Novel Strategies to Enhance Motor Function After Stroke

增强中风后运动功能的新策略

• 批准号: 9145249
• 负责人: Pablo Ariel Celnik
• 金额: $ 43.86万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-27 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9145249
• 关键词: Adult; Age; Age-Months; Algorithms; Animal Model; Animals; Behavior; Biological; Biological Assay; Brain; Cerebellum; Dependence; Development; Educational process of instructing; Exercise; Financial compensation; Fostering; Future; Goals; Health; Human; Impairment; Intervention; Learning; Left; Leg; Measurable; Measures; Methods; Molecular Conformation; Motor; Motor Skills; Movement; Neurorehabilitation; Patient Education; Patients; Physiological; Process; Recovery; Regimen; Rehabilitation therapy; Residual state; Rotation; Side; Speed; Stroke; Testing; Time; Training; Visual; Work; arm; base; disability; gamma-Aminobutyric Acid; hemiparesis; innovation; kinematics; motor control; motor impairment; motor learning; motor recovery; novel; novel strategies; post stroke; repaired; stroke recovery; treatment strategy; visual motor

 DESCRIPTION (provided by applicant): Hemiparesis (loss of motor control and strength in the arm and leg on one side of the body) is the most common problem after stroke, the leading cause of adult disability. Most recovery of strength and control occurs in the first 3 months post stroke. Subsequent recovery is mainly the result of learning to compensate with residual capacities. Animal models suggest that the early recovery occurs as the result of interactions between up-regulated repair processes around the region of the stroke (heightened plasticity) and training regimens. There has been very little study of the early period of stroke recovery in humans. In this proposal we will use two principal approaches to determine what distinguishes the state of the brain in the first 3 months after stroke compared to the next 6 months. The first approach uses non-invasive brain stimulation methods to test the hypothesis that the human brain has heightened excitability and plasticity in the first 3 months after stroke compared both to later after stroke and to age-matched controls. The second approach tests the hypothesis that patients are more responsive to motor training in the first 3 months after stroke compared to subsequent months. That is to say, patients early after stroke may be particularly good learners. Conformation of our two hypotheses about a time window of heightened plasticity and increased responsiveness to training will have important implications for future innovations in neuro-rehabilitation. First, if it is possible to detect the state of heightened plasticity in any given atient then it could be used to devise an algorithm for how to plan rehabilitation. For example, if heightened plasticity were still present then rehabilitation of impairment would be emphasized rather than teaching compensatory strategies that rely on spared capacities. If plasticity were seen to have returned to normal levels then compensation would be emphasized. Second, having assays of heightened plasticity will allow assessment of pharmacological and other approaches that attempt to prolong, augment or re-open this critical time window of recovery.

 描述（由申请人提供）：偏瘫（身体一侧手臂和腿部失去运动控制和力量）是中风后最常见的问题，是成人残疾的主要原因。力量和控制力的大部分恢复发生在中风后的前 3 个月内。随后的恢复主要是学习用剩余能力进行补偿的结果。动物模型表明，早期恢复是中风区域周围修复过程上调（可塑性增强）和训练方案之间相互作用的结果。对人类中风恢复早期的研究很少。在本提案中，我们将使用两种主要方法来确定中风后前 3 个月与接下来 6 个月大脑状态的区别。第一种方法使用非侵入性脑刺激方法来检验这样的假设：与中风后的后期和年龄匹配的对照组相比，人脑在中风后的前 3 个月内具有更高的兴奋性和可塑性。第二种方法检验了这样的假设：与随后的几个月相比，患者在中风后的前 3 个月对运动训练的反应更敏感。也就是说，中风后早期的患者可能是特别好的学习者。我们关于增强可塑性和增强训练反应性的时间窗口的两个假设的验证将对神经康复领域的未来创新产生重要影响。首先，如果可以检测任何给定个体的可塑性增强状态，那么它可以用于设计一种如何规划康复的算法。例如，如果高度可塑性仍然存在，那么将强调损伤的康复，而不是教授依赖于备用能力的补偿策略。如果可塑性恢复到正常水平，那么补偿就会受到重视。其次，对增强的可塑性进行分析将允许评估试图延长、增强或重新打开这一关键恢复时间窗口的药理学和其他方法。