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Transcranial Direct Current Stimulation and Robotic Training in Chronic Stroke

慢性中风的经颅直流电刺激和机器人训练

基本信息

批准号：
9024355
负责人：
Dylan James Edwards
金额：
$ 64.29万
依托单位：
WINIFRED MASTERSON BURKE MED RES INST
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-03-01 至 2017-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9024355
关键词：
Affect Area Behavior Behavioral Brain Caring Characteristics Chronic Clinical Clinical Trials Data Elbow Flexor Hemiplegia Human Injury Intervention Investigation Knowledge Lead Left Literature Location Measurement Measures Methods Motor Motor Skills Movement Muscle Nature Neuronal Plasticity Neurorehabilitation Outcome Measure Patients Performance Physical Rehabilitation Physiological Physiology Publishing Randomized Randomized Controlled Clinical Trials Rehabilitation therapy Reporting Residual state Robotics Shoulder Speed Staging Stroke Techniques Testing Therapeutic Time Training Transcranial magnetic stimulation Upper Extremity Upper arm Wolves Work Wrist base behavioral outcome chronic stroke clinical predictors design economic cost functional improvement functional outcomes group intervention group support improved indexing kinematics motor control motor deficit motor disorder motor learning motor recovery nervous system disorder neurophysiology outcome forecast programs rehabilitation strategy response robot therapy robotic training secondary outcome skills training social stroke rehabilitation stroke survivor success tool visual motor

项目摘要

DESCRIPTION (provided by applicant): Motor skill training and transcranial direct current stimulation (tDCS) have separately been shown to alter cortical excitability and enhance motor function in humans. Their combination is appealing for augmenting motor recovery in stroke patients, and this is an area presently under heavy investigation globally. We had previously proposed that the success of transcranial direct current stimulation (tDCS) as a complementary therapeutic tool in physical neurorehabilitation may be contingent upon a more precise knowledge of the circumstances under which the two techniques interact, and the subsequent behavioral outcome. To test this we applied tDCS with conventional parameters (polarity, location, intensity and duration), but manipulated the timing of application in relation to a simple robotic motor practice task, in affected muscles of hemiplegic patients. We showed a profound effect of timing. We showed that performance improvement over one session of practice was differentially affected by tDCS depending on the timing of application. 20 mins of robotic visuomotor training only, led to a preferential increase in movement speed without a loss of accuracy. tDCS applied at any of the timings obliterated this effect, yet when tDCS was applied before training, the effect was substituted for an improvement in smoothness. Movement smoothness is associated with more advanced stages of motor learning and has high correlation with functional clinical scales. We showed for the first time that the timing of tDCS application has functional significance, that tDCS applied prior to training can be beneficial for voluntary behavior, and that tDCS effects may not simply be additive to training effects, but may change the nature of the training effect. We have separately reported in a randomized-controlled clinical trial, that upperlimb robotic training alone over 12 weeks can improve clinical function of chronic stroke patients. Based on our results with tDCS and robotic training, we hypothesize that the same repeated sessions of robotic training, but preceded by tDCS, would lead to a sustained and functional change greater than robotic training alone. In the proposed training study, 66 stable chronic stroke patients will be randomized to receive sham or real tDCS prior to robotic upperlimb training, and will be assessed at 3 levels of change: (i) clinical, (ii) kinematic, and (iii) neurophysiologic. We will determine if clinical function can be improved and sustained with tDCS-robotic training, the precise kinematic aspects of movement, and cortical physiology changes that underlie functional improvements.

描述(由申请人提供)：运动技能训练和经颅直流电刺激(Tdcs)分别被证明可以改变人类的皮质兴奋性和增强运动功能。它们的结合是为了促进中风患者的运动恢复，这是目前全球正在大力研究的一个领域。我们先前提出，经颅直流电刺激(TDC)作为物理神经康复的补充治疗工具的成功可能取决于对这两种技术相互作用的环境以及随后的行为结果的更准确的了解。为了测试这一点，我们在偏瘫患者的受影响肌肉中应用了具有常规参数(极性、位置、强度和持续时间)的tDCS，但操纵了与简单的机器人运动练习任务相关的应用时间。我们表现出了对时机的深刻影响。我们发现，根据应用时间的不同，tdcs对一次练习的性能改善有不同的影响。只进行20分钟的机器人视觉运动训练，在不损失精确度的情况下优先提高运动速度。在任何时间点应用tdcs都会消除这种影响，但当tdcs在训练前应用时，这种效果会取代平顺性的改善。动作流畅性与运动学习的高级阶段有关，与功能性临床评分高度相关。本研究首次证明了tdcs应用的时机具有功能意义，tdcs在训练前应用对自愿行为是有益的，tdcs效应可能不是简单地增加训练效果，而是可能改变训练效果的性质。我们已经分别在一项随机对照临床试验中报道，仅上肢机器人训练超过12周就可以改善慢性中风患者的临床功能。根据我们对tDCS和机器人培训的结果，我们假设，相同的重复机器人培训课程，但在tDCS之前，将导致持续的和功能上的变化，比单独的机器人培训更大。在拟议的训练研究中，66名稳定的慢性中风患者将在机器人上肢训练之前随机接受假的或真实的tDC，并将在3个水平上进行评估：(I)临床、(Ii)运动学和(Iii)神经生理学。我们将确定是否可以通过tdcs-机器人训练、运动的精确运动学方面以及作为功能改善基础的皮质生理学变化来改善和维持临床功能。

项目成果

期刊论文数量（23）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Robotic Kinematic measures of the arm in chronic Stroke: part 1 - Motor Recovery patterns from tDCS preceding intensive training.

慢性中风手臂的机器人运动学测量：第 1 部分 - 强化训练前 tDCS 的运动恢复模式。

DOI：
10.1186/s42234-021-00081-9
发表时间：
2021-12-29
期刊：
Bioelectronic medicine
影响因子：
0
作者：
Moretti CB;Edwards DJ;Hamilton T;Cortes M;Peltz AR;Chang JL;Delbem ACB;Volpe BT;Krebs HI
通讯作者：
Krebs HI

Polarity-Dependent Misperception of Subjective Visual Vertical during and after Transcranial Direct Current Stimulation (tDCS).

经颅直流电刺激 (tDCS) 期间和之后主观视觉垂直的极性依赖性误解。

DOI：
10.1371/journal.pone.0152331
发表时间：
2016
期刊：
PloS one
影响因子：
3.7
作者：
Santos-Pontelli,TaizaEG;Rimoli,BrunnaP;Favoretto,DiandraB;Mazin,SuleimyC;Truong,DennisQ;Leite,JoaoP;Pontes-Neto,OctavioM;Babyar,SuzanneR;Reding,Michael;Bikson,Marom;Edwards,DylanJ
通讯作者：
Edwards,DylanJ

Multivariable dynamic ankle mechanical impedance with active muscles.

DOI：
10.1109/tnsre.2014.2328235
发表时间：
2014-09
期刊：
IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society
影响因子：
0
作者：
Lee H;Krebs HI;Hogan N
通讯作者：
Hogan N

Robotic measurement of arm movements after stroke establishes biomarkers of motor recovery.

DOI：
10.1161/strokeaha.113.002296
发表时间：
2014-01
期刊：
Stroke
影响因子：
8.3
作者：
Krebs HI;Krams M;Agrafiotis DK;DiBernardo A;Chavez JC;Littman GS;Yang E;Byttebier G;Dipietro L;Rykman A;McArthur K;Hajjar K;Lees KR;Volpe BT
通讯作者：
Volpe BT

Robotic Therapy and the Paradox of the Diminishing Number of Degrees of Freedom.

机器人治疗和自由度递减的悖论。