Cognitive Screening for CI Therapy after Stroke

中风后 CI 治疗的认知筛查

• 批准号: 6608752
• 负责人: Victor William Mark
• 金额: $ 6.27万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-04-15 至 2005-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6608752
• 关键词: adult human (21+); age difference; attention; body movement; brain imaging /visualization /scanning; brain injury; clinical research; cognition; computed axial tomography; emotional adjustment; functional ability; human subject; human therapy evaluation; magnetic resonance imaging; medical rehabilitation related tag; memory; outcomes research; paralysis; patient oriented research; statistics /biometry; stroke; stroke therapy; therapy compliance; urinary incontinence

DESCRIPTION (provided by applicant): Stroke is the leading neurologic disorder and a major cause of chronic disability. Functional deficits following stroke can be ameliorated through rehabilitation, but until recently there has been little development of testable models of stroke therapies. Furthermore, despite the identification of several predictors of treatment outcomes, comprehensive models to account for how such variables affect therapy outcomes have not been developed. Constraint-Induced Movement Therapy (CI therapy) is a treatment for chronic stroke hemiparesis that has controlled evidence for efficacy on actual daily living tasks. The treatment was developed from basic neuroscience research that postulates that learned non-use is a major determinant of chronic hemiparesis and can be reversed through intensive practice. The intensive practice is associated with massive cortical reorganization on functional imaging studies. The PIs hypothesize that several cognitive mechanisms are essential to the therapeutic benefits of intensive practice: sustained attention, declarative memory, and emotional regulation. About one-third of patients in the CI therapy clinic demonstrate impaired cognitive regulation or memory disturbances, and they tend to have reduced treatment gains and retention of benefits after discharge. The purpose of this pilot application will be to prospectively assess CI therapy clinic patients on the above cognitive functions, and then through multivariable regression analysis determine their contributions to treatment outcomes in comparison to other predictors of general stroke rehabilitation outcomes (age, lesion findings, stroke severity, pre-treatment function, incontinence). The findings will indicate whether specific cognitive processes are importantly involved with the mechanism hypothesized to account for treatment benefit. Understanding of cognitive contributions to CI therapy benefit will help to propose treatment modifications for patients with behavioral disorders who undergo therapy, and as well to better inform prospective patients of their likely treatment benefit.

描述(申请人提供)：中风是主要的神经系统疾病，也是慢性残疾的主要原因。中风后的功能障碍可以通过康复来改善，但直到最近，中风治疗的可测试模型的开发还很少。此外，尽管已经确定了几个治疗结果的预测因素，但尚未开发出全面的模型来解释这些变量如何影响治疗结果。强制诱导运动疗法(CI疗法)是一种治疗慢性中风偏瘫的疗法，已有证据表明其在实际日常生活任务中的有效性。这种治疗是从基础神经科学研究发展而来的，该研究假设习得性不使用是慢性偏瘫的主要决定因素，并可以通过强化练习逆转。这种密集的练习与功能成像研究中的大规模皮质重组有关。PI假设有几种认知机制对强化练习的治疗益处至关重要：持续注意力、陈述性记忆和情绪调节。CI治疗诊所约三分之一的患者表现出认知调节或记忆障碍，他们往往在出院后减少治疗收益和保留益处。这一试点应用的目的将是前瞻性地评估CI治疗临床患者的上述认知功能，然后通过多变量回归分析确定他们与其他预测一般中风康复结果的因素(年龄、病变发现、中风严重程度、治疗前功能、大小便失禁)对治疗结果的贡献。这些发现将表明特定的认知过程是否与假设的解释治疗益处的机制重要相关。了解认知对CI治疗益处的贡献将有助于为接受治疗的行为障碍患者提出治疗修改建议，以及更好地向潜在患者告知他们可能的治疗益处。