A Treatment for Excess Motor Disability in the Aged

描述（由申请人提供）：在这个实验室里，我们开发了一套技术，随机对照研究表明，这些技术可以大大减少轻度至中度慢性中风患者的运动缺陷。这种技术被称为约束诱导运动疗法（CI疗法），包括连续几周限制受影响较小的上肢的运动，同时强化训练受影响较大的手臂。在过去的工作中，所有CI治疗患者都给予6小时/天的治疗。CI治疗与常规物理治疗的主要区别在于治疗的持续时间和强度，假设6小时/天的治疗是获得最佳治疗结果的必要条件。然而，在初步工作中，有一个强烈的建议，每天3小时的高强度训练可以产生与以前标准强度下每天6小时一样大的效果。这项拨款的目的是在一项严格设计、随机、盲法研究中评估这些关于3小时CI治疗疗效的初步结果。该研究将包含8组2x2因子设计，分别用于功能较高和较低的患者。为了获得最佳的治疗效果，这两类患者的一些重要治疗参数必须不同，因此需要进行这种分离。每天的治疗时间（6小时vs 3小时）将独立于训练强度（标准vs高）而变化。这种设计将允许对训练持续时间和强度的影响分别进行检查（主效应），并确定强度的影响是否随训练持续时间而变化（交互效应）。在初步研究中，给予3小时/天组的治疗比给予6小时/天组的治疗更强烈，因此持续时间（小时/天）和强度（试验/小时）是混淆的。对于不同程度的损伤严重程度的患者，哪一个是这两个参数最有效的组合，需要本项目进行严格的评估。CI治疗开始以加速的速度在临床应用。临床使用这种干预的主要缺点是其推荐的持续时间和强度，就昂贵的治疗师时间而言是昂贵的。如果每天3小时的高强度治疗的效果与6小时低强度治疗的效果一样好，那么治疗的成本将大大降低，使其能够提供给比目前更多的患者。

DESCRIPTION (provided by applicant): In this laboratory we have developed a set of techniques that randomized controlled studies indicate can substantially reduce the motor deficit of patients with mild to moderately severe chronic strokes. The techniques, termed Constraint-Induced Movement therapy (CI therapy), involve motor restriction of the less-affected upper extremity for consecutive weeks while at the same time intensively training the more-affected arm. In past work all CI therapy patients were given treatment for 6 hr/day. The primary difference between CI therapy and conventional physical therapy is in the duration and intensity of the treatment, and it was assumed that 6 hr/day of treatment was necessary to obtain an optimal treatment outcome. However, in preliminary work there is a strong suggestion that 3 hr/day of intensive training can give as large an effect as 6 hr/day at the previous standard intensity. The purpose of this grant is to evaluate these preliminary results concerning the efficacy of 3 hours of CI therapy in a rigorously designed, randomized, blinded study. The study will contain 8 groups in a pair of 2x2 factorial designs, a separate one for higher and lower functioning patients. This separation is necessitated by the fact that some important parameters of treatment must differ for the 2 types of patients to obtain an optimal treatment effect. Duration of treatment per day (6 hr vs. 3 hr) will be varied independently of intensity of training (standard vs high). This design will permit the effects of duration and intensity of training to be examined separately (main effects) as well as to determine whether the effect of intensity varies with training duration (interaction effect). In the preliminary study, the treatment administered to the 3 hr/day group was more intense than the treatment administered to the 6 hr/day group so that duration (hr/day) and intensity (trials/hr) were confounded. This project is needed to rigorously evaluate which is the most efficacious combination of these two parameters for patients for different levels of severity of impairment. CI therapy is beginning to be employed clinically at an accelerating pace. The main drawback in the clinical use of this intervention is its recommended duration and intensity, which is expensive in terms of costly therapist time. If 3 hr/day of intense treatment gives as good a result as 6 hr of less intense treatment, the cost of the therapy would be substantially reduced making it feasible to provide it to a larger number of patients than is presently possible.