Customized cortical stimulation therapy in the rehabilitation of stroke patients

 描述（由申请人提供）：虽然有证据表明卒中对侧半球（对侧病灶M1）的运动皮层重组将影响卒中后急性和慢性期麻痹肢体的运动功能，但具体影响其的程度和确切事件以及其与运动功能恢复的关系仍有待确定。更好地理解对侧病变M1重组对于 最佳治疗策略的未来发展，如非侵入性刺激方案，以改善中风后的功能恢复。本申请的目的是确定影响对侧病灶M1重组的因素，确定对侧病灶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。在卒中患者的纵向研究中，将在两个特定目标中评估对侧病灶M1重组和刺激。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以及行为测量的互补技术进行功能和结构对侧病变M1重组的程度。在第二个特定目标中，将研究对侧病灶M1重组对运动功能恢复的贡献。重复TMS（rTMS）将用于短暂破坏对侧病灶M1功能，从而确定其对麻痹肢体运动性能的作用。RTMS相关的运动性能的改善将确定对侧损伤M1的支持作用，而运动性能的恶化将表明其有害作用。此外，我们将探讨生物标志物，可以确定的作用对侧病变M1在恢复过程中。在这个项目的完成，这是我们的期望 我们将确定在中风后恢复的急性和慢性阶段，对侧损伤M1活动决定运动表现的程度，并根据其在恢复过程中的“状态”（作用）进行干预。后者的知识将有望对未来中风患者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.