Mirror Imitation Therapy for Motor Recovery After Stroke

中风后运动恢复的镜像疗法

• 批准号: 7454314
• 负责人: ANA SOLODKIN
• 金额: $ 33.58万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7454314
• 关键词: Acute; Address; Adult; Affect; Behavior; Behavioral; Biological Neural Networks; Brain; Brain region; Bypass; Central Nervous System Diseases; Chronic Phase; Clinical; Cognitive; Complement; Corticospinal Tracts; Disease; Elements; Enhancing Lesion; Exercise; Functional disorder; Hand; Human; Imaging Techniques; Individual; Inferior; Intervention; Investigation; Ischemic Stroke; Lead; Learning; Lesion; Limb structure; Lobule; Long-Term Effects; Magnetic Resonance Imaging; Manuals; Methods; Modeling; Motor; Motor Skills; Movement; Natural regeneration; Neural Network Simulation; Neuraxis; Neuroanatomy; Neurobiology; Neurons; Outcome Measure; Output; Parietal; Pathway interactions; Patients; Physiological; Physiology; Play; Procedures; Process; Production; Psychological reinforcement; Purpose; Recovery; Research; Research Personnel; Role; Sensory; Source; Stroke; System; Therapeutic; Therapeutic Intervention; Training; Visual; base; central nervous system injury; disability; functional improvement; mental practice; network models; neural circuit; post stroke; programs; relating to nervous system; remediation; repaired; restoration; skills; theories

DESCRIPTION (provided by applicant): Research into the acute treatment of central nervous system (CNS) injury has become a national priority, and recent progress has been remarkable. Unfortunately this progress has not carried over to the less acute sequelae of CNS injury, which often include serious cognitive and motor disability. Of all diseases affecting the CNS, stroke is both the most prevalent and the primary cause of serious disability among adults. Treatment for the long-term effects of stroke lags behind treatment for the acute illness and typically focuses on developing compensatory neural circuits rather than on reinstatement of pre-existing pathways. This proposal addresses physiological remediation, in which behavior is restored by direct remodeling, aimed at reinstatement of original neural circuits. The proposal specifically focuses on methods for remediation of hand motor skill after ischemic stroke. Our approach is based on principles of functional remediation that involves restoration of function through remodeling of pre-existing motor networks. Convergent neural inputs are the functional basis of overlapping, distributed neural circuits, in which even simple behaviors are the product of a highly integrated process. Within this framework, therapeutic interventions can involve the manipulation of the intensity and diversity of interactions among elements of particular motor circuits. Motor behaviors differ in the degree to which they integrate convergent neural inputs from sensory, motor and limbic sources, and thus have different therapeutic potential for stroke patients. In this proposal we use a motor imitation therapy based on the physiology of the mirror system. The behavioral tasks studied here are skilled hand movements, which are used in the context of hand motor imitation. These tasks differ in the degree to which they harness neural circuit activity corresponding to the potential sources of sensory, motor, and associational information. All have established potential in hand motor remediation. Motor imitation consists of mental practice using external proprioceptive and visual sensory inputs and can be applied with hand motor tasks. Neural remodeling has a large potential impact after stroke. We investigate the neural remodeling that occurs with specialized late remediation-based intervention. We propose that supervised practice and specialized training with manual skill through the involvement of the motor observation-imitation system (mirror neuron system), used in a program of graded incremental complexity, will lead to notable neural circuit changes that favor recovery of impaired limbs (dominant and non-dominant). We also postulate that these neural circuit changes will be accompanied by therapeutic long-term benefits. Although we assess therapeutic benefit with primary outcome measures that reflect hand motor skill, we make extensive use of neural network modeling procedures to characterize the physiological aspects of this remediative process.

描述（由申请人提供）：中枢神经系统（CNS）损伤的急性治疗研究已成为国家优先事项，近期进展显著。不幸的是，这一进展并没有延续到较不急性的中枢神经系统损伤后遗症，其中往往包括严重的认知和运动障碍。在所有影响中枢神经系统的疾病中，中风是成人中最普遍的严重残疾的主要原因。中风长期影响的治疗落后于急性疾病的治疗，通常侧重于开发补偿性神经回路，而不是恢复先前存在的通路。这一建议涉及生理补救，其中通过直接重塑恢复行为，旨在恢复原始神经回路。该提案特别关注缺血性中风后手部运动技能的补救方法。我们的方法是基于功能修复的原则，包括通过重塑预先存在的运动网络来恢复功能。收敛神经输入是重叠的分布式神经回路的功能基础，其中即使是简单的行为也是高度集成过程的产物。在这个框架内，治疗干预可以涉及操纵特定运动回路的元素之间的相互作用的强度和多样性。运动行为在整合来自感觉、运动和边缘系统来源的会聚神经输入的程度上不同，因此对中风患者具有不同的治疗潜力。在这个建议中，我们使用基于镜像系统的生理学的运动模仿疗法。这里研究的行为任务是熟练的手部动作，这是在手部运动模仿的背景下使用的。这些任务的不同之处在于，它们在多大程度上利用了与感觉、运动和联想信息的潜在来源相对应的神经回路活动。所有人都有手部运动修复的潜力。运动模仿包括使用外部本体感受和视觉感官输入的心理练习，可以应用于手部运动任务。脑卒中后神经重塑具有很大的潜在影响。我们研究了专门的后期补救干预发生的神经重塑。我们建议，监督的做法和专门的培训与手工技能，通过参与运动观察-模仿系统（镜像神经元系统），在一个程序中使用的分级增量复杂性，将导致显着的神经回路的变化，有利于恢复受损的肢体（显性和非显性）。我们还假设，这些神经回路的变化将伴随着治疗的长期效益。虽然我们用反映手部运动技能的主要结果指标评估治疗益处，但我们广泛使用神经网络建模程序来表征这种治疗过程的生理方面。