Effects of device-assisted practice of activities of daily living in a close-to-normal pattern on upper extremity motor recovery in individuals with moderate to severe stroke

设备辅助的接近正常模式的日常生活活动练习对中重度卒中患者上肢运动恢复的影响

• 批准号: 10413805
• 负责人: JUN YAO
• 金额: $ 35.85万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-12 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10413805
• 关键词: Activities of Daily Living; Acute; Address; Affect; Animal Model; Area; Brachial Paresis; Chronic; Clinical; Clinical assessments; Control Groups; Coupled; Coupling; Devices; Dose; Elbow; Financial compensation; Fingers; Goals; Hand; Hand functions; Impairment; Individual; Intervention; Measures; Mediation; Morphology; Motor; Movement; Names; Neuronal Plasticity; Outcome; Paresis; Participant; Pattern; Performance; Population; Randomized; Recovery; Reporting; Robot; Robotics; Self-Help Devices; Shoulder; Side; Stroke; Testing; Training; Training Activity; Upper Extremity; Wrist; arm; arm function; chronic stroke; clinical practice; constraint induced movement therapy; density; design; experimental group; follow-up; functional disability; grasp; gray matter; hemiparesis; hemiparetic stroke; inclusion criteria; injured; kinematics; motor recovery; post intervention; post stroke; recruit; relating to nervous system; restoration; sensory feedback; stroke survivor; success; synergism; treatment arm; white matter

Project Summary Up to 85% of stroke survivors have hemiparesis that affects the upper extremity (UE) on one side and usually impacts the hand more than shoulder and elbow. Currently, for mildly impaired stroke survivors (about 20-25%), constraint-induced movement therapy (CIMT) and modified CIMT have been reporting positive results. However, intervention options for a large percentage of stroke survivors, who have moderate to severe impairment, are lacking. Device use has been studied to assist arm/hand function for individuals with moderate to severe stroke. Positive clinical outcomes have been reported, but the quality of the evidence is low. One of the factors that impact the effects of device-assisted interventions is how the device is used. We suggest that devices should assist the practice of Activities of Daily Living (ADLs) in a way that enhances the neural activities related to ‘normal’ motor patterns, and minimizes undesired irrelevant activities. We call this ‘training ADLs in a close-to-normal pattern’. The importance of practicing ADLs has been demonstrated by previous hand/arm interventions in mildly impaired individuals. When success in ADL tasks becomes the primary goal, individuals usually develop compensatory movements and evoke neural activities unrelated to the required movements. As demonstrated in animal models, compensatory neural activities negatively impact neuroplasticity and motor recovery, while close-to- normal training heightened ipsilesional plasticity and enhanced recovery. This has prompted the opinion that interventions should focus on maximizing motor recovery versus task accomplishment via compensation. We aim to investigate the feasibility of minimizing compensation and maximizing motor recovery in the more severely impaired chronic post-stroke population. Specifically, we propose to use devices to address 2 issues that are commonly presented in this population: 1) inability to open the paretic hand, and 2) abnormal UE synergic movement patterns, defined as the abnormal coupling between shoulder, elbow, wrist, and fingers. Recently, we developed and tested an EMG-triggered functional electrical stimulator (ReIn-Hand) to assist voluntary hand use during the practice of ADLs, and found promising preliminary results in gaining finger extension ability and UE motor function. We also have evidence demonstrating that ACT3D robotic modulation of shoulder abduction loading during actively reaching can reduce the UE synergy both acutely and long-term. By combining ReIn-Hand with an ACT3D robot, we propose a reaching-grasping-retrieving-releasing (GR3) intervention in individuals with moderate to severe chronic stroke. This design aims at practicing ADLs with a ‘close-to-normal’ movement pattern to achieve functional goals while maximizing potential motor recovery. We will measure not only the intervention-induced changes in clinical outcomes, but also in UE kinematics and functional and morphologic neuroplasticity to disentangle motor compensation versus recovery. If successful, the expected results may impact current clinical practice by pushing towards implementing device-assisted practice of ADLs in a close-to-normal pattern and have the potential to benefit a large population.

项目概要 高达 85% 的中风幸存者患有偏瘫，影响一侧上肢 (UE)，通常会影响一侧上肢 (UE) 对手的影响大于对肩部和肘部的影响。目前，对于轻度受损的中风幸存者（约 20-25%）， 约束诱导运动疗法（CIMT）和改良 CIMT 已报告了积极的结果。然而， 对于大部分患有中度至重度损伤的中风幸存者来说，缺乏干预选择。 已研究使用设备来帮助中度至重度中风患者的手臂/手部功能。 已有积极的临床结果报告，但证据质量较低。影响的因素之一 设备辅助干预的效果取决于设备的使用方式。我们建议设备应该有助于练习 以增强与“正常”运动模式相关的神经活动的方式进行日常生活活动（ADL）， 并最大限度地减少不需要的无关活动。我们称之为“以接近正常模式的 ADL 训练”。这 之前对轻度受损的手/手臂进行的干预已经证明了练习 ADL 的重要性 个人。当 ADL 任务的成功成为主要目标时，个人通常会发展出补偿性行为 运动并唤起与所需运动无关的神经活动。正如动物实验所证明的 模型中，代偿性神经活动会对神经可塑性和运动恢复产生负面影响，同时接近 正常训练可增强病灶可塑性并促进恢复。这促使人们认为 干预措施应侧重于最大限度地提高运动恢复，而不是通过补偿来完成任务。 我们的目标是研究在更多情况下最小化补偿和最大化运动恢复的可行性 严重受损的慢性中风后人群。具体来说，我们建议使用设备来解决两个问题： 该人群中常见的症状有：1）瘫痪手无法张开，2）UE协同运动异常 模式，定义为肩、肘、腕和手指之间的异常耦合。最近，我们开发并 测试了 EMG 触发的功能性电刺激器 (ReIn-Hand)，以协助练习期间自愿使用手部 ADL 的研究，并在获得手指伸展能力和 UE 运动功能方面发现了有希望的初步结果。我们也 有证据表明 ACT3D 机器人在主动伸展过程中调节肩部外展负荷 会严重和长期地降低UE协同作用。通过将 ReIn-Hand 与 ACT3D 机器人相结合，我们提出了 对中度至重度慢性中风患者进行伸手-抓握-取回-释放（GR3）干预。这 设计旨在以“接近正常”的运动模式练习 ADL，以实现功能目标，同时 最大限度地提高潜在的运动恢复能力。我们不仅会衡量干预引起的临床结果变化， 而且还涉及 UE 运动学以及功能和形态神经可塑性，以解开运动补偿与 恢复。如果成功，预期结果可能会通过推动实施来影响当前的临床实践 以接近正常模式的设备辅助 ADL 练习，有可能使大量人群受益。