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

每年有超过6000名退伍军人患有缺血性中风，这通常会导致某种程度的 偏瘫中风治疗的不良结果使退伍军人参与随访的能力降低- 出院后的治疗，降低了完成日常生活活动的能力，并有助于 平均医疗费用是退伍军人的三倍。 目前的康复治疗方案要求强化康复，包括： 高强度、长时间的治疗。大脑愈合和动物研究的证据，沿着 与运动学习原则表明，一个治疗方案组成的短期时间 全天分布的治疗疗程可以为患者提供更好的康复效果。 中风患者这样的程序可以使用约束诱导疗法来实现，其中， 退伍军人在参与视频时有机会使用患肢 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， 出院后在家，而不必前往诊所或接受 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约束诱导治疗的治疗模型 在治疗中进行运动再训练的游戏环境 sessions.一小群患者将参加一个问答环节， 构成转移任务的活动的首选项。传输任务与 在玩视频游戏时进行的运动。患者还将接受自动化 提醒您全天使用受损的手臂。每年将招募10名退伍军人 住院中风专科项目5名患者将被分配至治疗组 组并接受干预。其余五人将接受现行标准的护理。 结果测量将包括评估上肢功能的运动功能测试。 初步成果将在一次重要会议上介绍，项目成果将提交给 相关同行评审期刊。该项目的规范将作为一个更大的， 多地点优异奖助金提案。我们相信这个项目将导致实质性的变化， 治疗急性卒中，改善退伍军人的功能结局， 降低了VA的护理成本。

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.