RECOVERY AND REHABILITATION OF ARM USE AFTER STROKE

中风是成年人残疾的主要原因， 美国的 每年在美国，约55万 人遭受中风，近40万人在某种程度上幸存下来， 残疾人。 累计存活的中风患者总数 美国人将近300万。 每年300亿美元 是中风相关残疾的估计负担。 尽管 这些统计数字的准确性，很少有科学的 脑卒中后康复治疗效果的研究 干预措施。 因此，最近发表的临床 中风后康复的实践指南已经 被迫主要依靠专家意见，而不是良好的 受控科学研究。 这个项目是第一步 为了弥补这一点，它将提供试点数据，为大 康复干预的大规模随机临床试验 在亚急性期。 这项小额赠款的目的是 建议是获得初步数据，以：1）评估 进行大规模、随机、临床研究的可行性 随机对照试验（RCT）评估三种物理治疗的有效性 康复干预措施（“日常护理”、“强化”和 “功能性使用”）对单侧后恢复手臂使用的影响 2）微调实验设计和干预 大规模随机对照试验的有效性评价程序 （3）获得初步数据， 短期和长期有效性。 具体而言是 建议旨在：1）评估招聘，保留， 遵守;制定业务内容，包括手册 数据收集程序和标准化数据收集表格; 数据库系统和通信系统，2）检查 合格/不合格标准;评估 两组与三组RCT设计;并评估干预时间、结局 措施和评估工具的敏感性，以及3）确定 必要的样本量功效计算;获得初步数据 关于初始损伤的预后影响 （神经学和神经肌肉学） 干预措施;并获得有关是否 恢复和反应受损伤特征的影响。

Stroke is the leading cause of disability among adults in the United States. Each year in the U.S., approximately 550,000 people suffer strokes and nearly 400,000 survive with some level of disability. The cumulative total of living, stroke-affected Americans is nearly 3 million. Thirty billion dollars annually is the estimated burden from stroke-related disability. Despite the enormity of these statistics, there have been few scientific studies of the effectiveness of post-stroke rehabilitation interventions. As a result, the recently published Clinical practice guidelines for post-stroke rehabilitation have been forced to rely primarily on expert opinion and not on well controlled scientific studies. This project is a first step toward remedying this; it will provide pilot data for a large scale randomized clinical trial of rehabilitation interventions during the subacute phase. The goal of this small grants proposal is to obtain preliminary data to: 1) Assess the feasibility of conducting a large scale, randomized, clinical trial (RCT) evaluating the effectiveness of three physical rehabilitative interventions ("usual care", "strengthening" and "functional use") on restoration of arm use after unilateral stroke, 2) Fine tune the experimental design and intervention procedures for a large scale RCT to evaluate the effectiveness of these three interventions and 3) Obtain preliminary data on short-term and long-term effectiveness. Specifically, the proposal is designed to: 1) Assess recruitment, retention, and compliance; develop the operational components including a manual of procedures and standardized data collection forms; and build a database system and a communications system, 2) Examine eligibility/ineligibility criteria; assess the benefits/detriments of a two vs. three arm RCT design; and assess intervention time, outcome measures, and sensitivity of assessment instruments and 3) Determine requisite sample size power calculations; obtain preliminary data pertaining to the prognostic implications of initial impairments (neurological and neuromuscular) with regard to each of the interventions; and obtain preliminary data regarding whether the recovery and response is influenced by lesion characteristics.