Cognitive Screening for CI Therapy after Stroke

描述（由申请人提供）：中风是主要的神经系统疾病和慢性残疾的主要原因。中风后的功能缺陷可以通过康复来改善，但直到最近，中风治疗的可测试模型的发展很少。此外，尽管确定了治疗结果的几个预测因素，但尚未建立综合模型来解释这些变量如何影响治疗结果。约束诱导运动疗法（CI疗法）是慢性脑卒中偏瘫的一种治疗方法，有证据表明其对实际日常生活任务的疗效。这种治疗方法是从基础神经科学研究中发展出来的，该研究假设习得性不使用是慢性偏瘫的主要决定因素，并且可以通过强化练习来逆转。在功能成像研究中，强化训练与大量皮层重组有关。PIs假设强化练习的治疗效果需要几种认知机制：持续注意力、陈述性记忆和情绪调节。大约三分之一的CI治疗门诊患者表现出认知调节受损或记忆障碍，并且他们往往在出院后治疗效果和益处保留减少。本试点应用的目的是前瞻性评估CI治疗临床患者的上述认知功能，然后通过多变量回归分析确定其对治疗结果的贡献，并与其他一般中风康复结果的预测因素（年龄、病变发现、中风严重程度、治疗前功能、失禁）进行比较。研究结果将表明特定的认知过程是否与假设的机制有重要关系，以解释治疗效果。了解认知对CI治疗益处的贡献将有助于为接受治疗的行为障碍患者提出治疗修改，并更好地告知潜在患者他们可能的治疗益处。

DESCRIPTION (provided by applicant): Stroke is the leading neurologic disorder and a major cause of chronic disability. Functional deficits following stroke can be ameliorated through rehabilitation, but until recently there has been little development of testable models of stroke therapies. Furthermore, despite the identification of several predictors of treatment outcomes, comprehensive models to account for how such variables affect therapy outcomes have not been developed. Constraint-Induced Movement Therapy (CI therapy) is a treatment for chronic stroke hemiparesis that has controlled evidence for efficacy on actual daily living tasks. The treatment was developed from basic neuroscience research that postulates that learned non-use is a major determinant of chronic hemiparesis and can be reversed through intensive practice. The intensive practice is associated with massive cortical reorganization on functional imaging studies. The PIs hypothesize that several cognitive mechanisms are essential to the therapeutic benefits of intensive practice: sustained attention, declarative memory, and emotional regulation. About one-third of patients in the CI therapy clinic demonstrate impaired cognitive regulation or memory disturbances, and they tend to have reduced treatment gains and retention of benefits after discharge. The purpose of this pilot application will be to prospectively assess CI therapy clinic patients on the above cognitive functions, and then through multivariable regression analysis determine their contributions to treatment outcomes in comparison to other predictors of general stroke rehabilitation outcomes (age, lesion findings, stroke severity, pre-treatment function, incontinence). The findings will indicate whether specific cognitive processes are importantly involved with the mechanism hypothesized to account for treatment benefit. Understanding of cognitive contributions to CI therapy benefit will help to propose treatment modifications for patients with behavioral disorders who undergo therapy, and as well to better inform prospective patients of their likely treatment benefit.