A TREATMENT FOR EXCESS MOTOR DISABILITY IN THE AGED

老年人过度运动障碍的治疗

• 批准号: 6625273
• 负责人: Edward Taub
• 金额: $ 4.37万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-12-09 至 2003-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6625273
• 关键词: aging; behavioral /social science research tag; chronic brain damage; clinical research; clinical trials; disease /therapy duration; functional ability; human subject; human therapy evaluation; immobilization of body part; limb movement; longitudinal human study; magnetic resonance imaging; mesencephalon; outcomes research; person with disability; physical therapy; psychomotor function; rehabilitation; restricted physical activity; social psychology; stroke

Stroke afflicts over 700,000 persons in America every year. There is thus an urgent need to translate unique behavioral techniques shown to have an impact on plasticity of the nervous system into practical evidence-based therapeutic interventions, especially at a time when the duration of treatments has shortened. In this laboratory we have developed on such set of techniques derived from basic research with an8mal and human subjects. Randomized, controlled studies indicate that it can substantially reduce the motor deficit of patients with mild to moderate chronic strokes from the upper two quartiles of motor functioning and can increase their independence over a period of years. The techniques, termed Constrain- Induced (CI) Movement Therapy, involve motor restriction of the less affected upper extremity for a period of two or three weeks while at the same time training the more affected upper limb. This gives rise to massed or repetitive use of the more affected extremity and to a large increase in use-dependent cortical reorganization involving the recruitment of substantial new regions of the brain in the innervation of more-affected extremity movement. One of the main aims of the proposed research is to determine if Cl Therapy can be used with therapeutic success for increasing the amount of real work extremity use in patients with chronic stroke who have a greater level of motor impairment than those previously worked with in this laboratory (i.e., patients who are approximately in the next to lowest quartile of motor functioning). Another aim is to ascertain whether the locus of the lesion and its size as determined by MRI, are factors influencing the extent to which motor function can be recovered through the use of CI Therapy. This prospective, 4-year randomized trial, including 18-month follow-up will use a crossover design. Eight patients with chronic stroke from the next to lowest quartile of motor functioning will be randomly assigned to receive either Cl therapy (40 subjects) or a General Fitness placebo control intervention (40 subjects). Two years after intake the control patients will be crossed over to receive Cl Therapy. Primary outcome measures will be a laboratory motor function test and amount of extremity use in the real world setting. Changes in psychosocial functioning will also be measured.

在美国，每年有超过70万人罹患中风。因此，迫切需要将对神经系统可塑性有影响的独特行为技术转化为实际的循证治疗干预措施，特别是在治疗持续时间缩短的时候。在这个实验室里，我们从动物和人类的基础研究中发展出了这样一套技术。随机对照研究表明，它可以从运动功能的上两个四分位数显著减少轻度至中度慢性中风患者的运动缺陷，并可以在一段时间内增加他们的独立性。这种技术被称为约束诱导（CI）运动疗法，包括对受影响较小的上肢进行两到三周的运动限制，同时训练受影响较大的上肢。这导致大量或重复使用受影响更严重的肢体，以及使用依赖的皮层重组的大量增加，包括在受影响更严重的肢体运动的神经支配中招募大量新的大脑区域。拟议研究的主要目的之一是确定Cl疗法是否可以成功地用于增加慢性中风患者的实际工作肢体使用量，这些患者的运动损伤程度比先前在该实验室工作的患者更严重（即，大约处于运动功能最低四分之一的患者）。另一个目的是确定MRI确定的病变位置及其大小是否影响通过使用CI疗法恢复运动功能的程度。这项前瞻性的4年随机试验，包括18个月的随访，将采用交叉设计。8名慢性中风患者将被随机分配接受Cl治疗（40名受试者）或普通健身安慰剂控制干预（40名受试者）。两年后，对照组患者将接受氯离子治疗。主要结果测量将是实验室运动功能测试和在现实世界中肢体使用的数量。还将测量心理社会功能的变化。