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: 10516065
• 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/10516065
• 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; Learning; 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; 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; transcranial direct current stimulation; 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.

由于中风是退伍军人残疾的主要原因，因此迫切需要开发 改善中风后运动能力的治疗会影响与运动功能相关的大脑网络。 我们的目标是通过将联合收割机脑刺激与 实践为了推进这一目标，我们需要了解网络的变化，这些变化是恢复的基础。 有用的运动行为，如伸手。非初级皮质运动区已经被证明具有 与其他运动区域，包括初级运动皮层，有一些证据表明， 他们的功能角色在中风后会发生变化。我们和其他人也展示了影响 达到行为与局灶性皮层刺激，并影响皮层代表达到 通过皮层刺激与伸展练习相结合来进行运动。 我们将利用这些新知识，增加我们对大脑网络变化及其影响的理解 通过完成以下三个目标进行大脑刺激和练习：1。量化干扰的影响 活动PMd和PMv在每个半球在达成任务的参与者和没有 包囊性中风每个区域的职能作用将通过以下简短培训的效果进行评估： 在每个半球的背侧和腹侧运动前区重复经颅磁刺激 在有和没有囊中风的人类参与者的到达任务期间。白色的特性 物质损伤将影响每一侧的哪个区域对连通性的影响最大。2.量化连通性 与M1和其他运动区域的关系。这将是 通过静息状态和任务相关的连接使用功能磁共振成像评估，并将证明之间的差异 三种类型的功能连接性测量：TMS对运动输出的区域效应，静息状态 fMRI和任务相关fMRI的动态因果模型。运动功能与 因此，将测试功能连通性。3.评估运动的影响- 最易化区域的同步TMS对练习对运动输出的影响， 行为表现功能最相关的运动前区的TMS将与 练习受影响的上肢。这项工作的一个创新特点是对内囊的研究 中风，这是一个更同质和适当的人口比整个中风类型， 影响运动，它有很多变化。这些发现将使我们能够制定明确的 关于中风后哪些运动前区应该被调制的假设，以及在中风的背景下， 动作练习我们将能够设计一种新的治疗方案， 在练习伸展运动时的刺激。