Modulating brain plasticity in rehabilitation of stroke and other brain lesions

调节中风和其他脑损伤康复中的大脑可塑性

• 批准号: 10017632
• 负责人: Leonardo Gregorio Cohen
• 金额: $ 112.7万
• 依托单位: NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10017632
• 关键词: Adult; Brain; Clinical; Collaborations; Computer software; Custom; Data; Devices; Disease; Electroencephalography; Goals; Hand; Individual; International; Investigation; Knowledge; Laboratories; Lesion; Link; Long-Term Effects; Motor; Neurorehabilitation; Paralysed; Paresis; Patients; Pattern; Pharmacology; Physical therapy; Process; Randomized; Recovery of Function; Rehabilitation therapy; Reporting; Schedule; Stroke; Techniques; Therapeutic Intervention; Time; Training; Traumatic Brain Injury; Work; base; brain computer interface; chronic stroke; cost; disability; exoskeleton; experimental study; follow-up; functional gain; improved; loss of function; motor deficit; novel; novel therapeutic intervention; placebo group; randomized trial; response; skills; social; somatosensory; stroke patient; stroke rehabilitation; tool

Background: Disability resulting from stroke and traumatic brain injury represent the main causes of long-term complications in adults. There are no universally accepted treatments available to treat these conditions and the financial, personal, familial and social cost of these disabilities cannot be underestimated. Preliminary data from different laboratories have shown that it is possible to modulate plastic processes in the lesioned brain via pharmacological, or brain and somatosensory stimulation techniques. The purpose of this project is to identify mechanisms of stroke motor disability and characterize the most promising techniques to improve cortical plasticity in these patients to enhance functional recovery. Findings this year: Over the past year, we continued a successful international collaboration investigation the use of brain-computer interfaces (BCIs) as novel tools for therapeutic intervention following stroke. The work involved a randomized trial evaluating the long-term effects (up to 6 months) of combined physical therapy and BCI training on functional recovery of severe motor deficits in chronic stroke patients. At the outset of the trial, patients participated in approximately 18 therapy sessions on average, over an 8-week period. Patients were randomly assigned to one of two groups. The first group trained to modulate specific patterns of brain activity called EEG sensorimotor rhythms, which are known to be linked to motor function in healthy individuals. A custom software application was used to analyze the EEG data in real-time. Detected increases in the EEG sensorimotor rhythm were linked to opening of the paralyzed hand via an exoskeleton device, while decreases caused closing of the hand. For a second group of patients, there was no contingency between EEG sensorimotor rhythm modulation and action of the exoskeleton. The paralyzed hand was manipulated by the exoskeleton on a randomized schedule. Greater functional gains, as assessed with the Fugyl Meyer clinical rating scale, were observed in the group receiving contingent BCI training. A total of 30 patients returned at 6 months for a follow-up Fugyl-Meyer assessment. At 6 months, the group receiving real BCI training maintained significantly greater functional gains compared with the sham group. In summary, this work was an important first demonstration that BCI-based rehabilitation promotes long-lasting improvements in motor function of chronic stroke patients, even with severe paresis, and represents a promising strategy in severe stroke neurorehabilitation.

背景： 中风和创伤性脑损伤导致的残疾是成人长期并发症的主要原因。目前还没有普遍接受的治疗方法来治疗这些疾病，并且这些残疾造成的经济、个人、家庭和社会成本不可低估。来自不同实验室的初步数据表明，可以通过药理学或大脑和体感刺激技术来调节受损大脑的塑性过程。该项目的目的是确定中风运动障碍的机制，并描述最有前途的技术来改善这些患者的皮质可塑性，以促进功能恢复。 今年的调查结果： 在过去的一年里，我们继续进行了一项成功的国际合作研究，利用脑机接口（BCIs）作为中风后治疗干预的新工具。这项工作涉及一项随机试验，评估联合物理治疗和 BCI 训练对慢性中风患者严重运动缺陷功能恢复的长期影响（长达 6 个月）。 试验开始时，患者在 8 周的时间里平均参加了大约 18 次治疗。 患者被随机分配到两组中的一组。 第一组接受训练来调节称为脑电图感觉运动节律的特定大脑活动模式，众所周知，这与健康个体的运动功能有关。 使用定制软件应用程序实时分析脑电图数据。 检测到的脑电图感觉运动节律的增加与通过外骨骼装置张开瘫痪的手有关，而减少则导致手的闭合。 对于第二组患者，脑电图感觉运动节律调节和外骨骼动作之间不存在偶然性。外骨骼按照随机的时间表操纵瘫痪的手。 根据 Fugyl Meyer 临床评定量表的评估，在接受临时 BCI 训练的组中观察到了更大的功能增益。 共有 30 名患者在 6 个月后返回进行后续 Fugyl-Meyer 评估。 6 个月时，与假手术组相比，接受真正 BCI 训练的组保持了显着更大的功能增益。 总之，这项工作是一个重要的首次证明，基于 BCI 的康复可以促进慢性中风患者运动功能的持久改善，即使患有严重的瘫痪，并且代表了严重中风神经康复的一种有前途的策略。