Predicting Ipsilesional Motor Deficits in Stroke with Dynamic Dominance Model

项目摘要： 在上一个周期的资助，我们的特点是半球特定的运动控制缺陷，在非- 单侧损伤中风幸存者的瘫痪手臂。我们的初步数据表明，这些赤字是 严重轻瘫患者的严重和功能限制。我们专门设计了一个 使用虚拟现实干预来修复非麻痹手臂中的半球特异性缺陷 平台，然后在此训练之后进行各种真实的对象的操作训练，旨在 促进泛化和转移到自然环境中遇到的功能行为。我们 提出一个2中心、2组随机干预，其中一个治疗组将接受单侧 通过我们的虚拟现实和操作训练（VRMT）协议，对非瘫痪手臂进行训练。这 干预方案的前提是，有针对性地补救基本控制缺陷 表现出的非麻痹手臂将泛化和转移到实践任务以外的性能， 日常生活活动（ADL）。这种方法与更务实的针对具体任务的方法形成对比。 基本ADL的训练，其范围有限，更繁琐，并且忽略了已知的基本 运动控制缺陷我们的对照组将接受常规干预， 成人卒中上肢干预实践指南。拟议研究的影响是，我们 解决慢性卒中伴严重轻瘫患者的持续性功能表现缺陷， 在大多数当前的康复方案中，轻瘫手臂损伤通常被忽略。我们的首要目标是 这种干预的总体有效性，相对于我们的对照组： 在患有严重轻瘫的慢性卒中幸存者中，VRMT组将在非轻瘫患者中产生持久的改善。 手臂运动表现，将推广到改善功能活动和功能独立性， 更大程度上比传统的治疗集中在瘫痪的手臂。我们的第二个目标集中在 潜在的训练相关运动表现改善的机制基础：确定是否 干预诱导的非麻痹手臂表现的改善与以下方面的改善相关： 大脑半球特异性伸展运动学最后，我们的第三个目标是监测我们的产品的潜在负面影响。 实验性干预麻痹性臂损伤。我们已经整合了PI的实验室 （Sainburg-PSU，Winstein-USC）为我们的试点研究项目提供了很好的支持目标1 和3. !

Project Summary: In the previous cycle of this grant, we characterized hemisphere-specific motor control deficits in the non- paretic arm of unilaterally lesioned stroke survivors. Our preliminary data indicate these deficits are substantial and functionally limiting in patients with severe paresis. We have specifically designed an intervention to remediate the hemisphere-specific deficits in the non-paretic arm, using a virtual-reality platform, and then follow this training with manipulation training of a variety of real objects, designed to facilitate generalization and transfer to functional behaviors encountered in the natural environment. We propose a 2-site, two-group randomized intervention with a treatment group, which will receive unilateral training of the non-paretic arm, through our Virtual Reality and Manipulation Training (VRMT) protocol. This intervention protocol is grounded in the premise that targeted remediation of fundamental control deficits exhibited by the non-paretic arm will generalize and transfer beyond practiced tasks to performance of activities of daily living (ADL). This approach contrasts with the more pragmatic approach of task-specific training of essential ADL’s, which is limited in scope, more cumbersome, and ignores known fundamental motor control deficits. Our control group will receive conventional intervention, guided by recently released practice guidelines for upper limb intervention in adult stroke. The impact of the proposed research is that we address persistent functional performance deficits in chronic stroke patients with severe paresis, who’s non- paretic arm impairments are generally ignored in most current rehabilitation protocols. Our first aim addresses the overall effectiveness of this intervention, relative to our control group: To determine whether non-paretic arm VRMT in chronic stroke survivors with severe paresis will produce durable improvements in non-paretic arm motor performance that will generalize to improve functional activities and functional independence to a greater extent than conventional therapy focused on the paretic arm. Our second aim focuses on the mechanistic basis of potential training-related improvements in motor performance: To determine whether intervention-induced improvements in non-paretic arm performance are associated with improvements in hemisphere-specific reaching kinematics. Finally, our third aim monitors for potential negative effects of our experimental intervention on paretic arm impairment. We have already integrated the PI’s laboratories (Sainburg-PSU, Winstein-USC) for our pilot research project that has provided excellent support for aims 1 and 3. !