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The Role of the Cortex in Discoordination After Stroke

皮质在中风后协调障碍中的作用

基本信息

批准号：
7569034
负责人：
JULIUS P DEWALD
金额：
$ 20.7万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2005
资助国家：
美国
起止时间：
2005-05-20 至 2011-02-28
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Loss of independent control of joint movement in the impaired limb is a cardinal sign of stroke that is expressed in the form of stereotypic multi-joint movement patterns. Work from our laboratory has produced evidence for a loss of certain muscle coactivation patterns and associated abnormal shoulder/elbow torque coupling in the paretic arm of individuals with hemiparetic stroke. The general aim of this proposal is to elucidate the role of sensorimotor cortices in the loss of independent joint control of the paretic upper limb following stroke. We propose to study 20 individuals with chronic stroke and 20 control subjects to identify and quantify the characteristics of sensorimotor cortical activity related to the generation of isometric shoulder abduction/adduction and elbow flexion/extension torques. We hypothesize that an increased overlap of sensorimotor cortical activity is present in individuals with stroke (Aim 1). This aim will be realized using a 6 degree of freedom (DOF) load cell to provide simultaneous measurements of elbow and shoulder torques while measuring EEC from 163 scalp sites and EMG from 10 muscles in each arm. We postulate and have provided preliminary evidence for a significant overlap between cortical activity related to shoulder abduction and elbow flexion torque generation in chronic stroke subjects while not in able-bodied subjects. Subsequently, we plan to elucidate the relationship between the overlap of cortical activity and abnormal shoulder/elbow torque coupling in the paretic arm (Aim 2). We postulate that an increase in the overlap of cortical current activity is a reason for the abnormal torque coupling and serves as a predictor of the severity of discoordination in individuals with stroke. Finally, we propose to investigate the effect of a novel multidegree of freedom isometric training protocol on the overlap of cortical activity in individuals with stroke (Aim 3). Results from our recent work, using this training protocol, have shown a reduction in abnormal torque coupling between shoulder and elbow following an eight week intervention in all stroke subjects (n=7). We postulate and have provided preliminary evidence for a reduction in cortical-activity overlap in concurrence with a training-induced reduction in abnormal torque coupling. In conclusion, the combination of multichannel EEG imaging with a well controlled isometric elbow/shoulder torque generating task in subjects with chronic hemiparetic stroke is unmatched in the current literature. This study will provide new indices in the evaluation and study of discoordination as well as dynamic information on cortical plasticity in individuals with chronic hemiparetic stroke undergoing an upper extremity physical intervention. As such, the proposed study will substantially enhance our understanding of mechanisms driving discoordination in hemiparetic stroke and will provide foundations for further scientific inquiry into the development of more effective therapeutic interventions.

描述（由申请人提供）：受损肢体失去对关节运动的独立控制是中风的主要标志，表现为刻板的多关节运动模式。我们实验室的工作已经提供了证据，证明偏瘫中风患者的瘫臂中某些肌肉协同激活模式的丧失和相关的肩部/肘关节扭矩耦合异常。这项建议的总体目的是阐明感觉运动皮层在中风后失去独立的上肢关节控制中的作用。我们拟对20名慢性中风患者和20名对照者进行研究，以确定和量化与等距肩部外展/内收和肘关节屈伸扭矩产生相关的感觉运动皮质活动特征。我们假设在中风患者中存在感觉运动皮层活动重叠的增加（目的1）。这一目标将通过一个6自由度（DOF）的称重传感器来实现，该传感器可以同时测量肘部和肩部的扭矩，同时测量163个头皮部位的脑电图和每只手臂10块肌肉的肌电图。我们假设并提供了初步证据，证明慢性中风受试者中与肩外展和肘关节屈曲扭矩产生相关的皮质活动之间存在显著重叠，而在健全受试者中则没有。随后，我们计划阐明在麻痹性上臂皮层活动重叠与异常肩/肘扭矩耦合之间的关系（目的2）。我们假设皮质电流活动重叠的增加是异常扭矩耦合的一个原因，并作为中风患者协调失调严重程度的预测因子。最后，我们建议研究一种新的多自由度等距训练方案对脑卒中个体皮层活动重叠的影响（目的3）。我们最近的研究结果显示，在所有中风患者（n=7）进行为期8周的干预后，使用该训练方案的肩部和肘部之间的异常扭矩耦合减少。我们假设并提供了初步证据，证明在训练诱导的异常扭矩耦合减少的同时，大脑皮层活动重叠也减少了。总之，将多通道脑电图成像与控制良好的等距肘/肩扭矩生成任务相结合，在目前的文献中是无与伦比的。本研究将为评估和研究慢性偏瘫性脑卒中上肢肢体干预患者的协调障碍提供新的指标，并为上肢肢体干预患者的皮质可塑性提供动态信息。因此，拟议的研究将大大增强我们对偏瘫性卒中中导致协调失调的机制的理解，并将为进一步科学探索开发更有效的治疗干预措施提供基础。