Effects of Bilateral Motor Priming and Task Specific Training on Corticomotor Excitability and Transcallosal Inhibition in People with Upper Limb Hemiparesis Secondary to Stroke

项目摘要 在过去的20年里，严重和慢性卒中后的上肢康复干预试验 偏瘫在很大程度上没有发现干预之间在功能改善方面的显著差异 和对照组。这导致至少50%的中风幸存者缺乏治疗选择 继续遭受赤字，限制了他们在日常生活活动中的独立性。为了补救这一点 在神经康复领域的不足，有必要了解神经机制 是中风后运动恢复过程的中心环节。然后我们可以开发实验来利用这些 机制，目标是优化治疗效果，促进提高患者的独立性 个人的。 我们的实验室最近发表了一项针对慢性中风和中到重度损害的个人的初步研究 提示双侧运动启动结合任务专项训练是一种有效的治疗方法 可以使严重中风后偏瘫患者受益的治疗方案。然而，神经生理学 积极的行为变化背后的机制尚不清楚。这项拟议的研究将使用 一项正在进行的临床试验的经颅磁刺激(TMS)数据，以调查双侧 运动启动对患侧和对侧皮质运动性兴奋性和跨颧骨抑制的影响 慢性卒中患者的大脑半球(目标1和目标2)，并确定大脑半球变化之间的关系 神经生理和行为测量(目标3)，以更好地了解启动是如何以及为什么有效的。 拟议的工作将为启动的潜在机制提供新的见解，更广泛地说， 阐明卒中后马达恢复的机制。这些结果有可能改善功能 恢复手臂和手，从而改善中风幸存者的生活质量。 这项研究将在以下项目下的神经疾病治疗干预实验室进行 西北大学理疗系丹尼尔·科科斯博士的指导 人类运动科学(PTHMS)NU PTHMS的设施提供了完成这一任务所需的一切 研究成功，包括专家人员、最先进的实验室和必要的设备。 概述的培训计划将包括正式和非正式教育机会、数据培训 处理、分析和支持手稿准备和研究结果的传播。

Project Summary Over the last 20 years, upper limb rehabilitation intervention trials for severe and chronic post stroke hemiparesis have largely failed to find significant differences in functional improvement between intervention and control groups. This has resulted in a dearth of treatment options for at least 50% of stroke survivors who continue to experience deficits which limit their independence in activities of daily living. To remedy this shortcoming in field of neurorehabilitation, it is necessary to understand the neural mechanisms which are central to the motor recovery process following a stroke. We can then develop experiments to exploit these mechanisms with the goal of optimizing treatment efficacy and facilitating increased independence for the individual. Our lab recently published a pilot study on individuals with chronic stroke and moderate to severe impairments in the UL which suggests that bilateral motor priming in combination with task specific training is an effective treatment option that can benefit people with severe post-stroke hemiparesis. However, the neurophysiological mechanisms behind the positive behavioral changes remain unknown. This proposed research will use transcranial magnetic stimulation (TMS) data from an ongoing clinical trial to investigate the impact of bilateral motor priming on corticomotor excitability and transcallosal inhibition of the ipsilesional and contralesional hemispheres in people with chronic stroke (Aims 1 & 2) and determine the relationship between changes in neurophysiological and behavioral measures (Aim 3) to better understand how and why priming is effective. The proposed work will provide new insight into the mechanisms underlying priming and, more broadly, illuminate mechanisms of post stoke motor recovery. These results have the potential to improve functional restoration of the arm and hand thereby improving quality of life for stroke survivors. This research will be conducted in the Therapeutic Interventions for Neurological Disorders laboratory under the direction of Dr. Daniel Corcos at Northwestern University’s (NU) department of Physical Therapy and Human Movement Sciences (PTHMS). The facilities at NU PTHMS provide everything needed to complete this research successfully including expert personnel, state-of-the-art laboratories, and the necessary equipment. The training plan as outlined, will include formal and informal educational opportunities, training in data processing and analysis and support for manuscript preparation and dissemination of findings.