Mental Practice Dosing and Mechanisms in Stroke

描述（由申请人提供）：中风是美国致残的主要原因，导致运动障碍，影响生活质量。偏瘫是脑卒中致残的主要损害，也是最常见的损害，但传统的脑卒中康复往往不成功。补充和替代医学（CAM）技术在中风中的疗效还有待广泛研究。此外，尽管美国有4,400万慢性中风患者，但对于这一人群使用传统或CAM技术的有效运动治疗方案知之甚少。心理练习（MP）是一种CAM身心技巧，其中身体技能是认知预演，可以提高运动技能的学习和表现。同样的神经和肌肉结构在MP中被激活，就像在物理练习中一样。该实验室的数据表明，MP比传统的运动疗法更能显著减少中风引起的偏瘫。然而，MP的作用机制和最佳MP剂量尚不清楚，需要在进行大型MP临床试验之前进行鉴定。研究目的是：(1)确定MP持续时间与运动预后之间的剂量-反应关系；(2)利用功能磁共振成像（fMRI）确定MP的作用机制。计划将包括发展和完善MP和fMRI协议，并为康复人员提供服务。随后，对33名慢性中风患者进行了30、60和120分钟每日MP剂量的运动和神经效应的多基线研究。[另外11例患者将只接受运动治疗，无MP。]结果测量将包括逃亡-迈耶评估、行动研究臂测试、沃尔夫运动功能测试和中风影响量表，以及定性测量，功能磁共振成像将检查可能的mp诱导的皮层重组。拟议的研究符合NCCAM和R21的优先事项，包括：(1)改进有前途的CAM干预措施；(2)心身相互作用研究及CAM技术在心血管疾病（包括中风）中的应用；(3)阐明CAM的作用机理。确定MP的作用机制和最佳剂量是成本效益和适当实施这一有前途的CAM心身技术的基础，并将使后续的MP临床试验成为可能。

DESCRIPTION (provided by applicant): Stroke is the leading cause of disability in the United States, causing motor impairments that compromise quality of life. Hemiparesis is the primary impairment underlying stroke disability and the most frequent impairment treated, yet conventional stroke rehabilitation is often unsuccessful. The efficacy of Complementary and alternative medicine (CAM) techniques in stroke is yet to be extensively examined. Moreover, although > 4 million chronic stroke patients reside in the United States, little is known about efficacious motor therapy regimens for this population using either conventional or CAM techniques. Mental practice (MP), a CAM mind-body technique in which physical skills are cognitively rehearsed, increases motor skill learning and performance. The same neural and muscular structures are activated during MP as during physical practice of the same skill. Data from this laboratory suggest that MP reduces stroke-induced hemiparesis significantly more than conventional motor therapy. However, MP mechanisms of action and optimal MP dosing are unknown and require identification before a large MP clinical trial can be performed. Study aims are: (1) To determine the dose-response relationship between MP duration and motor outcomes; and (2) to determine the MP mechanisms of action using functional magnetic resonance imaging (fMRI). Planning would include development and refinement of MP and fMRI protocols and inservicing of rehabilitation personnel. This would be followed by a multiple baseline study of motor and neural effects of 30, 60 and 120-minute daily MP doses in 33 chronic stroke patients. [11 additional patients will receive motor therapy only with no MP.] Outcome measures would include the FugI-Meyer Assessment, the Action Research Arm Test, the Wolf Motor Function Test, and the Stroke Impact Scale, as well as qualitative measures, fMRI will examine possible MP-induced cortical reorganizations. The proposed study meets NCCAM and R21 priorities, including (1) refinement of promising CAM interventions; (2) study of mind-body interactions and application of CAM techniques to cardiovascular diseases, including stroke; and (3) elucidation of CAM mechanisms of action. Identification of MP mechanisms of action and optimal dosing is fundamental to cost-effective, appropriate implementation of this promising, CAM, mind-body technique, and will enable a subsequent MP clinical trial.