Contralaterally Controlled FES plus Video Games for Hand Therapy after Stroke

上肢轻瘫是中风导致的最严重的损伤之一。 在美国每年发生的超过795，000例中风中，约75%引起一定程度的脑卒中。 上肢瘫痪高达65%的中风幸存者仍然不能使用他们的影响手，以协助 中风后6个月的日常生活活动。拟议的项目是一项临床试验， 创新的神经肌肉电刺激疗法的效果，以整合电刺激疗法， 互动手部治疗视频游戏的刺激。拟议研究的目的是解决 通过评估这些治疗对双手的影响，需要有效的上肢康复治疗 和大脑功能。 双侧控制功能性电刺激（CCFES）是一种创新的神经肌肉 电刺激（NMES）治疗以改善中风后手功能的恢复。CCFES刺激 麻痹的手打开的程度与对侧未受损的手的意志打开的程度成比例。 这使中风患者能够在家中进行主动重复的手部开放练习， 在实验室里与治疗师一起完成功能性任务。在灵活性，上肢损伤， 和活动限制措施已被证明与CCFES，但改善的幅度取决于 损害的严重性和慢性性。它可能会改善结果，无论是适度的， 严重受损的患者通过增加运动再学习质量的家庭为基础的一部分， 治疗时间占总治疗时间的70%。因此，在本研究中，我们整合CCFES 通过定制设计的吸引注意力、目标导向、需要技能的CCFES辅助手部治疗视频， 游戏（HTVG），并比较联合治疗（CCFES+HTVG）的效果与CCFES的效果 一个人由于CCFES介导，视频游戏成分有望增强治疗效果 游戏更注重目标，需要更好的运动规划、运动控制和注意力集中， CCFES介导的重复性手部张开练习，因此可能产生更多的适应性神经可塑性 影响大脑。 该项目将招募52名慢性中风患者，并将他们随机分为12周， CCFES+HTVG或CCFES，以便：1）确定HTVG和CCFES的整合是否导致更大的 灵巧性、损伤、活动受限和生活质量的改善，2）确定 损伤和卒中后时间影响治疗的相对效果，从而定义 亚群最有可能受益，3）阐明和比较治疗如何影响皮质 在手部运动控制任务期间激活（fMRI评估）。这将是第一个随机对照试验 它整合了视频游戏和神经肌肉电刺激， 在玩视频游戏时传递。 这个项目对神经康复领域很重要，因为它认识到了 结合协同疗法，为患者带来更大的益处，并认识到需要量身定制 根据患者的特点进行治疗，以达到最佳效果。

Hemiparesis of the upper limb is one of the most serious impairments resulting from stroke. Approximately 75% of the over 795,000 strokes that occur annually in the United States cause some degree of upper extremity paralysis. Up to 65% of stroke survivors still cannot use their affected hand to assist with activities of daily living 6 months after their stroke. The proposed project is a clinical trial that compares the effects of an innovative neuromuscular electrical stimulation therapy to a therapy that integrates the electrical stimulation with interactive hand therapy video games. The purpose of the proposed research is to address the need for effective upper limb rehabilitation therapies by evaluating the effects of these treatments on both hand and brain function. Contralaterally controlled functional electrical stimulation (CCFES) is an innovative neuromuscular electrical stimulation (NMES) treatment for improving recovery of hand function after stroke. CCFES stimulates the paretic hand to open in proportion to the degree of volitional opening of the contralateral unimpaired hand. This enables stroke patients to perform active repetitive hand opening exercises at home and practice functional tasks with a therapist in the lab. Significant improvements in dexterity, upper extremity impairment, and activity limitation measures have been shown with CCFES, but the magnitude of improvement depends on the severity and chronicity of impairment. It may be possible to improve outcomes in both moderately and severely impaired patients by increasing the motor relearning qualities of the home-based part of the treatment, which comprises 70% of the total treatment hours. Therefore, in this study, we integrate CCFES with custom-designed attention-engaging, goal-oriented, skill-requiring CCFES-assisted hand therapy video games (HTVG) and compare the effects of the combined treatment (CCFES+HTVG) to the effects of CCFES alone. The video game component is expected to enhance the treatment effect because the CCFES-mediated games are more goal-oriented and require greater motor planning, motor control, and concentration than CCFES-mediated repetitive hand opening exercises, and therefore may produce more adaptive neuroplastic effects in the brain. This project will enroll 52 chronic stroke patients and randomize them to 12 weeks of either CCFES+HTVG or CCFES in order to: 1) determine if integrating HTVG and CCFES leads to greater improvement in dexterity, impairment, activity limitation, and quality of life, 2) determine how severity of impairment and time post-stroke influences the relative effects of the treatments, thereby defining subpopulations most likely to benefit, and 3) elucidate and compare how the treatments affect cortical activation during a hand motor control task (fMRI assessment). This will be the first randomized controlled trial that integrates video games and neuromuscular electrical stimulation in such a way that the stimulation is delivered during play of the video games. This project is important to the field of neurorehabilitation because it recognizes the potential of combining synergistic therapies to achieve greater benefits for patients, and also recognizes the need to tailor therapies to patient characteristics in order to achieve the best possible outcomes.