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。尽管常规疗法，大多数中风幸存者都有持续的手部功能障碍。这项拟议的研究将进一步了解我们对手部功能恢复机制的理解，并为临床实践中势头后的康复方案提供科学基础。运动恢复是通过运动学习进行的，这取决于至少三个过程：适应，重复和增强。适应性是根据行动的预期后果预测力和运动的能力，对运动技能学习至关重要。当通过重复加强改编运动时，学习就会增强。我们已经表明，指尖力和动作的适应在中风后被破坏。但是，我们发现来自未受影响的手的上下文特定的感官信息可以恢复受影响的手的适应性。这些结果表明，“好”手可以教授控制控制的“坏”手基本方面。我们还发现，抗重力姿势肌肉的活性增加与手指运动效率提高有关。基于这些结果，我们假设通过姿势肌肉激活增强的替代手动练习策略将提高运动率后的运动率并增强中风后手功能的恢复。该策略将利用大脑两侧之间的冗余连通性，以促进技能学习过程中的感觉运动积分。在AIM 1中，我们将完善替代手动练习策略，以恢复受影响的手的适应。实验将使对动力学，触觉和视觉感官方式在适应过程中如何相互作用，从而更好地理解鉴于中风后现有的感觉运动障碍。在AIM 2中，我们将描述提高掌握效率并减少异常方向偏见的姿势策略，以促进在练习过程中重复更有效的运动。在AIM 3中，我们将使用“增强的替代手训练范式”来检查会议内部和会议之间的运动学习和手动功能的改进率，并使用新型的任务面板和结构化的培训协议将其与单独使用受影响的手训练进行比较。我们将使用指尖力量，手指运动学，3-D ARM和躯干运动学以及在功能触及到抓紧和提升任务期间双侧上肢肌肉活动的肌电图记录以及双侧上肢肌肉活动的定量心理物理测量测量。 我们希望确定直接影响功能的障碍，提供有关如何执行任务的客观信息，并为治疗策略提供信息，并给予治疗剂量以增强重新学习。该项目将促进我们对如何利用冗余电路的理解，以将感官输入与电动机输出集成以进行重新学习，并为选择内容和实践结构提供科学基础。获得的知识将为恢复手功能的最佳实践康复方案提供信息，这将损害中风和其他神经系统状况后的个人生活质量。