RECOVERY AND REHABILITATION OF ARM USE AFTER STROKE

中风是导致中国成年人残疾的主要原因 美国。在美国，每年大约有55万人 人们遭受中风，近40万人在一定程度上存活下来 残疾的人。因中风而存活的累积总人数 美国有近300万人。每年300亿美元 是中风相关残疾造成的估计负担。尽管 这些巨大的统计数据，几乎没有科学的 卒中后康复治疗效果的研究 干预措施。因此，最近出版的《临床》 中风后康复的实践指南已经被 被迫主要依靠专家的意见，而不是很好的 受控制的科学研究。这个项目是第一步 以弥补这一点；它将为大型 康复干预的量表随机临床试验 在亚急性期。这笔小额赠款的目标是 建议获得初步数据以：1)评估 进行大规模、随机、临床试验的可行性 试验(RCT)评估三种物理疗法的有效性 康复干预措施(“通常护理”、“加强”和 “功能性使用”)关于单方面恢复手臂使用的问题 中风，2)微调实验设计和干预 一项大规模随机对照试验的有效性评估程序 这三项干预措施和3)获得关于 短期效果和长期效果。具体地说， 建议书旨在：1)评估招聘、保留和 合规性；制定操作组件，包括手册 程序和标准化数据收集表格；并建立一个 数据库系统和通信系统，2)检查 资格/不合格标准；评估以下各项的好处/不利因素 双臂与三臂随机对照试验设计；评估干预时间、结果 措施和评估工具的敏感性，以及3)确定 必要的样本量功率计算；获得初步数据 与初始损伤的预后含义有关的 (神经学和神经肌肉学)关于每个 干预措施；并获得初步数据，说明 恢复和反应受病变特征的影响。

Stroke is the leading cause of disability among adults in the United States. Each year in the U.S., approximately 550,000 people suffer strokes and nearly 400,000 survive with some level of disability. The cumulative total of living, stroke-affected Americans is nearly 3 million. Thirty billion dollars annually is the estimated burden from stroke-related disability. Despite the enormity of these statistics, there have been few scientific studies of the effectiveness of post-stroke rehabilitation interventions. As a result, the recently published Clinical practice guidelines for post-stroke rehabilitation have been forced to rely primarily on expert opinion and not on well controlled scientific studies. This project is a first step toward remedying this; it will provide pilot data for a large scale randomized clinical trial of rehabilitation interventions during the subacute phase. The goal of this small grants proposal is to obtain preliminary data to: 1) Assess the feasibility of conducting a large scale, randomized, clinical trial (RCT) evaluating the effectiveness of three physical rehabilitative interventions ("usual care", "strengthening" and "functional use") on restoration of arm use after unilateral stroke, 2) Fine tune the experimental design and intervention procedures for a large scale RCT to evaluate the effectiveness of these three interventions and 3) Obtain preliminary data on short-term and long-term effectiveness. Specifically, the proposal is designed to: 1) Assess recruitment, retention, and compliance; develop the operational components including a manual of procedures and standardized data collection forms; and build a database system and a communications system, 2) Examine eligibility/ineligibility criteria; assess the benefits/detriments of a two vs. three arm RCT design; and assess intervention time, outcome measures, and sensitivity of assessment instruments and 3) Determine requisite sample size power calculations; obtain preliminary data pertaining to the prognostic implications of initial impairments (neurological and neuromuscular) with regard to each of the interventions; and obtain preliminary data regarding whether the recovery and response is influenced by lesion characteristics.