Strategies for recovery of dexterity post stroke

中风后恢复灵活性的策略

• 批准号: 8704287
• 负责人: PREETI RAGHAVAN
• 金额: $ 67.07万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8704287
• 关键词: 3-Dimensional; Adult; Affect; Age; Back; Bilateral; Brain; Clinical; Data; Development; Devices; Dose; Educational process of instructing; Factor Analysis; Feedback; Fingers; Force of Gravity; Functional disorder; Hand; Hand functions; Impairment; Individual; Knowledge; Lead; Learning; Lifting; Measurement; Measures; Modality; Motor; Motor output; Movement; Muscle; Neurologic; Neurological rehabilitation; Patients; Posture; Process; Protocols documentation; Psychological reinforcement; Psychophysics; Public Health; Quality of life; Recovery; Rehabilitation therapy; Research; Savings; Sensory; Shapes; Side; Skeletal Muscle; Staging; Stroke; Structure; Survivors; Tactile; Testing; Texture; Time; Training; Upper Extremity; Visual; Weight; arm; base; conventional therapy; disability; grasp; improved; instrument; kinematics; motor learning; motor skill learning; novel; object shape; post stroke; public health relevance; research study; response; restoration; restraint; sensory integration; skills; stroke rehabilitation; trapezius muscle; treatment strategy

DESCRIPTION (provided by applicant): Stroke is the leading cause of adult disability. Despite conventional therapy, a majority of stroke survivors have persistent hand dysfunction. This proposed research will further our understanding of mechanisms of recovery of hand function and provide a scientific basis for post-stroke rehabilitation protocols in clinical practie. Motor recovery occurs through motor learning, which depends on at least three processes: adaptation, repetition and reinforcement. Adaptation is the ability to predict forces and movements according to the expected consequences of an action, and is fundamental to motor skill learning. When adapted movements are reinforced through repetition, learning is enhanced. We have shown that adaptation of fingertip forces and movements is disrupted after stroke. However, we found that context-specific sensory information from the unaffected hand can restore adaptation in the affected hand. These results suggest that the 'good' hand can teach the 'bad' hand fundamental aspects of grasp control. We also found that increased activity in anti-gravity postural muscles is associated with increased efficiency of finger movements. Based on these results we hypothesize that an alternate hand practice strategy, enhanced with postural muscle activation, will improve the rate of motor re-learning and enhance recovery of hand function post stroke. This strategy will tap into redundant connectivity between the two sides of the brain to facilitate sensorimotor integration during skill learning. In Aim 1, we will refine the alternate hand practice strategy to restore adaptation in the affected hand. The experiments will lead to a better understanding of how kinesthetic, tactile and visual sensory modalities interact during adaptation, given existing sensorimotor impairments after stroke. In Aim 2, we will delineate postural strategies that improve grasp efficiency and reduce abnormal directional biases to facilitate repetition of more efficient movements during practice. In Aim 3, we will examine the rate of within-session and between- session motor learning and improvement in hand function with the 'enhanced alternate hand training paradigm', and compare this to training with the affected hand alone, using a novel task panel and structured training protocols. We will test our Aims using quantitative psychophysical measurements of fingertip forces, finger kinematics, 3-D arm and trunk kinematics, and electromyographic recordings of bilateral upper limb muscle activity during functional reach-to-grasp and lift tasks. We expect to identify impairments that directly affect function, provide objective information about how a task is performed, and inform treatment strategies and dosing of therapy for enhanced re-learning. This project will advance our understanding of how redundant circuitry can be harnessed for integration of sensory input with motor output for re-learning, and provide a scientific basis for the selection of content and structure of practice. The knowledge obtained will inform best- practice rehabilitation protocols for recovery of hand function, which will impac the quality of life of individuals after stroke and other neurological conditions.

描述（由申请人提供）：中风是成人残疾的主要原因。尽管接受常规治疗，大多数中风幸存者仍存在持续的手部功能障碍。这项研究将进一步加深我们对手功能恢复机制的理解，并为临床实践中的中风后康复方案提供科学依据。运动恢复是通过运动学习来实现的，运动学习至少取决于三个过程：适应、重复和强化。适应是根据行动的预期结果预测力量和运动的能力，是运动技能学习的基础。当通过重复强化适应的动作时，学习就会得到加强。我们已经证明，中风后指尖力量和运动的适应会受到干扰。然而，我们发现来自未受影响的手的特定环境的感觉信息可以恢复受影响手的适应能力。这些结果表明，“好”手可以教会“坏”手掌握控制的基本方面。我们还发现，反重力姿势肌活动的增加与手指运动效率的提高有关。基于这些结果，我们假设通过姿势肌肉激活增强的替代手部练习策略将提高运动重新学习的速度并增强中风后手部功能的恢复。该策略将利用大脑两侧之间的冗余连接，以促进技能学习期间的感觉运动整合。在目标 1 中，我们将完善交替手练习策略，以恢复受影响手的适应能力。鉴于中风后现有的感觉运动障碍，这些实验将有助于更好地理解动觉、触觉和视觉感觉方式在适应过程中如何相互作用。在目标 2 中，我们将描述提高抓握效率并减少异常方向偏差的姿势策略，以促进在练习过程中重复更有效的动作。在目标 3 中，我们将使用“增强型交替手部训练范例”检查训练内和训练间运动学习的速度以及手部功能的改善，并将其与使用新颖的任务面板和结构化训练方案单独使用受影响的手进行的训练进行比较。我们将使用指尖力、手指运动学、3D 手臂和躯干运动学的定量心理物理测量，以及功能性抓握和举起任务期间双侧上肢肌肉活动的肌电图记录来测试我们的目标。 我们期望识别直接影响功能的损伤，提供有关如何执行任务的客观信息，并告知治疗策略和治疗剂量以增强再学习。该项目将加深我们对如何利用冗余电路将感觉输入与运动输出集成以进行再学习的理解，并为练习内容和结构的选择提供科学依据。获得的知识将为手部功能恢复的最佳实践康复方案提供信息，这将影响中风和其他神经系统疾病后个体的生活质量。