Reach Forward: Mechanisms of Practice-Induced Reaching Improvement After Stroke

描述（由申请人提供）：中风是美国长期残疾的主要原因。中风通常会导致手臂功能的严重损害，这在很大程度上导致残疾。这个拟议的项目将研究慢性中风患者手臂功能运动的练习诱导改善的神经机制，其广泛的长期目标是通过新的康复干预措施减少由于手臂损伤导致的中风相关残疾。其基本原理是，了解中风后手臂运动的神经基础对于为那些有明显障碍的人制定有针对性的干预策略至关重要。该项目将直接有助于国家卫生研究院的使命，减少“疾病和残疾的负担”。“该项目的目的是1）确定参与中风影响手臂运动表现的大脑区域，2）确定参与练习引起的手臂功能改善的大脑区域，3）确定练习引起的改善是否可以通过在练习过程中应用有针对性的大脑刺激来增强。为了实现这些目标，功能性磁共振成像（fMRI）将用于测量中度受损中风患者在达到运动期间的大脑激活，经颅磁刺激（TMS）和TMS-fMRI共配准技术将用于上调与练习诱导的性能改善相关的特定大脑区域的活动。PHS 398/2590（2004年9月修订，2006年4月重新印发）

DESCRIPTION (provided by applicant): Stroke is the leading cause of long-term disability in the United States. Frequently, stroke results in significant impairment of arm function which contributes heavily to the resulting disability. This proposed project will examine the neural mechanisms of practice-induced improvements in functional arm movements in individuals with chronic stroke, with the broad, long-term objective of reducing stroke-related disability due to arm impairment through novel rehabilitation interventions. The rationale is that knowing the neural bases of post- stroke arm movements is crucial for the development of targeted intervention strategies for those with significant impairment. This project will directly contribute to the NIH mission of reducing "the burdens of illness and disability." The aims of the project are to 1) identify brain areas involved in movement performance of the stroke-affected arm, 2) identify brain areas involved in practice-induced improvements in arm function, and 3) determine whether practice-induced improvements could be enhanced with targeted brain stimulation applied during practice. To address these aims, functional magnetic resonance imaging (fMRI) will be used to measure brain activation during reaching movements in moderately-impaired stroke patients and transcranial magnetic stimulation (TMS) and TMS-fMRI co-registration techniques will be used to upregulate activity in specific brain areas associated with practice-induced performance improvement during practice. PHS 398/2590 (Rev. 09/04, Reissued 4/2006) Page Continuation Format Page