fMRI and Robot-Assisted Practices of Activities of Daily Living

描述（由申请人提供）：中风是成人中最常见的获得性神经功能障碍，女性中风率高于男性。受影响的女性比男性更有可能因中风相关残疾而活得更长。机器人辅助治疗代表了中风康复的最前沿，并有望改善因中风而残疾的退伍军人的生活。使用这些工具的初步研究已经证明了其有效性和局限性的令人信服的证据。然而，这些增益到ADL的结转不一致。因此，目前尚不清楚什么治疗策略可以最大限度地提高ADL的功能结局。了解如何优化机器人辅助治疗对于增强患者康复和改善功能结果非常重要。功能性磁共振成像（fMRI）和弥散张量成像（DTI）等成像技术可以帮助我们确定谁可能从机器人辅助训练中受益，以及为什么机器人训练后可能发生训练诱导的功能性皮层变化。我们建议进行一项干预性研究加对照，以评估为期三周的机器人辅助实践任务的有效性，这些任务具有类似于ADL的熟练功能任务。我们将评估这种培训的能力，以实现即时收益和长期的功能改善。此外，使用功能磁共振成像和弥散张量成像，我们计划将运动损伤水平和功能任务表现水平中观察到的行为变化与白色物质损伤和连接以及运动皮层和大脑其他区域中氧利用率的变化相关联。我们假设如下：机器人辅助的熟练的达到任务的实践，改善中风后的ADL功能。我们的短期目标是：1）评估这些熟练任务的短期功能增益实践; 2）评估这些改善的长期（6个月）维持; 3）量化与机器人训练相关的中枢神经系统变化; 4）根据皮质活动变化模式和白色物质连接类型确定高应答者和低应答者的趋势。我们的长期目标是：1）优化机器人训练策略，以练习ADL的强度和持续时间，以最大限度地提高皮质变化; 2）确定病变特征如何影响功能、白色物质连接和皮质活动的变化。

DESCRIPTION (provided by applicant): Strokes are the most commonly acquired neurological disability in adults and stroke rates are higher in women than in men. Affected women are more likely than men to live longer with their stroke-related disabilities. Robot-assisted therapy represents the cutting edge of stroke rehabilitation and promises to improve the lives of veterans with disabilities due to stroke. Preliminary studies using these tools have demonstrated compelling evidence of their effectiveness and limitations. However, inconsistent carryovers of these gains to ADLs are seen. Therefore, it is still not clear what treatment strategies maximize functional outcomes on ADLs. Understanding how to optimize robot-assisted therapies is important for enhanced patient rehabilitation and improved functional outcomes. Imaging techniques such as functional Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) can assist us in determining who may benefit from robot-assisted training and why training induced functional cortical changes may occur after robot training. We propose to conduct an interventional study plus control to assess the effectiveness of three weeks of robot-assisted practice of tasks with skilled functional tasks that resemble ADLs. We will assess the ability of such training to effect immediate gains and long-term functional improvements. Further, using fMRI and DTI, we plan to associate behavioral changes seen in motor impairment levels and functional task performance levels with white matter injuries and connectivity and changes in oxygen utilization in the motor cortex as well as other areas of the brain. We hypothesize the following: Robot-assisted practice of skilled reaching tasks improves ADL function after stroke. Our short-term aims are to 1) assess short-term functional gains practice of these skilled tasks; 2) assess long-term (six months) maintenance of these improvements; 3) quantify the central nervous system changes associated with robotic training, and 4) identify trends across high and low responders in terms of patterns of change in cortical activity and type of white matter connectivity. Our long-term aims are to 1) optimize robot-training strategies for practice of ADLs for intensity and duration to maximize cortical changes and 2) determine how lesion characteristics affect changes seen in function, white matter connectivity, and cortical activity.