A Treatment for Excess Motor Disability in the Aged

老年人过度运动障碍的治疗

• 批准号: 6921443
• 负责人: Edward Taub
• 金额: $ 47.96万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-12-09 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6921443
• 关键词: brain injury; clinical research; disabling disease; disease /therapy duration; fatigue; functional ability; human subject; human therapy evaluation; limb movement; limbs; magnetic resonance imaging; medical rehabilitation related tag; neuropsychological tests; outcomes research; patient oriented research; physical therapy; pyramidal tracts; rehabilitation; statistics /biometry; stroke therapy

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.

描述（由申请人提供）：在本实验室中，我们开发了一套技术，随机对照研究表明，该技术可以大大减少轻度至中度慢性卒中患者的运动缺陷。该技术，被称为约束诱导运动疗法（CI疗法），涉及运动限制的影响较小的上肢连续几周，而在同一时间密集训练的影响较大arm. In过去的工作中，所有CI治疗患者给予治疗6小时/天。CI疗法和常规物理疗法之间的主要差异在于治疗的持续时间和强度，并且假设6小时/天的治疗对于获得最佳治疗结果是必要的。然而，在初步工作中，有一个强烈的建议，即3小时/天的强化训练可以产生与先前标准强度下6小时/天一样大的效果。本基金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。本研究将包含一对2x2析因设计中的8个组，一个单独的组用于较高和较低功能的患者。这种分离是必要的，因为两种类型的患者的一些重要治疗参数必须不同，以获得最佳治疗效果。每天的治疗持续时间（6小时与3小时）将独立于训练强度（标准与高）而变化。这种设计将允许单独检查训练的持续时间和强度的影响（主效应），以及确定强度的影响是否随训练持续时间而变化（相互作用效应）。在初步研究中，给予3小时/天组的治疗强度高于给予6小时/天组的治疗强度，因此混淆了持续时间（小时/天）和强度（试验/小时）。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的最有效组合。CI疗法开始以加速的步伐在临床上应用。这种干预在临床应用中的主要缺点是其推荐的持续时间和强度，这在昂贵的治疗师时间方面是昂贵的。如果3小时/天的强度治疗与6小时的强度较低的治疗产生同样好的结果，则治疗的成本将大大降低，使得向比目前可能的更多的患者提供治疗是可行的。