PC-based Rehabilitation of Motor Planning Deficits in Parkinson Disease

基于 PC 的帕金森病运动规划缺陷康复

• 批准号: 8857400
• 负责人: Elizabeth A Disbrow
• 金额: --
• 依托单位: VA NORTHERN CALIFORNIA HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8857400
• 关键词: Activities of Daily Living; Adverse effects; Area; Basal Ganglia; Behavior; Behavioral; Brain; Brain imaging; Clinical; Cognition; Cognitive; Cognitive deficits; Cues; Disease; Effectiveness; Functional Magnetic Resonance Imaging; Functional disorder; Gait; Goals; Impaired cognition; Impairment; Individual; Language; Link; Measures; Mission; Modeling; Motor; Movement; Neurobehavioral Manifestations; Occupational Therapy; Parkinson Disease; Parkinsonian Disorders; Patients; Pattern; Performance; Pharmaceutical Preparations; Physical therapy exercises; Preparation; Production; Protocols documentation; Rehabilitation therapy; Research; Speech Therapy; Staging; Symptoms; Task Performances; Testing; Thinking; Training; Translating; Traumatic Brain Injury; Treatment Cost; Treatment outcome; Tremor; Veterans; Visuospatial; Walking; Work; abstracting; base; cognitive control; cognitive function; cognitive rehabilitation; cost effective; daily functioning; design; efficacy evaluation; falls; health administration; improved; memory process; motor deficit; motor disorder; nervous system disorder; neuromechanism; neuropsychological; novel; rehabilitation strategy; therapy development

DESCRIPTION (provided by applicant): Project Abstract: Parkinson's disease (PD) is one of the most common neurological disorders, and the Veterans Health Administration treats approximately 40,000 veterans with PD each year nationwide. PD has traditionally been considered a motor disorder, but it is now clear that there are cognitive symptoms as well, with at least 60% of non-demented patients impaired in one or more cognitive domains. While cognitive function is fundamental to normal motor behavior, the development of treatment has focused primarily on motor symptoms. There is growing evidence in the field of cognitive rehabilitation that training strategies focused on specific aspects of cognition can improve treatment outcomes in neurological disorders. However, there is no model of cognitive impairment that allocates specific neuropsychological rehabilitation strategies to cognitive dysfunction. In addition, there has been no systematic evaluation of the efficacy of cognitive rehabilitation in PD subjects, and the neural mechanisms underlying cognitive rehabilitation in PD are unknown. We have three aims, 1) to systematically evaluate cognitive rehabilitation in PD subjects, 2) to examine the neural mechanisms underlying cognitive rehabilitation in PD and 3) to assess the ecological validity of cognitive rehabilitation in PD. We will focus on a single aspect of cognitive function, the decision to initiate a movement. Movements can be internally generated or externally cued, and motor deficits in PD are typically linked to internally generated (IG) movements. Our approach is to use PC-based adaptive training to improve performance of IG movement initiation in patients with PD. The protocol is designed to drive beneficial neuroplastic changes using paradigms similar to those that have shown promising results in traumatic brain injury patients. In addition, we will use fMRI to measure activity in underlying BG-thalamocortical circuits, specifically patterns of insufficient normal activation and recruitment of additional brain areas, and measure changes in these patterns related to training. Finally, because the goal of any research regarding the pathophysiology of disease is to improve the lives of patients with the disease, behavioral and neuropsychological measures will be correlated with fMRI measured functional abnormalities before and after training. Improvement in the initiation of internally generated movements has the potential to dramatically improve daily functioning including reducing falls, improving language production and increasing proficiency of daily self initiated tasks such as opening a medication bottle or preparing a meal. Efforts to provide new and better treatment approaches for PD are crucial to the mission of the Veterans Health Administration. The key contribution of this work is that we will provide a novel adjunct therapy in the treatment of the cognitive symptoms of PD that is non-invasive, free from side effects, cost effective, and easily implemented.

描述（由申请人提供）： 项目摘要：帕金森病 (PD) 是最常见的神经系统疾病之一，退伍军人健康管理局每年在全国范围内治疗约 40,000 名患有帕金森病的退伍军人。帕金森病传统上被认为是一种运动障碍，但现在很明显，帕金森病也存在认知症状，至少 60% 的非痴呆患者在一个或多个认知领域受损。虽然认知功能是正常运动行为的基础，但治疗的发展主要集中在运动症状上。认知康复领域越来越多的证据表明，专注于认知特定方面的训练策略可以改善神经系统疾病的治疗结果。然而，没有认知障碍模型可以为认知功能障碍分配特定的神经心理康复策略。此外，目前尚未对PD受试者认知康复的效果进行系统评价，PD认知康复的神经机制尚不清楚。我们有三个目标，1）系统地评估帕金森病受试者的认知康复，2）检查帕金森病认知康复的神经机制，3）评估帕金森病认知康复的生态有效性。我们将关注认知功能的一个方面，即发起运动的决定。运动可以是内部产生的，也可以是外部提示的，PD 中的运动缺陷通常与内部产生的 (IG) 运动有关。我们的方法是使用基于 PC 的适应性训练来提高 PD 患者 IG 运动启动的表现。该方案旨在使用类似于在创伤性脑损伤患者中显示出有希望结果的范例来推动有益的神经塑性变化。此外，我们将使用功能磁共振成像来测量基础 BG 丘脑皮质回路的活动，特别是正常激活不足和额外大脑区域招募的模式，并测量这些模式与训练相关的变化。最后，由于任何有关疾病病理生理学的研究的目标都是改善疾病患者的生活，因此行为和神经心理学测量将与训练前后功能磁共振成像测量的功能异常相关。改善内部产生的运动启动有可能显着改善日常功能，包括减少跌倒、提高语言能力和提高日常自我启动任务（例如打开药瓶或准备饭菜）的熟练程度。努力为帕金森病提供新的、更好的治疗方法对于退伍军人健康管理局的使命至关重要。这项工作的关键贡献在于，我们将提供一种新型辅助疗法来治疗帕金森病的认知症状，该疗法是非侵入性的、无副作用、成本有效且易于实施。