Nerve Stimulation to Improve Hand Weakness in Stroke

描述（由申请人提供）：本提案旨在开发一种新的治疗方法来增加慢性卒中患者的肌肉力量并减少手部运动障碍。对于中风引起的长期运动障碍，目前还没有普遍接受的治疗方法。手运动功能对脑卒中患者的独立性有显著影响。体感输入影响运动皮层的活动，是足够的运动表现和运动学习所必需的。我们已经证明，以神经电刺激的形式进行体感刺激是一种直接且耐受性良好的干预，当应用于慢性中风患者的弱手时，即使在没有训练的情况下，也能改善手部肌肉力量。中度至重度手部残疾患者不能很好地训练。我们将比较神经电刺激和运动训练与单独运动训练对没有有效替代治疗方法的中度至重度手部残疾患者的影响。我们期望产生关于刺激会增强训练效果的假设的初步数据。我们将评估患者对研究方案的依从性，还将收集有关可能影响巴西人群对康复干预反应的生物和社会/环境因素的试点数据。评估年龄、皮质运动功能的神经生理测量、家庭支持和社会地位的影响。重要的是要确定哪些因素是治疗反应的基础，因为如果有了这些知识，就有可能调整治疗方法并指导卫生政策以这些因素为目标。该提案将提供神经生理学和神经康复研究方面的培训。我们将建立研究能力并为未来的研究发展合作：电刺激和训练在改善慢性中风患者手部力量和减少运动障碍方面的有效性；影响康复治疗效果的预后因素。这项研究将在一所参考大学医院进行，并得到神经内科的全力支持，这将有助于建立卓越的机构。这项研究旨在开发一种新的康复策略，针对一种没有普遍接受的治疗方法的疾病，针对发展中国家的现实生活结果。如果成功，这些目标可能会对慢性中风患者的治疗方式产生重大影响。研究结果对中风致残对医疗保健构成挑战的人群非常有价值。

DESCRIPTION (provided by applicant): This proposal intends to develop a novel therapy to increase muscle strength and decrease hand motor disability in chronic stroke patients. There is no universally accepted treatment for long-term motor disability from stroke. Hand motor function significantly impacts independence of stroke patients. Somatosensory input influences activity in the motor cortex and is required for adequate motor performance and motor learning. We have shown that somatosensory stimulation in the form of electrical nerve stimulation, a straightforward and well-tolerated intervention, results in improvement in hand muscle strength when applied to the weak hand of chronic stroke patients, even in the absence of training. Patients with moderate to severe hand disability cannot train well. We will compare the effects of electrical nerve stimulation and motor training to motor training alone, in patients with moderate to severe hand disability, to whom there is no effective alternative treatment available. We expect to generate preliminary data regarding the hypothesis that the stimulation will enhance the effects of training. We will evaluate patient compliance to the research protocol, and will also collect pilot data regarding biological and social/environmental factors that can influence the response to rehabilitative interventions in a Brazilian population. The influence of age, neurophysiological measurements of corticomotor function, family support and social status will be evaluated. It is important to determine which factors underlie response to treatment because, if such knowledge were available, it would be possible to adapt therapies and guide health policies to target these factors. This proposal will provide training in neurophysiological and neurorehabilitation research. We will build research capacity and develop collaboration for future studies regarding: effectiveness of electrical stimulation and training in improving hand strength and decreasing motor disability in chronic stroke patients; prognostic factors for response to rehabilitation therapy. The research will be conducted in a reference university hospital, with full support from the Neurology Department, and will contribute to institutional excellence. This research intends to develop a novel rehabilitative strategy for a condition for which there is no universally accepted treatment, targeting real-life outcomes in a developing country. If successful, these goals may have a major impact in the way chronic stroke patients are treated. The results will be highly valuable to populations in which disability from stroke represents a challenge to health care.