Eye-Hand Coordination in Elderly Stroke Victims: A Visuomotor Rehab Study

描述(申请人提供)：中风是老年人残疾的主要原因，运动恢复的机制还不清楚。康复治疗中一个被忽视的部分是对眼手协调的清楚理解，尽管眼球和手的运动对于大多数功能活动是必要的。更令人担忧的是，老年人的视力障碍非常普遍，而且大多未被发现，目前用于筛查老年人的方法缺乏敏感性和特异性；不幸的是，当一个人在中风后增加视力损失时，会对ADL产生重大影响，并成为依赖的独立危险因素。本项目的目的是了解如何将眼睛训练推广到老年人的手臂训练中，以改善眼手协调和功能表现。这项研究提案背后的具体假设是，眼睛控制先于手臂控制；我们认为，偏瘫患者在眼睛运动的计划和控制方面存在未被充分认识的缺陷，这影响了手臂运动的计划和控制，当老化的视觉系统放大时，这是一个严重的事实，失去了空间和时间性能。在简单的物体提取任务中，眼球运动或眼跳在手臂运动或伸展之前完成。尽管使用了更保守的策略和广泛的反馈控制，但在到达的过程中，中风患者比健康受试者表现出明显更多的偏离直线路径的情况。低效的眼跳可能会增加眼外神经运动噪音，限制手臂动作的规划和执行。研究表明，健康的人使用不同的策略来规划伸展运动，但并不是所有的策略都同样有效。目前尚不清楚眼球运动是否也是如此，以及训练更有效的策略是否可以推广到肢体运动，以达到中风后的功能改善。对有效的眼球运动计划的清楚理解可以转化为功能性视力康复干预，以改善ADL。一种这样的方法可能是在视频游戏的设计中，以促进更有效的眼球运动策略和眼手协调。本研究的主要目标是更好地阐明老年人的视觉运动计划策略，这些策略可以在老年人和老年中风后实施，以促进长期的功能恢复。

DESCRIPTION (provided by applicant): Stroke is a leading cause of disability in the aged and the mechanisms underlying motor recovery are not well understood. A neglected component in rehabilitative therapies is a clear understanding of eye-hand coordination even though eye and hand movement is necessary for most functional activities. Of more concern is the fact that vision impairment in the aged is highly prevalent and largely undetected and the current methods used to screen the elderly lack sensitivity and specificity; unfortunately when one adds vision loss after stroke there is a significant impact on ADLs and an independent risk factor for dependency. The purpose of this project is to understand how eye training can be generalized to arm training in the elderly to improve eye-hand coordination and functional performance. The specific hypothesis behind this research proposal is that eye control precedes arm control; we propose that patients with hemiparesis have under-recognized deficits in the planning and control of eye movement that affects the planning and control of arm movement, a grave fact when amplified by the aging visual system, losing spatial and temporal performance. During simple object retrieval tasks, eye movements or saccades are completed prior to arm movements or reaches. During reaching, stroke patients demonstrate substantially more deviation from straight-line paths than do healthy subjects, despite using more conservative strategies and extensive feedback control. Inefficient saccades could increase extraocularneuromotor noise, limiting the planning and execution of arm movements. It has been shown that healthy individuals use various strategies to plan reaching movements, but not all of them are equally efficient. What is not known is whether the same is true for eye movements, and whether training the more efficient strategy can generalize to limb movements for reaching, yielding functional improvement post-stroke. A clear understanding of efficient oculomotor planning may translate into functional vision rehabilitation interventions to improve ADLs. One such approach may be in the design of videogames to promote more efficient oculomotor strategies and eye-hand coordination. The overarching goal of the present study is to better elucidate the visuomotor planning strategies in the elderly that may be implemented both in the elderly and in the elderly post-stroke to foster long-term functional recovery