Brain and Behavior Correlates of Arm Rehabilitation

描述（由申请人提供）：在脑中风导致的所有损伤中，可能最严重和最需要康复效果研究的是上肢偏瘫。总体而言，本研究将使用3- d行为运动学和MRI神经成像技术来检查卒中后3- 6个月的亚急性卒中患者与约束诱导（CI）运动治疗相关的运动控制和大脑活动变化。这是先前资助的多中心随机临床试验（H D37606-01），肢体约束诱导治疗评估（EXCITE）的伴随研究。该项目通过探索脑卒中康复临床干预的神经生物学和行为机制来补充EXCITE。具体目的是：1)确定病变大小与位置、残手能力和对CI治疗的反应性之间的关系；2)确定CI治疗对伸手和抓握动作运动控制的影响；3)确定Cl治疗对与目标定向手腕和抓握动作的计划和执行相关的皮质感觉运动神经网络的影响；4)确定一年后Cl治疗在运动控制、脑活动和功能结果方面的这些变化的持续性和/或稳定性。在符合EXCITE纳入标准的中风患者（n = 14）中，通过对受损上肢进行为期两周的强化训练，并结合对受影响较小的上肢进行约束，感觉运动区激活（学习依赖的神经可塑性）和运动行为的预期变化将与接受“常规和习惯”护理的延迟干预中风组（n = 14）进行比较。这种比较将使“强迫使用”的直接影响在神经生物学（大脑活动）和行为（运动表现和功能）水平上暴露出来，同时控制自发恢复过程和通过标准中风后物理康复方法实现的恢复过程。

DESCRIPTION (provided by applicant): Of all impairments that result from brain stroke, perhaps the most serious and most needing of rehabilitation effectiveness studies is hemiparesis of the upper extremity. Overall, this proposal will use 3-D behavioral kinematics and MRI neuroimaging techniques to examine the motor control and cerebral activity changes associated with constraint-induced (CI) movement therapy for patients with sub-acute stroke who are between 3 and 6 months post stroke. This is a companion study to the previously funded multi-center randomized clinical trial (H D37606-01), Extremity Constraint-Induced Therapy Evaluation (EXCITE). This project complements EXCITE by probing the neurobiological and behavioral mechanisms underlying this clinical intervention in stroke rehabilitation. The specific aims are to: 1) determine the relationship between lesion size and location, residual hand capability, and responsiveness to CI therapy; 2) determine the effects of CI therapy on the motor control of reaching and grasping actions; 3) determine the effects of Cl therapy on the cortical sensorimotor neural network associated with the planning and execution of goal-directed wrist and grasping actions; and 4) determine the persistence and or stability of these changes in motor control, brain activity, and functional outcomes one year later as a consequence of Cl therapy. Expected changes in sensorimotor area activation (learning-dependent neural plasticity) and motor behavior associated with two weeks of intensive practice of the impaired upper extremity in combination with restraint of the less affected upper extremity in stroke patients (n = 14) who meet the EXCITE inclusion criteria will be determined by comparison with that of a delayed-intervention stroke group (n = 14) who will receive "usual and customary" care. This comparison will allow the direct effects of "forced use" to be exposed at both the neurobiological (brain activity) and behavioral (motor performance and function) levels while controlling for spontaneous recovery processes and those achieved through standard post-stroke physical rehabilitation methods.