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

双侧运动启动和任务特定训练对中风继发上肢偏瘫患者皮质运动兴奋性和胼胝体抑制的影响

• 批准号: 10607582
• 负责人: Erin King
• 金额: $ 4.3万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-15 至 2024-12-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10607582
• 关键词: Activities of Daily Living; Address; Aerobic Exercise; Area; Back; Behavioral; Bilateral; Brain; Chronic; Clinical Trials; Control Groups; Data; Data Analyses; Data Collection; Dose; Educational Intervention; Equipment; Frequencies; Funding; Goals; Hand; Hand functions; Hour; Human; Human Resources; Impairment; Individual; Intervention; Intervention Trial; Ipsilateral; Kinesiology; Laboratories; Learning; Manuscripts; Measures; Methods; Motor; Movement; Nervous System; Neurologic; Neuronal Plasticity; Outcome; Participant; Persons; Physical therapy; Pilot Projects; Preparation; Prevalence; Process; Publishing; Quality of life; Randomized; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Research; Rest; Robotics; Secondary to; Stroke; Structure; Techniques; Testing; Therapeutic; Therapeutic Intervention; Time; Training; Training Programs; Transcranial magnetic stimulation; Treatment Efficacy; Universities; Upper Extremity; Work; Wrist; acute stroke; arm; arm function; behavior measurement; behavioral outcome; chronic stroke; computerized data processing; constraint induced movement therapy; design; disability; effective therapy; experience; experimental group; experimental study; follow-up; functional improvement; functional restoration; hemiparesis; improved; informal learning; insight; knowledge base; motor function improvement; motor recovery; nervous system disorder; neurological rehabilitation; neuromechanism; neurophysiology; noninvasive brain stimulation; post intervention; post stroke; recruit; stroke hemiparesis; stroke rehabilitation; stroke survivor; treatment arm; treatment effect; treatment optimization; upper limb hemiparesis

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.

项目摘要 在过去的20年里，重度和慢性卒中后上肢康复干预试验 轻偏瘫在很大程度上没有发现干预之间功能改善的显著差异 与对照组这导致至少50%的中风幸存者缺乏治疗选择， 残疾人继续面临缺陷，限制了他们在日常生活活动中的独立性。纠正这种 在神经康复领域的缺点，有必要了解神经机制， 中风后运动恢复过程的中心。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，并促进提高独立性， 单独的. 我们的实验室最近发表了一项针对慢性中风和中度至重度损伤患者的初步研究 在UL中，这表明双侧运动启动结合特定任务训练是一种有效的方法 治疗选择，可以受益于严重中风后偏瘫的人。然而，神经生理学 积极行为变化背后的机制仍然未知。这项研究将使用 来自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 运动启动对同侧和对侧皮质运动兴奋性和胼胝体抑制的影响 慢性中风患者大脑半球的变化（目的1和2），并确定 神经生理学和行为测量（目标3），以更好地了解如何以及为什么启动是有效的。 这项工作将为启动机制提供新的见解，更广泛地说， 斯托克后运动恢复照明机制。这些结果有可能改善功能性 恢复手臂和手，从而改善中风幸存者的生活质量。 这项研究将在神经疾病治疗干预实验室进行， 西北大学物理治疗系的丹尼尔·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目标所需的一切。 研究成功，包括专家人员，国家的最先进的实验室，和必要的设备。 概述的培训计划将包括正式和非正式的教育机会，数据培训， 处理和分析，并支持手稿编写和传播调查结果。