A Treatment for Excess Motor Disability in the Aged

描述(申请人提供)：在这个实验室中，我们开发了一套技术，随机对照研究表明，这些技术可以显著减少轻度到中度慢性中风患者的运动障碍。这些技术被称为强制诱导运动疗法(CI疗法)，包括对受影响较小的上肢进行连续几周的运动限制，同时对受影响较大的手臂进行强化训练。在过去的工作中，所有CI治疗患者都接受了6小时/天的治疗。脑梗塞治疗与传统物理治疗的主要区别在于治疗的持续时间和强度，一般认为每天治疗6小时才能获得最佳的治疗结果。然而，在初步工作中，有一个强有力的建议，即每天3小时的强化训练可以产生与以前标准强度下的6小时/天一样大的效果。这笔赠款的目的是在一项严格设计的、随机、盲目的研究中评估这些关于3小时CI治疗有效性的初步结果。这项研究将包括8组，采用一对2x2析因设计，分别用于功能较高和功能较低的患者。这种分离是必要的，因为一些重要的治疗参数必须不同，才能使两种类型的患者获得最佳的治疗效果。每天的治疗时间(6小时与3小时)将独立于训练强度(标准与高强度)而变化。这一设计将允许分别检查培训持续时间和强度的影响(主要影响)，并确定强度的影响是否随培训持续时间的不同而变化(交互影响)。在初步研究中，3小时/天组的治疗强度比6小时/天组的治疗强度大，因此持续时间(小时/天)和强度(试验/小时)是混淆的。该项目需要对不同程度损伤的患者严格评估这两个参数的最有效组合。CI疗法正开始加速应用于临床。这种干预的临床应用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，这是昂贵的。如果每天3小时的强化治疗效果与6小时的低强度治疗一样好，那么治疗的成本将大大降低，从而使其能够提供给比目前可能的更多的患者。

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.