CUped: An Approach to Motor Recovery Post-Stroke, not Compensation

项目摘要 脑卒中后下肢康复的目标是恢复在家中和家中的独立行走。 社区很少有中风幸存者能达到这个目标。次优结局是由于严重和 中风引起的运动障碍的顽固性和缺乏可行有效的 恢复因中风而失去的运动的疗法。 我们的团队开发了一种新颖的运动干预，称为Cuped（发音为丘比特，像罗马神） 以解决中风后恢复障碍和改善行走。Cuped之所以被称为Cuped，是因为它强制使用 在类似于踩踏板的运动中麻痹的肢体。该项目将检查安全性，可接受性， 和耐受性，表征其治疗效果，并确定剂量-反应关系。结果 将为R 01提供初步数据，以支持随机对照试验（RCT）。 CUped旨在帮助中风幸存者恢复因中风而失去的下肢运动，从而改善 走路其预期用作步态训练的辅助工具。Cuped使用机器人技术， 消除干扰恢复的代偿性运动，强迫使用麻痹下肢， 针对中风引起的3种主要运动障碍：麻痹肢体的肌肉输出减少， 不适当的麻痹肌肉时机和异常的肢体间协调。运动是坐着进行的， 可以进行高重复练习。像走路一样，CUped需要两个下肢的持续、相互使用; 影响可能会转移到步行上。 该提案的风险回报概况非常适合R21，这是NIH的资助机会，旨在 通过为早期和概念阶段提供支持，鼓励探索性/发展性研究 项目开发。CUped是一种基于生理前提和基于先前的新疗法 我们实验室的观察。我们有试验数据表明CUped符合其设计规范， 这项研究将是第一个测试其治疗效果的研究。在第一阶段康复试验中，我们将支持或 迅速反驳了CUPed是安全的、可接受的、能够引起治疗反应的假设， 中风幸存者我们还将检查对CUped的耐受性和剂量反应效应。如果我们的假设 支持，我们将准备运行一个随机对照试验，以隔离CUped的影响，并将其与标准品进行比较。 在乎未来的工作将调查生理机制的影响，CUped。

Project Summary The goal of lower limb rehabilitation after stroke is recovery of independent walking at home and in the community. Few stroke survivors achieve this goal. Suboptimal outcomes are due to the serious and intransigent nature of movement impairments caused by stroke and the scarcity of feasible and effective therapies that restore movement lost to stroke. Our team has developed a novel exercise intervention called CUped (pronounced cupid, like the Roman god) to address barriers to recovery and improve walking after stroke. CUped is so called because it compels use of the paretic limb during a movement that resembles pedaling. This project will examine safety, acceptability, and tolerance to CUped, characterize its therapeutic effects, and identify dose-response relationships. Results will provide preliminary data for an R01 to support a randomized controlled trial (RCT). CUped is designed to help stroke survivors recover lower limb movement lost to stroke, thereby improving walking. It is intended to be used as an adjunct to gait training. CUped uses a robotic technology that eliminates compensatory movements that interfere with recovery, compels use of the paretic lower limb, and targets 3 key movement impairments caused by stroke: decreased muscle output from the paretic limb, inappropriate paretic muscle timing, and abnormal interlimb coordination. Exercise is done in sitting which enables high repetition practice. Like walking, CUped requires continuous, reciprocal use of both lower limbs; effects are likely to transfer to walking. The risk-reward profile of this proposal is ideal for an R21, which is an NIH funding opportunity intended to encourage exploratory/developmental research by providing support for the early and conceptual stages of project development. CUped is a novel therapy grounded in a physiologic premise and based on prior observations from our laboratory. We have pilot data suggesting that CUped fulfills its design specifications, and this study will be the first to test its therapeutic effects. In this Stage 1 rehabilitation trial, we will support or quickly refute the hypothesis that CUped is safe, acceptable, and capable of eliciting a therapeutic response in stroke survivors. We will also examine tolerance to CUped and dose-response effects. If our hypotheses are supported, we will be poised to run an RCT to isolate the effects of CUped and compare them to standard care. Future work will investigate physiologic mechanisms underlying the effects of CUped.