Predicting Ipsilesional Motor Deficits in Stroke with Dynamic Dominance Model

使用动态优势模型预测中风中的同位运动缺陷

• 批准号: 10421097
• 负责人: Robert L Sainburg
• 金额: $ 7.51万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10421097
• 关键词: Activities of Daily Living; Address; Adult; Area; Behavior; Chronic; Control Groups; Data; Effectiveness of Interventions; Ensure; Environment; Exhibits; Frequencies; Grant; Hand; Hand functions; Impairment; Intervention; Intervention Studies; Laboratories; Left; Lesion; Measures; Modeling; Monitor; Motor; Paresis; Participant; Patients; Performance; Practice Guidelines; Process; Protocols documentation; Randomized; Recording of previous events; Rehabilitation therapy; Research; Research Project Grants; Site; Speed; Stroke; Testing; Training; Upper Extremity; Work; arm function; arm paresis; chronic stroke; conventional therapy; design; functional improvement; functional independence; hemisphere damage; improved; intervention effect; kinematics; motor control; motor deficit; motor impairment; recruit; remediation; stroke clinical trials; stroke patient; stroke survivor; therapy design; treatment group; virtual reality

Project Summary: In the previous cycle of this grant, we characterized hemisphere-specific motor control deficits in the non- paretic arm of unilaterally lesioned stroke survivors. Our preliminary data indicate these deficits are substantial and functionally limiting in patients with severe paresis. We have specifically designed an intervention to remediate the hemisphere-specific deficits in the non-paretic arm, using a virtual-reality platform, and then follow this training with manipulation training of a variety of real objects, designed to facilitate generalization and transfer to functional behaviors encountered in the natural environment. We propose a 2-site, two-group randomized intervention with a treatment group, which will receive unilateral training of the non-paretic arm, through our Virtual Reality and Manipulation Training (VRMT) protocol. This intervention protocol is grounded in the premise that targeted remediation of fundamental control deficits exhibited by the non-paretic arm will generalize and transfer beyond practiced tasks to performance of activities of daily living (ADL). This approach contrasts with the more pragmatic approach of task-specific training of essential ADL’s, which is limited in scope, more cumbersome, and ignores known fundamental motor control deficits. Our control group will receive conventional intervention, guided by recently released practice guidelines for upper limb intervention in adult stroke. The impact of the proposed research is that we address persistent functional performance deficits in chronic stroke patients with severe paresis, who’s non- paretic arm impairments are generally ignored in most current rehabilitation protocols. Our first aim addresses the overall effectiveness of this intervention, relative to our control group: To determine whether non-paretic arm VRMT in chronic stroke survivors with severe paresis will produce durable improvements in non-paretic arm motor performance that will generalize to improve functional activities and functional independence to a greater extent than conventional therapy focused on the paretic arm. Our second aim focuses on the mechanistic basis of potential training-related improvements in motor performance: To determine whether intervention-induced improvements in non-paretic arm performance are associated with improvements in hemisphere-specific reaching kinematics. Finally, our third aim monitors for potential negative effects of our experimental intervention on paretic arm impairment. We have already integrated the PI’s laboratories (Sainburg-PSU, Winstein-USC) for our pilot research project that has provided excellent support for aims 1 and 3. !

项目总结： 在这项资助的前一个周期中，我们描述了非大脑半球特有的运动控制缺陷 单侧卒中幸存者的偏瘫手臂。我们的初步数据显示，这些赤字 严重瘫痪患者的实质性和功能性限制。我们专门设计了一个 使用虚拟现实技术对非偏瘫手臂的半球特有缺陷进行干预 平台，然后在此培训之后进行各种真实对象的操作培训，旨在 促进在自然环境中遇到的泛化和向功能性行为的转移。我们 建议两点两组随机干预，其中一个治疗组将接受单侧治疗 通过我们的虚拟现实和操作训练(VRMT)协议，对非瘫痪手臂进行训练。这 干预方案的基础是有针对性地补救根本性控制缺陷 非偏瘫手臂的表现将泛化和转移到实践任务之外的执行 日常生活能力(ADL)。这种方法与更务实的针对特定任务的方法形成对比 基本ADL的培训，范围有限，比较繁琐，忽略了已知的基本知识 运动控制缺陷。我们的对照组将接受常规干预，由最近发布的指导 成人卒中上肢干预实践指南。拟议研究的影响是，我们 解决患有严重瘫痪的慢性中风患者的持续功能表现缺陷，世卫组织非 在目前的康复方案中，偏瘫的手臂损伤通常被忽略。我们的第一个目标是 这项干预的总体有效性，相对于我们的对照组：确定非偏瘫患者 严重瘫痪的慢性卒中幸存者的ARM VRMT将对非瘫痪患者产生持久的改善 手臂电机性能，将一般化，以提高功能活动和功能独立性 比传统疗法更大程度地集中在偏瘫的手臂上。我们的第二个目标是 运动能力潜在训练相关改善的机制基础：确定是否 干预导致的非偏瘫手臂功能的改善与 特定于半球的到达运动学。最后，我们的第三个目标监测我们的 偏瘫患者手臂损伤的实验干预。我们已经整合了PI的实验室 (Sainburg-PSU，Winstein-USC)用于我们的试点研究项目，为AIMS 1提供了极好的支持 和3. 好了！