Evaluation of brain recovery of stroke patients using a novel magnetic resonance compatible hand induced robotic device combined with magnetic resonance imaging

这项研究的广泛和长期目标是提高治疗效果，从而 卒中患者的生活质量。越来越多的人患有 卒中。直到最近，中风导致的残疾还被认为是不可逆转的。 中风恢复是一个新兴领域，仍然克服了长期以来关于中风功能丧失的观点 中风是不可恢复的。 我们假设(A)通过运动刺激大脑恢复的机器人设备 训练可以帮助恢复因中风而受损的运动能力 以及(B)中风后的神经变化可能是 由体内最先进的磁共振监测(因此后来预测) 通过脑恢复生物标记物和行为运动表现的改善进行成像(MRI)。 为了验证这一假设，我们建议对我们的新型手持设备进行纵向研究 3个靶点联合3-T脑部MRI监测慢性卒中患者康复情况 目标(1)是利用新开发的相控阵线圈和并行技术进行最先进的磁共振成像 成像(以最大限度地提高灵敏度和分辨率)，以记录可量化的大脑变化 100例确诊为大脑中动脉病变的慢性卒中患者的训练 范围缺血性卒中和影响运动带的缺血性损害。病人将被分配到 随机分为训练组和非训练组。参赛者每天训练30分钟， 3天/周，在家里进行，以便于参与。体积磁共振、功能磁共振 (FMRI)和弥散张量成像(DTI)将在开始之前进行 治疗(基线)，然后在为期3个月的训练期内每月进行一次。核磁共振测量 将集中在运动皮质及其周围的皮质区域和连接束。目标(2) 就是用标准的临床评估这些慢性中风患者的运动能力 指数和手持设备测量。目的(3)是为了证明大脑图谱 基于最先进的磁共振成像结合手持设备辅助治疗可以 为慢性中风的康复提供新的生物标记物，同时改善临床结果。我们会 对结构、fMRI、DTI和马达性能数据进行荟萃分析 通用线性混合模型(GLMM)方法，它处理异质数据和 尽管个体间存在差异，但有助于推断有用的结果。 影响：成功将促进患者的选择和个性化治疗计划 根据MRI指标进行了优化，以产生改进。具体来说，这项研究可能 确定可在治疗期间监测的脑恢复生物标志物，为治疗提供信息 调整，并提高我们预测中风恢复结果的能力。对于慢性中风 患者，我们预计会证明康复的时间比 之前认为，包括运动技能提高超过6个月。中风后 事件，由于大脑的可塑性和功能适应能力 重组。如果这项研究表明物理治疗的持续改善， 然后，应该延长联邦医疗保险和其他保险的限制，以帮助更长期的 中风患者的康复，从而改善他们的生活质量，特别是老年患者 中风最普遍的人群。

The broad, long-term objective of this study is to improve therapy efficacy for, and thus the quality of life (QoL) of, stroke patients. An increasing number of individuals suffer from stroke. Disabilities resulting from stroke were considered irreversible until very recently. Stroke recovery is an emerging field, still overcoming the longstanding view of functions lost to stroke being non-recoverable. We hypothesize that (a) robotic devices that stimulate brain recovery via motor training can support restoration of movement abilities compromised by stroke-induced pathological changes in the brain; and that (b) post-stroke neural changes can be monitored (and therefore later predicted) by in vivo state-of-the-art magnetic resonance imaging (MRI) via brain recovery biomarkers and behavioral motor performance improvements. To test this hypothesis, we propose to conduct a longitudinal study of our novel hand device in conjunction with 3-T brain MRI to monitor recovery in patients with chronic stroke via three Aims. Aim (1) is to perform state-of-the-art MRI with newly-developed phased-array coils and parallel imaging (to maximize sensitivity and resolution) to document quantifiable brain changes during training in 100 chronic stroke patients with confirmed middle cerebral artery (MCA) territory ischemic stroke and ischemic lesions affecting the motor strip. Patients will be assigned randomly to a training group and non-training control group. Participants will train for 30 min/d, 3 d/wk, to be conducted at home to facilitate participation. Volumetric MRI, functional MRI (fMRI), and diffusion tensor imaging (DTI) will be performed before the start of treatment (baseline) and then monthly over a 3-month training period. MRI measurements will focus on the motor cortex and its surrounding cortical areas and connecting tracts. Aim (2) is to evaluate motor performance in these chronic stroke patients with standard clinical indices and hand device measurements. Aim (3) is to demonstrate that brain mapping based on state-of-the art MRI in conjunction with hand device-assisted therapy can provide novel biomarkers for chronic stroke recovery while improving clinical outcome. We will perform a meta-analysis of structural, fMRI, DTI, and motor performance data using a general linear mixed-model (GLMM) approach, which handles heterogeneous data and facilitates deduction of useful results despite inter-individual variability. Impact: Success will facilitate selection of patients and personalized treatment planning optimized to yield improvements based on MRI metrics. Specifically, this study may identify biomarkers of brain recovery that can be monitored during therapy, inform therapy adjustments, and advance our ability to predict stroke recovery outcome. For chronic stroke patients, we anticipate demonstrating that recovery is possible for a longer period of time than previously thought, including motor skill improvements beyond 6 mos. after a stroke event, owing to the capacity for brain plasticity and functionally adaptive reorganization. If this research indicates continued improvement with physical therapy, then the limitations of Medicare and other insurances should be extended to assist in longer-term recovery of stroke victims, thus improving their QoL, especially in the geriatric patient population, where stroke is most prevalent.