Brain and Behavior Correlates of Arm Rehabilitation

描述（由申请人提供）：在脑卒中导致的所有损伤中，可能最严重和最需要进行康复有效性研究的是上肢轻偏瘫。总体而言，该提案将使用3-D行为运动学和MRI神经成像技术来检查与卒中后3至6个月的亚急性卒中患者的强制性（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）的伴随研究，约束诱导治疗评价（EXCITE）。该项目通过探索中风康复临床干预的神经生物学和行为机制来补充EXCITE。具体目标是：1）确定损伤大小和位置、残余手能力和对CI治疗的反应性之间的关系; 2）确定CI治疗对达到和抓握动作的运动控制的影响; 3）确定CI治疗对与目标导向的腕部和抓握动作的规划和执行相关的皮质感觉运动神经网络的影响;以及4）确定作为Cl治疗的结果，一年后运动控制、脑活动和功能结果的这些变化的持续性和/或稳定性。感觉运动区激活的预期变化将通过与延迟干预卒中组（n = 14）进行比较，确定符合EXCITE纳入标准的卒中患者（n = 14）中与受损上肢的两周强化练习联合较少受累上肢的约束相关的学习依赖性神经可塑性和运动行为。“习惯性”护理。这种比较将允许在神经生物学（大脑活动）和行为（运动性能和功能）水平上暴露“强迫使用”的直接影响，同时控制自发恢复过程和通过标准卒中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.