Contralaterally Controlled FES plus Video Games for Hand Therapy after Stroke

上肢偏瘫是中风引起的最严重的损伤之一。 在美国每年发生的795,000多例中风中，约有75%会导致不同程度的中风 上肢瘫痪。高达65%的中风幸存者仍然不能使用他们患病的手帮助 卒中后6个月日常生活活动能力。拟议的项目是一项临床试验，比较了 一种创新的神经肌肉电刺激疗法对整合电刺激的治疗的影响 通过互动手部治疗视频游戏进行刺激。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。 对侧控制功能电刺激(CCFES)是一种创新的神经肌肉电刺激技术 电刺激(NMES)治疗促进中风后手功能恢复。CCFES刺激 偏瘫的手张开的程度与健侧健手的意志性张开的程度成正比。 这使中风患者能够在家里和练习中进行积极的重复手张开练习 与实验室的治疗师一起完成功能性任务。在灵巧度、上肢损伤、 CCFES已经显示了活动限制措施，但改善的幅度取决于 损害的严重性和长期性。有可能在中等程度上和在 通过增加居家部分的运动再学习质量来严重损害患者 治疗，占总治疗时数的70%。因此，在本研究中，我们集成了CCFES 具有定制的引人入胜、面向目标、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)与CCFES的效果 独自一人。电子游戏组件有望增强治疗效果，因为CCFES调解 游戏更以目标为导向，需要更多的运动规划、运动控制和注意力 CCFES介导的重复手张开练习，因此可能产生更多适应性神经再生 对大脑的影响。 该项目将招募52名慢性中风患者，并将他们随机分配到12周的 CCFES+HTVG或CCFES，以：1)确定集成HTVG和CCFES是否会带来更大的 灵巧性、损伤、活动受限和生活质量的改善，2)决定了 中风后的损伤和时间影响治疗的相对效果，从而定义 最有可能受益的亚群，以及3)阐明和比较治疗如何影响皮质 在手部运动控制任务中的激活(功能磁共振成像评估)。这将是第一个随机对照试验 它集成了视频游戏和神经肌肉电刺激，刺激的方式是 在玩电子游戏的过程中交付。 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好处，并认识到有必要量身定做 根据患者的特点进行治疗，以达到尽可能好的效果。

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.