Strategies for recovery of dexterity post stroke

中风后恢复灵活性的策略

• 批准号: 8506627
• 负责人: PREETI RAGHAVAN
• 金额: $ 69.67万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8506627
• 关键词: 3-Dimensional; Adult; Affect; Age; Back; Bilateral; Brain; Clinical; Data; Development; Devices; Dose; Educational process of instructing; Factor Analysis; Feedback; Fingers; Force of Gravity; Functional disorder; Hand; Hand functions; Impairment; Individual; Knowledge; Lead; Learning; Lifting; Measurement; Measures; Modality; Motor; Motor output; Movement; Muscle; Neurologic; Neurological rehabilitation; Patients; Posture; Process; Protocols documentation; Psychological reinforcement; Psychophysics; Public Health; Quality of life; Recovery; Rehabilitation therapy; Research; Savings; Sensory; Shapes; Side; Skeletal Muscle; Staging; Stroke; Structure; Survivors; Tactile; Testing; Texture; Time; Training; Upper Extremity; Visual; Weight; arm; base; conventional therapy; disability; grasp; improved; instrument; kinematics; motor learning; motor skill learning; novel; object shape; post stroke; public health relevance; research study; response; restoration; restraint; sensory integration; skills; stroke rehabilitation; trapezius muscle; treatment strategy

DESCRIPTION (provided by applicant): Stroke is the leading cause of adult disability. Despite conventional therapy, a majority of stroke survivors have persistent hand dysfunction. This proposed research will further our understanding of mechanisms of recovery of hand function and provide a scientific basis for post-stroke rehabilitation protocols in clinical practie. Motor recovery occurs through motor learning, which depends on at least three processes: adaptation, repetition and reinforcement. Adaptation is the ability to predict forces and movements according to the expected consequences of an action, and is fundamental to motor skill learning. When adapted movements are reinforced through repetition, learning is enhanced. We have shown that adaptation of fingertip forces and movements is disrupted after stroke. However, we found that context-specific sensory information from the unaffected hand can restore adaptation in the affected hand. These results suggest that the 'good' hand can teach the 'bad' hand fundamental aspects of grasp control. We also found that increased activity in anti-gravity postural muscles is associated with increased efficiency of finger movements. Based on these results we hypothesize that an alternate hand practice strategy, enhanced with postural muscle activation, will improve the rate of motor re-learning and enhance recovery of hand function post stroke. This strategy will tap into redundant connectivity between the two sides of the brain to facilitate sensorimotor integration during skill learning. In Aim 1, we will refine the alternate hand practice strategy to restore adaptation in the affected hand. The experiments will lead to a better understanding of how kinesthetic, tactile and visual sensory modalities interact during adaptation, given existing sensorimotor impairments after stroke. In Aim 2, we will delineate postural strategies that improve grasp efficiency and reduce abnormal directional biases to facilitate repetition of more efficient movements during practice. In Aim 3, we will examine the rate of within-session and between- session motor learning and improvement in hand function with the 'enhanced alternate hand training paradigm', and compare this to training with the affected hand alone, using a novel task panel and structured training protocols. We will test our Aims using quantitative psychophysical measurements of fingertip forces, finger kinematics, 3-D arm and trunk kinematics, and electromyographic recordings of bilateral upper limb muscle activity during functional reach-to-grasp and lift tasks. We expect to identify impairments that directly affect function, provide objective information about how a task is performed, and inform treatment strategies and dosing of therapy for enhanced re-learning. This project will advance our understanding of how redundant circuitry can be harnessed for integration of sensory input with motor output for re-learning, and provide a scientific basis for the selection of content and structure of practice. The knowledge obtained will inform best- practice rehabilitation protocols for recovery of hand function, which will impac the quality of life of individuals after stroke and other neurological conditions.

描述（由申请人提供）：中风是成人残疾的主要原因。尽管常规治疗，大多数中风幸存者有持续的手功能障碍。本研究将进一步了解脑卒中后手功能恢复的机制，为临床制定脑卒中后康复方案提供科学依据。运动恢复通过运动学习发生，这取决于至少三个过程：适应，重复和强化。适应是根据动作的预期后果预测力和动作的能力，并且是运动技能学习的基础。当适应的动作通过重复得到加强时，学习就得到了加强。我们已经证明，适应指尖的力量和运动被打乱中风后。然而，我们发现，来自未受影响的手的特定于上下文的感觉信息可以恢复受影响的手的适应。这些结果表明，“好”的手可以教“坏”的手掌握控制的基本方面。我们还发现，反重力姿势肌肉活动的增加与手指运动效率的提高有关。基于这些结果，我们假设，一个交替的手练习策略，加强与姿势肌肉激活，将提高运动再学习的速度，提高中风后手功能的恢复。这种策略将利用大脑两侧之间的冗余连接，以促进技能学习期间的感觉运动整合。在目标1中，我们将改进交替手练习策略，以恢复受影响手的适应性。这些实验将导致更好地了解动觉，触觉和视觉感官方式如何在适应过程中相互作用，考虑到中风后现有的感觉运动障碍。在目标2中，我们将描述提高抓握效率和减少异常方向偏差的姿势策略，以促进在练习中重复更有效的动作。在目标3中，我们将使用“增强的交替手训练范例”检查会话内和会话之间的运动学习率和手功能的改善，并将其与单独使用受影响的手的训练进行比较，使用新的任务面板和结构化训练方案。我们将使用指尖力的定量心理物理测量、手指运动学、3-D手臂和躯干运动学以及功能性伸手抓握和举起任务期间双侧上肢肌肉活动的肌电图记录来测试我们的目标。 我们希望识别直接影响功能的损伤，提供有关如何执行任务的客观信息，并为增强再学习的治疗策略和治疗剂量提供信息。本项目将进一步了解如何利用冗余回路整合感觉输入和运动输出进行再学习，并为练习内容和结构的选择提供科学依据。所获得的知识将为手功能恢复的最佳实践康复方案提供信息，这将影响中风和其他神经系统疾病后个人的生活质量。