Novel Strategies to Enhance Motor Function After Stroke

描述(申请人提供)：有运动障碍和日常生活活动(ADL)执行困难的中风患者需要干预，以增强体育训练对运动康复的有益效果。获得复杂的运动技能，如用于执行ADL的技能，关键的第一步是运动训练，运动记忆的形成。老年人形成运动记忆的能力降低，特别是如果他们受到中风的影响。因此，需要新的战略来弥补这一赤字。动作观察(AO)，即观察另一个人进行运动训练，就是这样一种策略，因为它可以增强健康老年人的运动训练效果。然而，动作观察对中风患者运动记忆形成和日常生活能力的影响尚不清楚。在这里，我们建议检验这一假设，即与单独进行运动训练相比，AO将增强运动训练对慢性中风患者的运动记忆形成和ADL的影响。为了实现这一目标，我们将进行3种干预措施的交叉研究：运动训练(MT)，运动训练结合在训练方向上进行的运动的AO(MT-AO)，以及运动训练结合对身体练习的相反方向的训练的观察(MT-AO)。为了确定这些干预措施的效果，我们将测量：a)使用MRI引导的经颅磁刺激(TMS)形成运动记忆的大小；b)使用功能磁共振成像(FMRI)的皮质激活变化；以及c)每次干预后训练后ADL表现的变化。这项研究将阐明中风后提高运动功能的潜在机制和一种新的科学合理的策略的潜在用途。目前还没有普遍接受的治疗方法来提高中风后的训练效果。在这种情况下，行动观察可以演变为一种经济和易于实施的战略，以帮助解决重大的公共卫生负担。

DESCRIPTION (provided by applicant): Stroke patients with motor impairment and difficulties performing activities of daily living (ADL) require interventions to enhance the beneficial effects of physical training on motor rehabilitation. A crucial first step in the acquisition of complex motor skills, such as those used to perform ADL, is motor training, which results in the formation of motor memories. The ability to form motor memories is reduced in older adults, particularly if they are affected by stroke. Therefore, new strategies are required to compensate for this deficit. Action observation (AO), observing another individual perform motor training, is one such strategy since it enhances the effects of motor training in healthy older adults. However, the effects of action observation on motor memory formation and ADL are unknown in stroke patients. Here, we propose to test the hypothesis that AO will enhance the effects of motor training on motor memory formation and ADL in chronic stroke patients compared to motor training alone. To accomplish this we will conduct a cross over study with 3 interventions: motor training (MT), motor training combined with AO of movements performed in the training direction (MT+AO), and motor training combined with observation of training in the opposite direction to the physically practiced (MT-AO). To determine the effects of these interventions we will measure: a) the magnitude of motor memory formation using MRI-guided transcranial magnetic stimulation (TMS); b) cortical activation changes using functional MRI (fMRI); and c) changes in ADL performance after training with each intervention. This investigation will clarify the underlying mechanisms and potential use of a new scientifically sound strategy to enhance motor function after stroke. There is no universally accepted treatment to enhance training effects after stroke. In this setting, action observation could evolve into an economical and easily implemented strategy to help address a significant public health burden.