Reach Forward: Mechanisms of Practice-Induced Reaching Improvement After Stroke

描述(申请人提供)：中风是美国长期残疾的主要原因。通常，中风会导致手臂功能的严重损害，这是导致残疾的主要原因。这项拟议的项目将研究练习导致慢性中风患者手臂功能运动改善的神经机制，其广泛的长期目标是通过新的康复干预措施减少因手臂损伤而导致的中风相关残疾。其基本原理是，了解中风后手臂运动的神经基础对于为那些有显著损害的人制定有针对性的干预策略至关重要。该项目将直接促进美国国立卫生研究院减轻“疾病和残疾负担”的使命。该项目的目的是：1)确定与中风影响的手臂的运动表现有关的大脑区域；2)确定与练习引起的手臂功能改善有关的大脑区域；3)确定是否可以通过在练习中应用有针对性的脑刺激来增强练习引起的改善。为了实现这些目标，将使用功能磁共振成像(FMRI)来测量中度受损中风患者伸展运动过程中的大脑激活，并将使用经颅磁刺激(TMS)和TMS-fMRI联合配准技术来上调特定大脑区域的活动，这些区域与练习中通过练习导致的表现改善相关。PHS 398/2590(09/04版，2006年4月4日重新发布)页面续格式页面

DESCRIPTION (provided by applicant): Stroke is the leading cause of long-term disability in the United States. Frequently, stroke results in significant impairment of arm function which contributes heavily to the resulting disability. This proposed project will examine the neural mechanisms of practice-induced improvements in functional arm movements in individuals with chronic stroke, with the broad, long-term objective of reducing stroke-related disability due to arm impairment through novel rehabilitation interventions. The rationale is that knowing the neural bases of post- stroke arm movements is crucial for the development of targeted intervention strategies for those with significant impairment. This project will directly contribute to the NIH mission of reducing "the burdens of illness and disability." The aims of the project are to 1) identify brain areas involved in movement performance of the stroke-affected arm, 2) identify brain areas involved in practice-induced improvements in arm function, and 3) determine whether practice-induced improvements could be enhanced with targeted brain stimulation applied during practice. To address these aims, functional magnetic resonance imaging (fMRI) will be used to measure brain activation during reaching movements in moderately-impaired stroke patients and transcranial magnetic stimulation (TMS) and TMS-fMRI co-registration techniques will be used to upregulate activity in specific brain areas associated with practice-induced performance improvement during practice. PHS 398/2590 (Rev. 09/04, Reissued 4/2006) Page Continuation Format Page