The effects of combined brain stimulation and mirror therapy on movement, daily living and quality of life in stroke survivors

在英国，中风是导致残疾的主要原因，大约70%的幸存者手臂和手的运动都有困难。据预测，中风的数量将在未来20年内增加44%(Stevens等人，2017年)，给卫生和社会服务带来巨大压力。为了减轻这一负担，有必要开发负担得起的医疗设备，供中风幸存者在家中使用。还有必要了解有关使用设备的潜在有效性和改进可能性的信念，因为对以家庭为基础的方案的坚持程度往往很低。该博士学位的目的是评估脑刺激与镜面疗法相结合是否能为中风幸存者提供额外的治疗价值。它还将考察个人的信念和期望如何影响参与度和结果。镜像疗法(MT)要求患者使用受中风影响最小的肢体进行锻炼。观察这个肢体的反射可能会导致一种心理错觉，认为受影响的手臂做出了动作。这可以改善受影响手臂的机动性和手部灵活性，有时取得比传统理疗更好的效果(Deconinck等人，2015年)。经颅直流电刺激是一种非侵入性的脑刺激，可以暂时调节神经元的兴奋性。到目前为止，只有一项研究将tdcs和MT结合起来治疗中风(在设计上存在重大缺陷)。有一些相互竞争的假设认为，当与MT相结合时，tdcs电极配置将是最有利的，这些假设将被探索，以及信念、态度和期望的定性测量。运动捕捉技术的使用将提供对运动模式的详细量化分析，并将调查这些运动模式与中风幸存者对其表现/日常生活的看法之间的关系。

Stroke is the leading cause of disability in the UK with approximately 70% of survivors experiencing difficulties with arm and hand movements. It is predicted that the number of strokes will increase by 44% within the next 20 years (Stevens et al., 2017) placing enormous strain on health and social services. To ease this burden there is a need to develop affordable medical devices that stroke survivors can use at home. There is also a need to understand beliefs about the potential effectiveness and likelihood of improvement of using devices, as adherence to home-based programmes is often low. The aim of this PhD is to evaluate whether combining brain stimulation with mirror therapy provides additional therapeutic value for stroke survivors. It will also examine how the person's beliefs and expectations impact on engagement and outcome. Mirror therapy (MT) requires the person to perform exercises with the limb least affected by their stroke. Observing the reflection of this limb can lead to a psychological illusion of the affected arm making the movements. This can lead to improvements in the mobility and hand dexterity of the affected arm, sometimes achieving better results than conventional physiotherapy (Deconinck et al., 2015). Transcranial Direct Current Stimulation (tDCS) is a form of non-invasive brain stimulation that can temporarily modulate neuronal excitability. To date only one study has combined tDCS and MT for stroke (with significant shortcomings in design). There are competing hypotheses for which tDCS electrode configuration will be most advantageous when combined with MT and these will be explored, along with qualitative measures of beliefs, attitudes and expectations. The use of a motion capture technology will provide detailed quantitative analyses of movement patterns and the relationships between these and the perceptions that stroke survivors have about their performance/daily life will be investigated.