Developmental Clinical Studies - Does Repeated Vestibular Stimulation Induce Lasting Recovery From Hemi-Spatial Neglect?

发育临床研究 - 重复前庭刺激是否会导致半侧空间忽视的持久恢复？

• 批准号: G1001222/1
• 负责人: David Wilkinson
• 金额: $ 31.98万
• 依托单位: University of Kent
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2011
• 资助国家: 英国
• 起止时间: 2011 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=G1001222%2F1
• 关键词: Developmental; Clinical; Studies; Does; Repeated

The research will pilot a new treatment for hemi-spatial neglect. This is an attentional disorder that commonly arises after stroke, causing sufferers to act as if one half of their visual world is missing. Symptoms include bumping into objects, leaving food on one side of the plate, and failing to notice people on the affected side. Aside from these debilitating effects, the condition strongly predicts the rate at which individuals recover from the other symptoms of stroke. Many individuals who show hemi-spatial neglect at hospital admission still struggle with daily routine years later. The current treatment provides little relief. Our new approach involves passing tiny electrical currents through the part of the scalp that lies just behind the ears. The currents are too small to cause discomfort, but stimulate nerve pathways that project from the inner ear to those parts of the brain that are damaged. Unlike the current treatment which requires specialist staff and space, stimulation can be applied by a nurse at bedside with no technical expertise and at whatever time is convenient for the patient. More so, the apparatus can be cheaply miniaturised for personal use at home, reducing hospital stay and saving on the need to travel to clinic. A major drawback of our treatment is that the beneficial effects disappear as soon as stimulation is stopped. We need to find a way of triggering effects that last for much longer. Other kinds of neuro-stimulation are most effective when repeatedly applied across 5-10 days, inducing gains in stroke survivors that last for many weeks. Our own pilot data, albeit very preliminary, suggests that the same pattern holds for the new technique described here. A larger, properly controlled study is now needed to confirm this observation. Compellingly, other types of neuro-disability including aspects of dementia also recede during vestibular stimulation, so if lasting recovery is shown here then other types of patient might also be expected to benefit. We plan to recruit 60 individuals with hemi-spatial neglect from the East Kent Neuro-Rehabilitation Service to receive both 10 days of stimulation and then several follow-up sessions a few weeks later. These follow-ups will tell us whether lasting improvement has occurred, enabling us to determine if the technique might be relevant to rehabilitative practice. If so, then we will begin further trials with a miniature device that is currently undergoing validation by a downstream commerical collaborator.

这项研究将尝试一种治疗半空间忽视的新方法。这是一种注意力障碍，通常出现在中风后，导致患者表现得好像他们视觉世界的一半缺失了一样。症状包括撞到物体，食物留在盘子的一侧，以及没有注意到受影响一侧的人。除了这些使人虚弱的影响外，这种情况还强烈地预测了个人从中风的其他症状中恢复的速度。许多人在入院时表现出半空间忽视，几年后仍然在日常生活中挣扎。目前的治疗方法几乎没有缓解作用。我们的新方法包括让微小的电流通过位于耳朵后面的头皮部分。电流太小，不会引起不适，但会刺激从内耳投射到大脑受损部分的神经通路。与目前需要专业人员和空间的治疗不同，刺激可以由护士在床边进行，不需要技术专业知识，可以在患者方便的任何时间进行。更重要的是，这种设备可以廉价地微型化，供个人在家中使用，减少住院时间，并节省前往诊所的需要。我们治疗的一个主要缺点是，一旦刺激停止，有益的效果就会消失。我们需要找到一种方法来触发持续更长时间的效应。其他类型的神经刺激在重复应用5-10天时最有效，导致中风幸存者的收益持续数周。我们自己的试点数据，尽管是非常初步的，表明同样的模式适用于这里描述的新技术。现在需要一项更大规模的、适当控制的研究来证实这一观察结果。令人信服的是，包括痴呆症在内的其他类型的神经功能障碍在前庭刺激期间也会消退，所以如果这里显示的是持久的恢复，那么其他类型的患者可能也会受益。我们计划从东肯特神经康复服务中心招募60名半空间忽视患者，接受为期10天的刺激，并在几周后进行几次后续治疗。这些随访将告诉我们是否发生了持续的改善，使我们能够确定该技术是否可能与康复实践相关。如果是这样的话，我们将开始用一种微型设备进行进一步的试验，该设备目前正在接受下游商业合作者的验证。