Brain and Behavior Correlates of Arm Rehabilitation

描述(申请人提供)：在所有由中风引起的损伤中，也许最严重和最需要进行康复效果研究的是上肢偏瘫。总体而言，这项建议将使用3-D行为运动学和MRI神经成像技术来检查与强制诱导(CI)运动疗法相关的运动控制和大脑活动变化，这些患者在中风后3至6个月内患有亚急性中风。这是之前资助的多中心随机临床试验(H D37606-01)的配套研究，肢体约束诱导治疗评估(EXCITE)。该项目通过探索中风康复临床干预背后的神经生物学和行为机制来补充EXPLIT。这些研究的具体目的是：1)确定病变大小与位置、残手能力以及CI治疗的反应性之间的关系；2)确定CI治疗对伸手和握力动作的运动控制的影响；3)确定CI治疗对与目标导向手腕和握力动作的计划和执行相关的皮质感觉运动神经网络的影响；以及4)确定一年后由于CI治疗的结果，这些运动控制、脑活动和功能结果的持续性和或稳定性。符合EXPLITE纳入标准的中风患者(n=14)的感觉运动区激活(依赖于学习的神经可塑性)和运动行为的预期变化将通过与延迟干预中风组(n=14)的比较来确定，后者将接受“通常和习惯”的护理。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)两个层面上暴露出来，同时控制自然恢复过程和通过标准的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.