Dose-Response of Movement Practice During Stroke Rehabilitation

描述(申请人提供)：剂量已成为促进中风后功能恢复的关键因素。目前，缺乏剂量-反应关系的数据阻碍了中风康复领域的进展。拟议项目的目标是确定在慢性中风患者中产生最大改善效果的运动练习的剂量范围。借鉴中风的动物模型，人类的剂量可以通过特定任务练习的重复次数来量化。我们的中心假设是，中风患者存在一个剂量范围，低于这个范围，益处很小，超过这个范围，进一步的实践不会产生进一步的益处。受益剂量的范围可能会根据运动障碍的严重程度和其他领域非运动障碍的存在而有所不同。使用随机、平行的剂量-反应设计，我们将评估四种不同剂量的任务特定上肢训练的益处，其中匹配的计划为1小时，4次/周，共8周，在100名慢性中风患者中。要评估的总重复剂量(3200、6400、9600和个性化-最大)是基于我们的初步数据。个体化-最大值组可以将他们的会话延长超过8周，直到满足定义的停止标准。我们的主要目标是测试较大的总剂量是否比较小的总剂量产生更好的结果。四种剂量的益处将在损伤、活动和参与水平上进行评估，因为了解所有测量水平上的剂量-反应关系对于推进康复研究至关重要。我们假设在9600剂量组和个体化最大剂量组的改善最大，其次是6400剂量组，然后是3200重复剂量组。我们的第二个目标是描述上肢任务特定练习的剂量-反应关系。利用来自多个评估点的数据，将使用单独的曲线建模来估计剂量范围，低于该范围的益处微乎其微，超过该范围的进一步实践将不会产生进一步的益处。此外，我们将确定各种因素如何修改剂量估计。我们假设运动障碍的严重程度将是剂量-反应关系的主要修正因素，轻度运动障碍的患者需要更大的剂量。我们进一步预计，对于患有抑郁症和半空间忽视的人，所需的剂量将更大。由于我们在中风康复研究和测量方面的专业知识，我们对临床实践和临床研究的挑战的了解，以及我们随时可以接触到这些患者，我们的团队能够很好地研究剂量这一关键问题。该项目的预期结果是经验驱动的估计，表明推动最大改善所需的运动练习剂量，以及如何为接受中风康复的人单独修改这些估计。我们的估计将立即影响康复研究和临床实践。这个项目的重要性超越了中风康复；我们的初步结果将对许多其他康复人群具有很高的价值，这些人群也因缺乏关于剂量-反应关系的知识而受到阻碍。

DESCRIPTION (provided by applicant): Dose has emerged as a key factor promoting functional recovery after stroke. Currently, a lack of data on the dose-response relationship impedes progress in the field of stroke rehabilitation. The goal of the proposed project is to define the range of doses of movement practice that produce the greatest improvements in outcomes in people with chronic stroke. Borrowing from animal models of stroke, dose in humans can be quantified by the number of repetitions of task-specific practice. Our central hypothesis is that there exists a range of doses for people with stroke, below which, there is minimal benefit, and above which, further practice does not result in further benefit. The range of beneficial doses is likely to vary based on the severity of motor deficits and the presence of non-motor deficits in other domains. Using a randomized, parallel dose-response design, we will evaluate the benefits of four different doses of task-specific upper extremity training with matched schedules of 1 hr sessions, 4 sessions/wk for 8 wks, in 100 people with chronic stroke. Total repetition doses to be evaluated (3200, 6400, 9600, & individualized-maximum) are based on our preliminary data. The individualized-maximum group may extend their sessions beyond 8 wks until meeting defined stop criteria. Our primary aim will test whether larger total doses result in better outcomes than smaller total doses. Benefits of the four doses will be evaluated at the impairment, activity, and participation levels, since understanding the dose-response relationship at all levels of measurement is critical for advancing rehabilitation research. We hypothesize that improvements will be greatest in the 9600 and individualized-maximum, followed by the 6400, and then the 3200 repetition dose groups. Our secondary aim is to characterize the dose-response relationship of upper extremity task-specific practice. With data from multiple assessment points, individual curve modeling will be used to estimate dose ranges, below which, there is minimal benefit, and above which, further practice does not result in further benefit. Furthermore, we will determine how various factors modify the dose estimates. We hypothesize that the severity of motor deficits will be the primary modifier of the dose- response relationship, with larger doses needed for those with more mild motor deficits. We further expect that needed doses will be larger for those with depression and hemispatial neglect. Our team is well-positioned to investigate the critical issue of dose because of our expertise in stroke rehabilitation research and measurement, our understanding of the challenges of clinical practice and clinical research, and our ready access to this patient population. Expected outcomes from this project are empirically-driven estimates indicating the dose of movement practice required to drive maximal improvements and how these estimates can be individually modified for people undergoing stroke rehabilitation. Our estimates will immediately impact rehabilitation research and clinical practice. The importance of this project transcends stroke rehabilitation; our primary results will be of high value to many other rehabilitation populations also impeded by the lack of knowledge regarding dose-response relationships.