Brain areas that control reaching movements after stroke: Task-relevant connectivity and movement-synchronized brain stimulation

中风后控制伸手运动的大脑区域：任务相关连接和运动同步大脑刺激

• 批准号: 10316643
• 负责人: GEORGE F. WITTENBERG
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-11-01 至 2025-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10316643
• 关键词: Activities of Daily Living; Affect; Anatomy; Area; Behavior; Behavioral; Bilateral; Brain; Brain region; Clinical; Clinical Trials; Coupled; Data; Diffusion; Dorsal; Functional Magnetic Resonance Imaging; Goals; Human; Impairment; Individual Differences; Infarction; Internal Capsule; Intervention; Knowledge; Lesion; Magnetic Resonance Imaging; Measures; Methods; Motor; Motor Cortex; Motor output; Movement; Neurologic; Neuronal Plasticity; Participant; Patients; Performance; Persons; Population; Procedures; Productivity; Quality of life; Recovery; Resources; Rest; Robotics; Role; Shapes; Side; Stroke; Techniques; Testing; Training; Transcranial magnetic stimulation; Translations; Treatment Protocols; Upper Extremity; Veterans; Work; arm movement; arm paresis; base; causal model; design; disability; experience; functional loss; improved; innovation; lifetime risk; military veteran; motor behavior; motor control; motor function improvement; motor impairment; movement practice; neurological rehabilitation; neuroregulation; novel; post stroke; repetitive transcranial magnetic stimulation; robot exoskeleton; stroke patient; stroke risk; stroke survivor; trial comparing; white matter damage

As stroke is a leading cause of disability among veterans, there is a compelling need to develop treatments that improve motor ability after a stroke affects those brain networks relevant to motor function. Our goal is to improve motor function after stroke through methods that combine brain stimulation with practice. To advance this goal we need an understanding of the network changes that underlie recovery of useful motor behaviors such as reaching. Non- primary cortical motor areas have been shown to have strong connections with other motor areas, including the primary motor cortex, and there is some evidence that their functional role changes after stroke. We and others have also demonstrated the ability to influence reaching behavior with focal cortical stimulation, and to influence the cortical representation of reaching movement through the combination of cortical stimulation with reaching practice. We will use this new knowledge and increase our understanding of brain network changes and the effects of brain stimulation and practice by completing the following three aims: 1. Quantify effects of disrupting activity in PMd and PMv in each hemisphere during reaching tasks in participants with and without capsular stroke. The functional role of each region will be assessed through the effects of brief trains of repetitive transcranial magnetic stimulation in the dorsal and ventral premotor areas of each hemisphere during reaching tasks in human participants with and without capsular stroke. The specifics of white matter damage will influence which region on each side affects connectivity most. 2. Quantify connectivity with M1 and other motor regions in human participants with and without capsular stroke. This will be assessed by resting state & task-related connectivity using fMRI, and will demonstrate differences between the three types of functional connectivity measures: TMS regional effects on motor output, resting state fMRI, and dynamic causal models of task-related fMRI. The relationship between motor function and functional connectivity will therefore have been tested. 3. Evaluate the effects of movement- synchronized TMS of the most facilitatory region on the effects of practice on motor output and behavioral performance. TMS of the most functionally relevant premotor region will be synchronized with practice of the affected upper extremity. An innovative feature of this work is the study of internal capsule stroke, which is a more homogeneous and appropriate population than the overall set of stroke types that affect movement, which has a great deal of variety. These findings will allow us to formulate clear hypotheses about which premotor area should be modulated after stroke, and when, in the context of movement practice. We will be able to design a novel treatment protocol that delivers precisely timed stimulation during practice of reaching movements.

由于中风是导致退伍军人残疾的主要原因，因此迫切需要发展 中风后改善运动能力的治疗会影响与运动功能相关的大脑网络。 我们的目标是通过结合大脑刺激和治疗的方法来改善中风后的运动功能 练习一下。为了推进这一目标，我们需要了解作为恢复的基础的网络变化 有用的运动行为，如伸手。非初级皮质运动区已被证明具有 与其他运动区，包括初级运动皮质有很强的联系，而且有一些证据表明 他们的功能角色在中风后发生了变化。我们和其他人也展示了影响 局灶性皮质刺激的触达行为及其对触觉皮层表征的影响 通过皮质刺激和伸展练习相结合的运动。 我们将利用这一新知识，增加对大脑网络变化及其影响的理解 通过完成以下三个目标来实现大脑刺激和练习：1.量化干扰的影响 有任务和无任务参与者在完成任务时各半球PMD和PMV的活动 囊性卒中。每个地区的职能作用将通过简短的培训效果进行评估 双侧大脑半球背侧和腹侧运动前区重复经颅磁刺激 在人类完成任务的过程中，有或没有囊性中风的参与者。白色的细节 物质损伤会影响到两侧哪个区域对连通性影响最大。2.量化连接 有无包膜卒中的人类受试者的M1和其他运动区。这将是 通过使用功能磁共振成像的静息状态和任务相关连接进行评估，并将展示 三种类型的功能连通性测量：TMS区域对电机输出的影响、静息状态 以及任务相关功能磁共振的动态因果模型。运动功能与运动功能的关系 因此，功能连通性将得到测试。3.评估移动的效果-- 关于练习对电机输出的影响的最便利地区的同步TMS和 行为表现。最具功能相关性的前置马达区域的TM将与 练习受影响的上肢。这项工作的一个创新之处是对内囊的研究 中风，这是一个比整个中风类型集更同质和更合适的群体， 影响运动，它有很大的多样性。这些发现将使我们能够清楚地 关于卒中后哪些运动前区域应该被调节的假说，以及在 动作练习。我们将能够设计一种新的治疗方案，提供精确的时间 在练习伸展动作时的刺激。