submitted to a relevant peer-reviewed journal. Norms from this project will serve as the basis for a larger, multi-site Merit grant proposal. We believe this project will lead to substantive change in the treatment of acute stroke that will lead to improved functional outcomes for Veterans and reduced care costs for the VA.

每年有6000多名退伍军人患有缺血性中风，这种中风通常会导致不同程度的 偏瘫。卒中治疗的不良结果使退伍军人参与后续治疗的能力降低 出院后进行UP治疗，降低完成日常生活活动的能力，并做出贡献 平均护理费用是典型退伍军人的三倍。 目前对康复单元的治疗方案要求由以下部分组成的强化康复 高强度、长疗程的治疗。来自大脑康复和动物研究的证据，以及 配合运动学习原则建议短疗程组成的治疗方案 全天分发的治疗疗程可能会为 中风患者。这样的计划可以使用强制诱导治疗来实现，其中 退伍军人在参与视频时有机会使用受影响的肢体 游戏和完成治疗中的补充任务。此外，康复结果 如果为退伍军人提供定期参加游戏治疗的机会，可能会有所改善 出院后呆在家里，而不是去诊所或接受 农村地区的后续行动有限或没有后续行动。 该项目将开发一种通过视频应用强制诱导治疗的治疗模型 在治疗中将动作与运动再训练相结合的游戏环境 会话。一小部分患者将参加关于以下问题的问答环节 组成转移任务的活动的首选项。转接任务与配对 在玩视频游戏时执行的移动。患者还将接受自动 提醒全天使用受损的手臂。每年将招募10名退伍军人 来自住院中风专科项目。五名病人将被分配到治疗中。 分组并接受干预。其余五人将接受目前的护理标准。 结果测量将包括评估上肢功能的运动功能测试。 初步成果将在一个主要会议上提交，项目结果将提交给 相关同行评议期刊。这个项目的规范将作为一个更大的、 多站点奖励金提案。我们相信，这一项目将导致 急性卒中的治疗将改善退伍军人和 降低退伍军人管理局的护理成本。