Evaluation of brain recovery of stroke patients using a novel magnetic resonance compatible hand induced robotic device combined with magnetic resonance imaging

这项研究的广泛的长期目标是提高治疗效果， 脑卒中患者的生活质量。越来越多的人患有 中风直到最近，中风导致的残疾才被认为是不可逆的。 中风恢复是一个新兴领域，仍然克服了长期以来的观点，即功能丧失， 中风是不可恢复的。 我们假设（a）通过运动刺激大脑恢复的机器人设备 训练可以支持恢复由中风引起的运动能力受损， （B）中风后的神经变化， 通过体内最先进的磁共振监测（因此随后预测） 通过脑恢复生物标志物和行为运动表现改善进行MRI检查。 为了验证这一假设，我们建议对我们的新型手装置进行纵向研究， 结合3-T脑MRI，通过三个目标监测慢性卒中患者的恢复情况。 目的（1）是利用新开发的相控阵线圈和并行 成像（以最大限度地提高灵敏度和分辨率），以记录可量化的大脑变化， 100例确诊为大脑中动脉（MCA）的慢性卒中患者的训练 局部缺血性卒中和影响运动神经条的缺血性病变。患者将分配 随机分为训练组和非训练对照组。参加者每天训练30分钟， 每周3天，在家中进行，以促进参与。容积MRI、功能MRI （fMRI）和弥散张量成像（DTI）将在开始前进行。 治疗（基线），然后在3个月的训练期内每月一次。MRI测量 将集中在运动皮层及其周围的皮层区域和连接束。第1102章目的（二） 是用标准的临床试验评估这些慢性中风患者的运动表现， 指数和手持设备测量。目的（3）是证明大脑映射 基于最先进的MRI结合手部设备辅助治疗， 为慢性中风恢复提供新的生物标志物，同时改善临床结果。我们将 进行荟萃分析的结构，功能磁共振成像，弥散张量成像，和运动性能数据使用 通用线性混合模型（GLMM）方法，该方法处理异构数据， 尽管个体间存在差异，但有助于推导出有用的结果。 影响：成功将有助于选择患者和个性化治疗计划 优化以基于MRI指标产生改进。具体而言，这项研究可能 识别可以在治疗期间监测的大脑恢复生物标志物，为治疗提供信息 调整，并提高我们预测中风恢复结果的能力。对于慢性中风 患者，我们预计证明，恢复是可能的一个更长的时间比 以前认为，包括运动技能改善超过6个月。中风后 事件，由于大脑可塑性和功能适应能力 重组。如果这项研究表明通过物理治疗可以持续改善， 那么医疗保险和其他保险的限制应该扩大到帮助长期的 中风患者康复，从而改善他们的生活质量，尤其是老年患者 人口，其中中风最普遍。

The broad, long-term objective of this study is to improve therapy efficacy for, and thus the quality of life (QoL) of, stroke patients. An increasing number of individuals suffer from stroke. Disabilities resulting from stroke were considered irreversible until very recently. Stroke recovery is an emerging field, still overcoming the longstanding view of functions lost to stroke being non-recoverable. We hypothesize that (a) robotic devices that stimulate brain recovery via motor training can support restoration of movement abilities compromised by stroke-induced pathological changes in the brain; and that (b) post-stroke neural changes can be monitored (and therefore later predicted) by in vivo state-of-the-art magnetic resonance imaging (MRI) via brain recovery biomarkers and behavioral motor performance improvements. To test this hypothesis, we propose to conduct a longitudinal study of our novel hand device in conjunction with 3-T brain MRI to monitor recovery in patients with chronic stroke via three Aims. Aim (1) is to perform state-of-the-art MRI with newly-developed phased-array coils and parallel imaging (to maximize sensitivity and resolution) to document quantifiable brain changes during training in 100 chronic stroke patients with confirmed middle cerebral artery (MCA) territory ischemic stroke and ischemic lesions affecting the motor strip. Patients will be assigned randomly to a training group and non-training control group. Participants will train for 30 min/d, 3 d/wk, to be conducted at home to facilitate participation. Volumetric MRI, functional MRI (fMRI), and diffusion tensor imaging (DTI) will be performed before the start of treatment (baseline) and then monthly over a 3-month training period. MRI measurements will focus on the motor cortex and its surrounding cortical areas and connecting tracts. Aim (2) is to evaluate motor performance in these chronic stroke patients with standard clinical indices and hand device measurements. Aim (3) is to demonstrate that brain mapping based on state-of-the art MRI in conjunction with hand device-assisted therapy can provide novel biomarkers for chronic stroke recovery while improving clinical outcome. We will perform a meta-analysis of structural, fMRI, DTI, and motor performance data using a general linear mixed-model (GLMM) approach, which handles heterogeneous data and facilitates deduction of useful results despite inter-individual variability. Impact: Success will facilitate selection of patients and personalized treatment planning optimized to yield improvements based on MRI metrics. Specifically, this study may identify biomarkers of brain recovery that can be monitored during therapy, inform therapy adjustments, and advance our ability to predict stroke recovery outcome. For chronic stroke patients, we anticipate demonstrating that recovery is possible for a longer period of time than previously thought, including motor skill improvements beyond 6 mos. after a stroke event, owing to the capacity for brain plasticity and functionally adaptive reorganization. If this research indicates continued improvement with physical therapy, then the limitations of Medicare and other insurances should be extended to assist in longer-term recovery of stroke victims, thus improving their QoL, especially in the geriatric patient population, where stroke is most prevalent.