Predicting Ipsilesional Motor Deficits in Stroke with Dynamic Dominance Model

使用动态优势模型预测中风中的同位运动缺陷

• 批准号: 8307542
• 负责人: Robert L Sainburg
• 金额: $ 28.15万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8307542
• 关键词: 3-Dimensional; Accounting; Activities of Daily Living; Address; Affect; Age; American Heart Association; Attention; Bilateral; Cerebral hemisphere; Clinic; Clinical; Contralateral; Custom; Development; Environment; Exercise; Force of Gravity; Friction; Hand; Image; Laboratories; Lead; Learning; Left; Leg; Lesion; Limb structure; Location; Measures; Modality; Modeling; Motor; Movement; Nature; Patients; Performance; Phase; Play; Positioning Attribute; Process; Publishing; Recovery; Recruitment Activity; Recurrence; Rehabilitation Research; Rehabilitation therapy; Reporting; Research; Role; Rotation; Sensory; Side; Specific qualifier value; Stroke; System; Test Result; Testing; Therapeutic; Time; Transportation; United States; arm; base; brain tissue; chronic stroke; cost; design; electric impedance; experience; hemiparesis; hemiparetic stroke; hemisphere damage; improved; inclusion criteria; motor control; motor deficit; motor learning; novel; public health relevance; research study; therapy development; virtual; virtual reality; visual motor

DESCRIPTION (provided by applicant): Unilateral sensory-motor stroke can cause significant motor deficits in the arm and leg on the same side of the body as the lesion (ipsilesional), in addition to producing more severe deficits on the opposite side of the body (contralesional). While ipsilesional deficits have been recognized in the clinic for decades, therapeutic attention has understandably focused on the more severe nature of contralesional deficits. However, ipsilesional deficits have recently been shown to substantially limit efficient performance of functional tasks, including activities of daily living. Such limitations are not difficult to understand given that the ipsilesional arm tends to be used as the primary manipulator during both unimanual and bimanual tasks for patients with moderate to severe hemiparesis. These coordination deficits are thought to result from diminished contributions from the damaged hemisphere to control of the arm on the same side of the body, an idea supported by our preliminary studies. Based on the dynamic dominance model of motor lateralization, we hope to explain and predict the differential deficits in unimanual and bimanual coordination that result from either right or left hemisphere damage. The proposed studies exploit the expertise of two laboratories that have invested substantial effort in studying motor lateralization (Sainburg), and ipsilesional motor performance in stroke patients (Haaland). [We expect our results to have tangible applications to rehabilitation, including the development of interventions to improve ipsilesional and bilateral function in chronic stroke patients.] Our proposed experiments examine targeted reaching movements, using a custom designed virtual-reality system that allows real-time display and recording of bilateral arm movements. The first two aims directly examine predictions from our model of lateralization for ipsilesional motor control and learning. Specifically, we will examine whether intersegmental coordination deficits result from left hemisphere damage, while positional deficits result from right hemisphere damage. In addition, we will examine the potential effect of such coordination deficits on functional performance. Our second aim examines whether unilateral stroke produces motor learning deficits that vary with the side of the lesion. Our third and fourth aims address the specific control processes that might underlie ipsilesional deficits: First, we ask whether left hemisphere related deficits in coordination and adaptation are related to errors in predicting task dynamics. Second, we examine whether position errors that result from right hemisphere damage are accounted for by deficient impedance control mechanisms, or rather by deficits in specification of spatial locations. In our final study, we will test our model's predictions for bilateral coordination during virtual object transportation and manipulation tasks. This is particular important for patients with moderate to severe hemiparesis, who often rely on bimanual arm use to carry out activities of daily living. In addition, recent research has indicated that bilateral exercise can serve as an effective therapeutic modality for such patients (Harris-Love et al, 2005). ! PUBLIC HEALTH RELEVANCE: The American Heart Association reports that each year, about 780,000 people in the United States experience a new or recurrent stroke, a large proportion of which involves asymmetrical damage to the cerebral hemispheres. Because the cerebral hemispheres are not functional mirror images of one another, lesion to either hemisphere can produce unique deficits in both arms of stroke patients, including the non-paretic arm. The studies proposed here should lead to a more complete understanding of motor deficits in the non-paretic arm of stroke patients, and the effects of these deficits on both unimanual and bimanual coordination. This is particularly important for patients with moderate to severe hemiparesis, who tend to rely on the non-paretic arm to carry out activities of daily living. We expect that our findings should produce tangible applications to clinical rehabilitation, and to rehabilitation research.

描述（由申请人提供）：单侧感觉-运动卒中除了在身体的对侧（对侧病灶）产生更严重的功能障碍外，还可在与病灶同侧的手臂和腿部造成显著的运动障碍（同侧病灶）。虽然同病灶缺陷已在临床上认识了几十年，但治疗注意力集中在对病灶缺陷的更严重性质上是可以理解的。然而，同病灶缺陷最近已被证明大大限制了有效的性能的功能任务，包括日常生活活动。这种局限性并不难理解，因为对于中度至重度轻偏瘫患者，同侧臂倾向于在单手和双手任务中用作主要操纵器。这些协调缺陷被认为是由于受损半球对控制身体同侧手臂的贡献减少所致，我们的初步研究支持了这一观点。基于运动侧化的动态优势模型，我们希望解释和预测的差异缺陷，单手和双手协调，无论是右半球或左半球的损害。拟议的研究利用了两个实验室的专业知识，这两个实验室投入了大量精力研究中风患者的运动侧化（Sainburg）和同侧运动表现（Haaland）。[We期望我们的结果对康复有实际的应用，包括开发干预措施来改善慢性中风患者的同侧和双侧功能。我们提出的实验研究有针对性的达到运动，使用定制设计的虚拟现实系统，允许实时显示和记录的双边手臂动作。前两个目标直接检验我们的同侧化模型对同侧运动控制和学习的预测。具体来说，我们将检查是否intersegmented协调赤字的结果，左半球的损害，而位置赤字的结果，右半球的损害。此外，我们将研究这种协调缺陷对功能表现的潜在影响。我们的第二个目的是检查单侧中风是否会产生运动学习障碍，这些障碍因病变侧而异。我们的第三和第四个目标解决的具体控制过程，可能是基础isilesional赤字：首先，我们问是否左半球相关的协调和适应的赤字有关的错误预测任务动态。其次，我们研究是否位置错误，导致右半球损伤占不足的阻抗控制机制，或者更确切地说，在指定的空间位置的赤字。在我们的最后一项研究中，我们将测试我们的模型在虚拟对象运输和操作任务中对双边协调的预测。这对于中度至重度轻偏瘫患者尤其重要，他们经常依赖双手手臂进行日常生活活动。此外，最近的研究表明，双侧运动可作为此类患者的有效治疗方式（Harris-Love et al，2005）。! 公共卫生关系：美国心脏协会报告说，每年美国约有78万人经历新的或复发性中风，其中很大一部分涉及大脑半球的不对称损伤。由于大脑半球不是彼此的功能镜像，因此任何一个半球的损伤都会在中风患者的双臂（包括非瘫痪手臂）中产生独特的缺陷。这里提出的研究应该能够更全面地了解中风患者非瘫痪手臂的运动缺陷，以及这些缺陷对单手和双手协调的影响。这对于中度至重度轻偏瘫患者尤其重要，他们倾向于依赖非轻瘫手臂进行日常生活活动。我们希望我们的研究结果能在临床康复和康复研究中产生切实的应用。