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Translating Intensive Arm Rehabilitation in Stroke to a Telerehabilitation Format

将中风强化手臂康复转化为远程康复形式

基本信息

批准号：
9901446
负责人：
CHRISTOPHER T BEVER
金额：
--
依托单位：
BALTIMORE VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-01 至 2020-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9901446
关键词：
Activities of Daily Living Adult Affect Aging Auditory Behavioral Bilateral Blinded Caring Chronic Chronic Phase Classification Clinic Comorbidity Continuity of Patient Care Coupling Cues Data Collection Devices Dose Feedback Foundations Functional disorder Funding General Population Goals Hand Hand functions Home environment Impairment Improve Access Incidence Individual International Internet Intervention Investigation Laboratories Laboratory Finding Lead Mechanics Methods Modeling Motor Cortex Multiple Sclerosis Neurologic Neurorehabilitation Outcome Outcome Measure Paresis Participant Patients Periodicity Population Protocols documentation Quality of life Randomized Recovery Rehabilitation therapy Residual state Robot Specialist Specificity Stroke System Testing Time Training Translating Translations Traumatic Brain Injury Upper Extremity Veterans Work aging population arm arm function base chronic stroke cost design disability education resources functional improvement functional independence health related quality of life improved intervention cost motor learning patient oriented post stroke primary outcome programs prototype psychosocial public health relevance robot assistance robotic device stroke survivor telerehabilitation treatment as usual two-arm study

项目摘要

DESCRIPTION (provided by applicant): Background: Stroke is the primary cause of adult long-term disability and its incidence is predicted to rise with our aging population. Residual arm deficits persist in 55% or more of stroke survivors six months post onset. The upper extremity (UE) is an important target for rehabilitation as it impacts independence in activities of daily living (ADL) and quality of life. ur investigations utilizing robot-assisted therapy for intense repetition and task specificity have resulted in positive effects on reducing UE impairment in Veterans with moderate to severe deficits ≥ six months post stroke. An expansion of our work suggests that intensive robot- assisted reaching combined with a brief period of task specific (Transition to Task Training (TTT)) leads to greater gains than robot training alone. Current robotic devices are large and expensive to deploy in large numbers. An alternative shown to have positive effect in this population is Bilateral Arm Training with Rhythmic Auditory Cueing (BATRAC). This is a low- cost mechanical device based on similar motor learning features. Unlike the robot, it does not have an assist mode and requires engagement of the less impaired arm to work in concert with the affected arm. This bilateral practice may enhance inter-hemispheric coupling of the damaged motor cortex to promote spatial and temporal interactions of the arms not seen in other forms of repetitive training. Objective: We propose to adapt the lab-based BATRAC training into a home-based model with a telerehabilitation platform. We will add TTT since it appears to be quite powerful in promoting paretic hand use based on the Stroke Impact Scale Hand Section. Our primary objective is to compare the effects of 6 weeks of UE neuro-rehabilitation using Home-based BATRAC telerehabilitation with TTT on arm function in patients with chronic stroke to the usual and customary care provided at this time point. Additional objectives are to determine whether Home-based BATRAC telerehabilitation + TTT will be at least as effective as lab-based and whether patient-centered telerehabilitation has an effect on behavioral-psychosocial outcomes. Methods: Participants with UE deficits ≥ 6 months duration due to stroke will be stratified by impairment and randomly assigned to immediate therapy or delayed-entry therapy. The immediate therapy group will be randomly assigned to one of two study arms: (1) lab-based BATRAC+TTT or (2) a home-based BATRAC telerehabilitation for repetitive, dose-matched reaching+TTT. Similarly, after serving as a usual care control for 6 weeks, the delayed-entry group will be randomized to either study arm 1 or 2. When the delayed entry individuals have completed their interventions, the two groups (1 and 2) will be compared (after 6 week training and after 8 week retention) to the immediate therapy study arms. The primary outcome measure is the WMFT conducted by the blinded assessment team at baseline, week 6, and week 14. All assessments for each group will occur in the clinic setting. Results: Expanding the continuum of stroke care with a home telerehabilitation format has the potential to increase opportunity for intensive UE practice and translation of gains to real world use. When we have completed these aims we expect the results to provide an objective basis for expansion of UE training in neurological populations such as traumatic brain injury, multiple sclerosis as well as design a program that can be disseminated more broadly through the "MyHealtheVet" web system.

描述（由申请人提供）：背景：中风是成人长期残疾的主要原因，预计其发病率会随着人口老龄化而上升。 55% 或更多的中风幸存者在发病后六个月仍存在残余手臂缺陷。上肢（UE）是康复的重要目标，因为它影响日常生活活动（ADL）的独立性和生活质量。我们的研究利用机器人辅助治疗进行高强度重复和任务特异性，对减少中风后 6 个月以上患有中度至重度缺陷的退伍军人的 UE 损伤产生了积极的影响。我们工作的扩展表明，密集的机器人辅助到达与短暂的特定任务（过渡到任务训练（TTT））相结合比单独的机器人训练能带来更大的收益。当前的机器人设备体积庞大，大量部署成本高昂。另一种被证明对该人群具有积极效果的替代方案是带有节奏听觉提示的双侧手臂训练 (BATRAC)。这是一种基于类似运动学习功能的低成本机械设备。与机器人不同的是，它没有辅助模式，需要受损较轻的手臂与受影响的手臂配合工作。这种双边练习可以增强受损运动皮层的半球间耦合，从而促进手臂的空间和时间相互作用，这在其他形式的重复训练中是看不到的。目标：我们建议将基于实验室的 BATRAC 培训改编为具有远程康复平台的家庭模型。我们将添加 TTT，因为根据中风影响量表手部部分，它在促进麻痹性手部使用方面似乎非常强大。我们的主要目标是比较使用家庭 BATRAC 远程康复和 TTT 进行 6 周的 UE 神经康复对慢性中风患者手臂功能的影响与此时提供的常规护理的效果。其他目标是确定基于家庭的 BATRAC 远程康复 + TTT 是否至少与基于实验室的远程康复一样有效，以及以患者为中心的远程康复是否对行为心理社会结果产生影响。方法：因中风导致 UE 缺陷持续时间≥ 6 个月的参与者将按损伤进行分层，并随机分配接受立即治疗或延迟进入治疗。立即治疗组将被随机分配到两个研究组之一：(1) 基于实验室的 BATRAC+TTT 或 (2) 家庭 BATRAC 远程康复，用于重复、剂量匹配的到达 +TTT。同样，在作为常规护理对照 6 周后，延迟进入组将被随机分配到研究组 1 或 2。当延迟进入个体完成干预后，将（6 周训练后和 8 周保留后）将两组（1 和 2）与立即治疗研究组进行比较。主要结局指标是盲法评估团队在基线、第 6 周和第 14 周进行的 WMFT。每组的所有评估都将在临床环境中进行。结果：通过家庭远程康复形式扩大中风护理的连续性有可能增加强化 UE 实践和将成果转化为现实世界使用的机会。当我们完成这些目标时，我们期望结果能够为扩大神经学人群（例如创伤性脑损伤、多发性硬化症）的 UE 培训提供客观基础，并设计一个可以通过“MyHealtheVet”网络系统更广泛传播的计划。