A Treatment for Excess Motor Disability in the Aged

描述（由申请人提供）：在这个实验室中，我们开发了一套技术，随机对照研究表明可以显着减少轻度至中度慢性中风患者的运动缺陷。这些技术被称为约束诱导运动疗法（CI 疗法），涉及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 治疗患者每天接受 6 小时的治疗。 CI 疗法和传统物理疗法之间的主要区别在于治疗的持续时间和强度，并且假设需要每天 6 小时的治疗才能获得最佳治疗结果。然而，在初步工作中，强烈建议每天 3 小时的强化训练可以产生与之前标准强度下每天 6 小时的效果一样大的效果。这笔资助的目的是在一项严格设计、随机、盲法研究中评估有关 3 小时 CI 治疗疗效的初步结果。该研究将包含 8 组，采用一对 2x2 因子设计，分别针对功能较高和功能较低的患者。这种分离是必要的，因为两类患者的一些重要治疗参数必须不同，才能获得最佳治疗效果。每天的治疗持续时间（6 小时与 3 小时）将根据训练强度（标准与高）而变化。这种设计将允许单独检查训练持续时间和强度的影响（主效应），并确定强度的影响是否随训练持续时间变化（交互效应）。在初步研究中，3小时/天组的治疗强度比6小时/天组的治疗强度更大，因此持续时间（小时/天）和强度（试验/小时）是混杂的。该项目需要严格评估这两个参数对于不同损伤严重程度的患者来说哪一个是最有效的组合。 CI 疗法开始加速应用于临床。这种干预措施在临床使用中的主要缺点是其推荐的持续时间和强度，这在治疗师的时间成本方面是昂贵的。如果每天 3 小时的强化治疗与 6 小时强度较低的治疗效果一样好，那么治疗的成本将大大降低，从而可以向比目前更多的患者提供治疗。

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.