Hemispheric Dominance for Ipsilesional Movement

同侧运动的半球优势

• 批准号: 8262643
• 负责人: Kathleen Y Haaland
• 金额: --
• 依托单位: ALBUQUERQUE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8262643
• 关键词: Acceleration; Activities of Daily Living; Address; Affect; Age; Animals; Bilateral; Brain; Brain Injuries; Case Study; Cerebral Dominance; Chronic; Collaborations; Contralateral; Control Groups; Dissociation; Functional Imaging; Goals; Grant; Hand; Human; Hybrids; Hypogravity; Impairment; Incidence; Individual; Ipsilateral; Joints; Kinetics; Lead; Left; Lesion; Life; Limb structure; Link; Location; Longitudinal Studies; Maps; Measures; Mediating; Minority; Mission; Modeling; Modification; Motor; Motor Cortex; Movement; Nature; Occupational Therapy; Optics; Paper; Paresis; Parietal; Parietal Lobe; Patient Care; Patients; Performance; Play; Positioning Attribute; Process; Proprioception; Protocols documentation; Publishing; Recovery of Function; Rehabilitation therapy; Relative (related person); Reporting; Research; Role; Sensory; Specific qualifier value; Specificity; Stroke; Survivors; Symptoms; System; Testing; Theoretical model; Therapeutic; Time; Torque; Training; Translating; Translational Research; United States; Universities; Upper Extremity; Veterans; Vision; Visual; Work; abstracting; arm; base; chronic stroke; constraint induced movement therapy; design; disability; hemiparesis; hemiparetic stroke; hemisphere damage; improved; indexing; interest; joint mobilization; kinematics; motor control; motor deficit; neuroregulation; post stroke; programs; public health relevance; rehabilitation strategy; relating to nervous system; research study; response; robot assistance; stroke rehabilitation; theories; virtual reality; visual information; visual motor

DESCRIPTION (provided by applicant): Project Summary Abstract Motor deficits after stroke produce long term disability. While contralesional motor deficits are most obvious, ipsilesional deficits are common & influence functioning even in chronic stroke patients, especially hemiplegics who rely on their ipsilesional limb. This grant is a renewal of Haaland's previous CSR&D grant, which established collaboration with Robert Sainburg, a kinesiologist at Penn State. The current proposal is designed to elucidate the underlying mechanisms for the hemispheric differences demonstrated in the first grant, which is critical for theories of hemispheric specialization & for designing more specific stroke rehabilitation. The previous grant supported a hybrid model that incorporated Haaland's view that hemispheric specialization for movement was associated with differential control of open & closed loop processing and Sainburg's hypothesis that the two hemispheres differed in their control of limb dynamics (e.g., joint torque interactions) and steady state positional control. However, this conclusion was not based on a direct comparison of the two hypotheses. Therefore, this proposal will extend our previous findings in three experiments to determine: 1) Whether both left & right hemisphere damage (LHD, RHD) produce deficits in on- line response modification, which would be inconsistent with the open loop/closed loop hypothesis; 2) Whether movement errors after LHD & RHD will be more common depending on whether the underlying motor control mechanism is specification of limb dynamics or steady state positional control in an experiment where each type of control is manipulated independently. 3) Whether these hemispheric asymmetries are associated with differences in utilizing visual & proprioceptive information during planning. We will also compare patients with & without hemiparesis to determine the importance of damage to the motor system on these hemispheric differences. And, finally the differential impact of frontocentral & posterior parietal damage will be assessed with the predictions that dynamic control will be more impaired after left frontocentral than posterior parietal damage, & steady state positional control will be equally impaired after right frontocentral or posterior parietal damage. Three kinematic reaching experiments will be performed by 60 right-handed stroke patients (30 RHD, 30 LHD) who are > 6 months post stroke, using their ipsilesional arm & by 60 demographically matched, right-handed healthy control subjects using either arm (30 right & 30 left hand). Lesion size & location will be measured using MRIcro & a program to normalize individual brains to Talairach space. Region of interest analyses & voxel-based lesion symptom mapping will be done to identify the role of frontocentral & posterior parietal lesions. PUBLIC HEALTH RELEVANCE: Relevance to the VA Patient Care Mission This project is an example of translational research that tests the utility of a theoretical model, the dynamic dominance hypothesis, for understanding hemispheric specialization of movement with the eventual goal of translating that understanding into better rehabilitation after stroke. Most studies of the neural basis of movement focus upon contralateral control. While many have demonstrated ipsilesional movement deficits and the functional implications of those deficits, few have examined if each hemisphere is dominant for a different aspect of limb control. If this is confirmed in the current grant, then rehabilitation strategies for patients with RHD or LHD may benefit from different therapeutic strategies. Our findings from the previous CSR&D showed there is hemispheric specialization for different aspects of reaching. The current grant will be the first to study the mechanisms of these hemispheric differences after brain damage and their intrahemispheric correlates. About 600,000 people suffer a stroke each year, and incidence doubles for each decade of life after age 55. The number of veterans over 55 is projected to be more than 14 million in 2010 with more than 90% having some disability, many of whom will have strokes. Therefore, the long term functional impact of stroke is a significant concern for the patient care mission of the VA system. Forty percent of stroke survivors in the United States have moderate functional limitations related to motor function, and 37% require assistance with basic activities of daily living. Recent experimental protocols designed to rehabilitate the hemiparetic upper extremity including, reduced gravity training, constraint induced movement therapy, robot-assisted therapy, and bilateral training, have shown substantial promise. However, regardless of improvements in contralesional arm function, longitudinal studies have estimated that a minority of hemiplegic stroke patients will demonstrate full functional recovery in the contralesional limbs. Bonifer et al. reported that even after engaging in a constraint induced movement therapy trial that improved active movement, the contralesional arm of moderately impaired patients continued to be used to assist with bimanual activities, rather than as the lead controller, even in the case of dominant arm paresis. Finally, one paper showed that chronic hemiparetic stroke patients used the ipsilesional limb three to six times more frequently than its hemiparetic counterpart. Thus, for many hemiparetic patients, functional recovery relies heavily on ipsilesional limb function. The chronic persistence of ipsilesional deficits suggests that this arm does not spontaneously improve coordination through practice, alone. While occupational therapy has often employed "compensatory" training of the ipsilesional limb to regain independence in ADL, we now suggest that better understanding the nature of ipsilesional deficits might facilitate more adaptive.

描述（由申请人提供）： 中风后的运动障碍会导致长期的残疾。虽然对侧病变的运动缺陷是最明显的，但同侧病变的缺陷也很常见，甚至影响慢性中风患者的功能，特别是依赖于同侧病变肢体的偏瘫患者。这项资助是哈兰德先前的CSR&D资助的延续，该资助与宾夕法尼亚州立大学的运动机能学家罗伯特·塞恩堡建立了合作关系。目前的建议是为了阐明在第一次拨款，这是关键的半球专业化的理论和设计更具体的中风康复半球的差异的潜在机制。先前的资助支持一个混合模型，该模型结合了Haaland的观点，即半球运动的专门化与开环和闭环处理的差异控制有关，以及Sainburg的假设，即两个半球在控制肢体动力学方面不同（例如，关节扭矩相互作用）和稳态位置控制。然而，这一结论并不是基于对两种假设的直接比较。因此，本研究将扩展我们先前的研究结果，在三个实验中确定：1）是否左和右半球都受损（LHD，RHD）在在线反应修改中产生缺陷，这与开环/闭环假设不一致; 2）铲运机和铲运机后是否出现运动误差RHD将更常见，这取决于潜在的运动控制机制是肢体动力学的规范还是实验中的稳态位置控制，其中每种类型的控制都是独立操作。3)这些半球的不对称性是否与规划过程中利用视觉和本体感受信息的差异有关。我们还将比较有和没有轻偏瘫的患者，以确定运动系统损伤对这些半球差异的重要性。最后，额中央和后顶叶损伤的差异影响将评估与预测，动态控制将更受损后左额中央比后顶叶损伤，和稳态位置控制将同样受损后右额中央或后顶叶损伤。将由中风后> 6个月的60名右利手中风患者（30名RHD，30名LHD）使用他们的同侧臂进行三次运动学伸展实验，以及由60名人口统计学匹配的右利手健康对照受试者使用任一臂（30名右手和30名左手）进行三次运动学伸展实验。将使用MRIcro测量病变大小和位置&将个体大脑标准化至Talairach空间的程序。将进行感兴趣区域分析和基于体素的病变症状映射，以确定额中央和后顶叶病变的作用。 公共卫生相关性： 与VA患者护理使命的相关性该项目是转化研究的一个例子，该研究测试了理论模型（动态优势假说）的效用，用于理解半球运动的专业化，最终目标是将这种理解转化为中风后更好的康复。大多数关于运动神经基础的研究都集中在对侧控制上。虽然许多人已经证明了同病灶运动缺陷和这些缺陷的功能影响，很少有人检查，如果每个半球是占主导地位的肢体控制的不同方面。如果这一点在目前的资助中得到证实，那么RHD或LHD患者的康复策略可能会从不同的治疗策略中受益。我们在之前的CSR&D中的发现表明，大脑半球在不同的触达方面存在专门化。目前的拨款将是第一个研究脑损伤后这些半球差异的机制及其半球内相关性的项目。每年约有60万人中风，55岁以后每十年发病率翻一番。预计2010年55岁以上的退伍军人人数将超过1400万，其中90%以上有某种残疾，其中许多人将中风。因此，卒中的长期功能影响是VA系统的患者护理使命的重要问题。在美国，40%的中风幸存者有与运动功能相关的中度功能限制，37%的人需要日常生活基本活动的帮助。最近的实验方案，旨在恢复偏瘫上肢，包括减少重力训练，约束诱导运动疗法，机器人辅助治疗，和双边的培训，已显示出很大的希望。然而，无论对侧病变臂功能的改善如何，纵向研究估计，少数偏瘫卒中患者将表现出对侧病变肢体的完全功能恢复。Bonifer等人报告称，即使在参与改善主动运动的限制性诱导运动治疗试验后，中度受损患者的对侧病变臂仍继续用于辅助双手活动，而不是作为主要控制者，即使是在优势臂麻痹的情况下。最后，一篇论文表明，慢性偏瘫中风患者使用同侧肢体的频率是偏瘫患者的三到六倍。因此，对于许多偏瘫患者，功能恢复严重依赖于同侧肢体功能。慢性持续性的同病灶缺陷表明，这只手臂不自发地提高协调，通过实践，单独。虽然职业治疗往往采用“补偿”的同侧肢体的训练，以恢复独立的ADL，我们现在建议，更好地了解同侧赤字的性质可能会促进更多的适应。