Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke

治疗期间伴随感觉刺激以增强中风后手部功能恢复

• 批准号: 10677809
• 负责人: Na Jin Seo
• 金额: $ 49.23万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10677809
• 关键词: Accelerometer; Action Research; Activities of Daily Living; Address; Affect; American; Biomechanics; Brachial Paresis; Caregiver Burden; Clinical; Communication; Control Groups; Data; Devices; Digit structure; Dose; Double-Blind Method; Electric Stimulation; Electroencephalography; Esthesia; Esthetics; Evaluation; Feedback; Fingers; Frequencies; Future; Hand; Hand functions; Intervention; Leisures; Lifting; Literature; Location; Lower Extremity; Manipulative Therapies; Manuals; Measures; Mechanoreceptors; Methods; Modality; Motion; Motor; Motor Activity; Motor Cortex; Movement; Neurons; Outcome; Outcome Measure; Paresis; Participant; Patient-Focused Outcomes; Peripheral; Pilot Projects; Quality of life; Randomized; Randomized, Controlled Trials; Recovery of Function; Research; Research Design; Rest; Risk; Self Care; Sensory; Skin; Standardization; Stroke; Testing; Therapeutic; Time; Translations; Treatment Efficacy; United States; Upper Extremity; Vocation; Wrist; arm; chronic stroke; clinical practice; compliance behavior; cost; cost effective; dexterity; disability; finger movement; follow-up; functional independence; grasp; hand dysfunction; hand rehabilitation; improved; innovation; longitudinal analysis; motor impairment; neural; new technology; novel; novel marker; post intervention; post stroke; programs; randomized, controlled study; secondary analysis; smart watch; stroke survivor; translational potential; treatment group; vibration

Project Summary: Post-stroke hand impairment is prevalent, persistent, and difficult to treat, with negative impact on functional ability and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. While promising, most modalities of sensory stimulation interfere with natural hand tasks. Thus they are administered prior to therapy, requiring additional time commitment and hindering patient adherence and implementation. Further, effects diminish after stimulation, weakening its potency during therapy. To address limitations of existing sensory stimulation and fully leverage the therapeutic benefits of sensory stimulation, a novel sensory stimulation `TheraBracelet' has been developed: A wristwatch applies imperceptible vibration during task practice to stimulate the sensorimotor cortex neurons for coherent firing during hand tasks, leading to enhanced neural communication and hand function recovery. The objective of this project is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone in an adequately powered study. The study design is a double-blinded randomized controlled trial. Chronic stroke survivors will undergo a standardized hand task-practice therapy program (3 days/week for 6 weeks) with the TheraBracelet device worn on the paretic wrist. The device will deliver vibration for the treatment group and no vibration for the control group. Double blinding is possible because the treatment vibration is imperceptible. Evaluation will be performed at baseline, 2, 4, and 6 weeks of therapy, and 1 month after. Aim 1: To determine clinical potential of TheraBracelet in improving hand functional recovery. Hypothesis: Improvement of hand motor function will be greater for the treatment than control. Hand function will be assessed using the Wolf Motor Function, Box and Block, and Action Research Arm Tests, along with the quantity/quality of the upper limb use in daily living, abilities for daily activities, and participant feedback. Aim 2: To determine the effects of TheraBracelet on sensorimotor grip control and neural communication. Hypothesis: The treatment will enhance sensorimotor grip control and neural communication for hand grip compared with control. Sensorimotor grip control will be assessed using the well-established biomechanical measure of digit force directional control and efficient scaling of grip force during grip-and-lift. Neural communication for hand grip will be quantified as increase in EEG coherence in the cortical sensorimotor network for grip compared to rest. Secondary analyses will include characterizing the time course of effects and responder analysis. Impact: This research will determine clinical utility and biomarkers of this novel stimulation to guide potential translation. This research is translational as this stimulation is implemented in an aesthetically appealing smartwatch, does not interfere with hand motion, and can be easily integrated in clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life, and reduce caregiver burden.

项目概述：脑卒中后手功能障碍普遍存在，持续存在，治疗困难， 影响功能和独立性。提高治疗效果的一种方法是加强治疗 通过外周感觉刺激。虽然有希望，但大多数感官刺激方式都会干扰 自然的手工作业。因此，它们在治疗前施用，需要额外的时间承诺， 阻碍患者的依从性和实施。此外，刺激后效果会减弱，削弱其作用 在治疗期间的潜力。为了解决现有感官刺激的局限性，并充分利用治疗 感官刺激的好处，一种新的感官刺激'TheraBracelet'已经开发出来：手表 在任务练习过程中，使用不易察觉的振动来刺激感觉运动皮层神经元， 在手部任务中发射，导致增强的神经通信和手部功能恢复。客观 本项目的目的是确定TheraBracelet与手工任务练习相结合是否上级手工任务 在充分把握度的研究中单独练习。研究设计为双盲随机对照 审判慢性中风幸存者将接受标准化的手部任务-实践治疗计划（每周3天， 6周），其中TheraBracelet装置佩戴在麻痹手腕上。该器械将为 对照组不振动。双盲是可能的，因为治疗 振动是察觉不到的。将在基线、治疗2、4和6周以及1个月时进行评价 after.目的1：确定TheraBracelet在改善手功能恢复方面的临床潜力。 假设：治疗组手部运动功能的改善大于对照组。手功能 将使用Wolf运动功能、方块和行动研究手臂测试以及沿着 日常生活中上肢使用的数量/质量、日常活动能力和参与者反馈。 目的2：确定TheraBracelet对感觉运动抓握控制和神经通信的影响。 假设：治疗将加强感觉运动抓握控制和神经通信的手握 与对照相比。将使用成熟的生物力学评估感觉运动抓握控制 手指力量方向控制的措施和有效的抓地力在抓地力和升降机。神经 将手抓握的通信量化为皮层感觉运动中EEG相干性的增加 网络的抓地力相比，休息。次要分析将包括表征效应的时间过程 和响应者分析。影响：这项研究将确定这种新的临床效用和生物标志物 刺激以引导潜在翻译。这项研究是翻译，因为这种刺激是在一个 美观的智能手表，不干扰手部运动，并且可以很容易地集成在临床上， 实践增强手的功能应该大大提高中风幸存者的独立性和生活质量。 生活，减轻照顾者的负担。