Home-based mirror therapy for treating hemiparesis in stroke patients

家庭镜像疗法治疗中风患者偏瘫

• 批准号: 8442769
• 负责人: Steven Jax
• 金额: $ 30.21万
• 依托单位: ALBERT EINSTEIN HEALTHCARE NETWORK
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8442769
• 关键词: Address; Affect; Behavioral; Brain; Case Study; Clinical; Controlled Clinical Trials; Data; Dose; Elbow; Enrollment; Equipment; Feedback; Future; Genetic Crossing Over; Goals; Hand; Hemispatial Neglect; Home environment; Illusions; Imagery; Individual; Individual Differences; Insurance Coverage; Lead; Lesion; Limb structure; Literature; Location; Maps; Measures; Medical; Motor; Movement; Outcome; Pain management; Patients; Performance; Placebo Control; Placebos; Process; Production; Proprioception; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation Research; Relative (related person); Reporting; Robotics; Sampling; Selection for Treatments; Sensory; Source; Stroke; Survivors; Symptoms; Testing; Therapeutic; Time; Touch sensation; Training; United States; Upper Extremity; Visual; Wrist; alternative treatment; arm; base; behavior measurement; chronic stroke; clinical decision-making; clinically significant; constraint induced movement therapy; cost; cost effectiveness; effective therapy; experience; follow-up; functional disability; hemiparesis; improved; innovation; relating to nervous system; stem; success; theories

DESCRIPTION (provided by applicant): Each year in the United States 550,000 people develop upper-extremity movement deficits after stroke (hemiparesis). The recent success of mirror therapy (MT) is notable because it is a simple treatment for hemiparesis, and may be feasible for home use. MT uses a standard mirror to create a compelling illusion in which movements of the unimpaired limb appear as if they are being made by the impaired limb. We propose to complete a randomized placebo-controlled clinical trial of MT with a target enrollment of 100 chronic stroke patients. The therapy will consist of a standardized set of hand, wrist, and elbow movements completed in two daily 30-minute sessions, 5 times per week for 4 weeks. Patients assigned to the placebo treatment (identical therapy with an opaque divider rather than a mirror) will be crossed over to receive MT after a three month follow-up. The first goal of the study will be to determine whether a home-based form of MT is an effective treatment of hemiparesis. Providing evidence that mirror therapy could be administered at home would have enormous implications for the cost of treating hemiparesis, especially relative to alternative treatments that require a significant amount of therapist time (constraint-induced movement therapy) or expensive equipment (robotic training). Pilot data suggest that home-based mirror therapy could lead to clinically significant improvements in functioning. The second goal will be to determine the optimal dosing of MT by including weekly measures of improvement. The third goal will be to understand individual differences in the efficacy of mirror therapy. Previous MT studies have not reported, or lacked the power to test, why some patients benefit from MT and others do not, even though significant individual differences have been reported. Our use of a large sample of patients will allow us to assess predictors of therapeutic benefit. Being able to predict beneficial clinical outcomes would be quite innovative because this issue is rarely addressed in rehabilitation research more generally and is crucial to the real world task of treatment selection for individual patients.

描述（由申请人提供）：在美国，每年有55万人在中风后出现上肢运动障碍（偏瘫）。镜像疗法（MT）最近的成功是值得注意的，因为它是一个简单的治疗偏瘫，可能是可行的家庭使用。MT使用一个标准的镜子来制造一种令人信服的幻觉，在这种幻觉中，未受损肢体的运动看起来好像是由受损肢体做出的。我们建议完成一项随机安慰剂对照的MT临床试验，目标纳入100名慢性卒中患者。治疗将包括一套标准化的手、手腕和肘部运动，每天两次，每次30分钟，每周5次，持续4周。分配到安慰剂治疗组的患者（采用不透明隔板而不是镜子的相同治疗）将在三个月的随访后交叉接受MT治疗。该研究的第一个目标将是确定以家庭为基础的MT是否有效治疗偏瘫。提供镜像疗法可以在家中进行的证据将对治疗偏瘫的成本产生巨大的影响，特别是相对于需要大量治疗师时间的替代疗法（约束诱导运动疗法）或昂贵的设备（机器人训练）。试点数据表明，基于家庭的镜像疗法可能导致临床上显著的功能改善。第二个目标是通过包括每周改善措施来确定MT的最佳剂量。第三个目标是了解镜像疗法疗效的个体差异。以前的MT研究没有报道，或者缺乏检验的能力，为什么一些患者受益于MT而另一些患者没有，尽管已经报道了显著的个体差异。我们使用大量患者样本将使我们能够评估治疗益处的预测因素。能够预测有益的临床结果将是相当创新的，因为这个问题很少在康复研究中得到更广泛的解决，对个体患者的治疗选择的现实世界任务至关重要。