Customized cortical stimulation therapy in the rehabilitation of stroke patients

 描述(申请人提供)：虽然有证据表明中风对侧大脑半球(对侧M1)的运动皮质重组会影响中风后急慢期瘫痪肢体的运动功能，但具体影响的程度和确切事件以及它与运动功能恢复的关系仍有待定义。更好地理解对抗性M1重组对于 未来最佳治疗策略的发展，如非侵入性刺激方案，以改善中风后的功能恢复。本应用的目的是确定影响对侧M1重组的因素，确定对侧M1重组的程度及其在急性和慢性卒中后运动恢复中的作用。在一项对中风患者的纵向研究中，对侧M1重组和刺激将在两个特定目标中进行评估。在第一个具体目标中，我们将确定 使用经颅磁刺激(TMS)、大脑功能和结构MRI以及行为测量的补充技术进行功能和结构对比的M1重组的程度。在第二个具体目标中，将研究对侧M1重组对运动功能恢复的贡献。重复TMS(RTMS)将被用于一过性干扰对侧M1功能，从而确定其对截瘫肢体运动功能的作用。与rTMS相关的运动性能改善将确定对侧M1的支持作用，而运动性能的恶化将表明其不利作用。此外，我们还将探索能够确定对照M1在恢复过程中的作用的生物标记物。在这个项目完成时，我们的期望是 我们将确定对侧M1活动在多大程度上决定卒中后恢复的急性和慢性阶段的运动表现，并根据其在恢复过程中的“状态”(作用)而成为干预的目标。后一项知识预计将对未来中风患者的循证治疗方案的设计产生实质性的积极影响，这将显着改善功能恢复。

 DESCRIPTION (provided by applicant): While there is evidence that reorganization in the motor cortex of the hemisphere contralateral to the stroke (contralesional M1) will impact motor function of the paretic limb in the acute and chronic phase post-stroke, the extent and the precise events that specifically influence it and how it relates to recovery of motor function remain to be defined. A better understanding of contralesional M1 reorganization is critical to the future development of optimal therapeutic strategies such as non-invasive stimulation protocols to improve functional recovery following stroke. The objectives in this application are to define the factors that influence contralesional M1 reorganization, determine the extent of contralesional M1 reorganization and its role in motor recovery in the acute and chronic post-stroke period. In a longitudinal study of stroke patients, contralesional M1 reorganization and stimulation will be assessed in two Specific Aims. In the first Specific Aim, we will determine the extent of functional and structural contralesional M1 reorganization using complementary techniques of transcranial magnetic stimulation (TMS), functional and structural MRI of the brain and behavioral measures. In the second Specific Aim, the contribution of contralesional M1 reorganization to the recovery of motor function will be studied. Repetitive TMS (rTMS) will be used to transiently disrupt contralesional M1 function, thereby determine its role for the motor performance of the paretic limb. RTMS related improvement of motor performance would identify a supportive role of contralesional M1 while deterioration of motor performance would indicate its detrimental role. In addition we will explore biomarkers that can determine the role contralesional M1 in the recovery process. At the completion of this project, it is our expectation that we will have identified the extent to which contralesional M1 activity determines motor performance during the acute and chronic phases of post-stroke recovery and can be targeted by interventions depending on its "state" (role) in the recovery process. This latter knowledge would be expected to have a substantial positive impact on the design of future evidence based treatment protocols for stroke patients that will significantly improve functional recovery.