A TREATMENT FOR EXCESS MOTOR DISABILITY IN THE AGED

在美国，每年有70多万人患中风。因此，迫切需要将对神经系统可塑性有影响的独特行为技术转化为实际的循证治疗干预措施，特别是在治疗持续时间缩短的情况下。在这个实验室中，我们已经开发了这样一套技术，这些技术来自于对动物和人类受试者的基础研究。随机对照研究表明，它可以从运动功能的前两个四分位数大幅减少轻度至中度慢性中风患者的运动缺陷，并可以在数年内增加他们的独立性。这些技术被称为约束诱导（CI）运动疗法，涉及对受影响较小的上肢进行两到三周的运动限制，同时训练受影响较大的上肢。这引起了大量或重复使用的更受影响的肢体和大量增加使用依赖性皮层重组涉及招聘大量新的大脑区域的神经支配更受影响的肢体运动。拟议研究的主要目的之一是确定Cl疗法是否可以成功地用于增加慢性卒中患者的真实的工作肢体使用量，这些患者的运动障碍水平高于本实验室先前治疗的患者（即，大约处于运动功能的下一个最低四分位数的患者）。另一个目的是确定MRI确定的病变部位及其大小是否是影响通过使用CI疗法恢复运动功能的程度的因素。这项前瞻性、4年随机试验（包括18个月随访）将采用交叉设计。8例运动功能倒数第二的慢性卒中患者将被随机分配接受Cl治疗（40例受试者）或一般健身安慰剂对照干预（40例受试者）。服用后2年，对照组患者将交叉接受氯离子治疗。主要结局指标将是实验室运动功能测试和真实的世界环境中的肢体使用量。还将测量心理社会功能的变化。

Stroke afflicts over 700,000 persons in America every year. There is thus an urgent need to translate unique behavioral techniques shown to have an impact on plasticity of the nervous system into practical evidence-based therapeutic interventions, especially at a time when the duration of treatments has shortened. In this laboratory we have developed on such set of techniques derived from basic research with an8mal and human subjects. Randomized, controlled studies indicate that it can substantially reduce the motor deficit of patients with mild to moderate chronic strokes from the upper two quartiles of motor functioning and can increase their independence over a period of years. The techniques, termed Constrain- Induced (CI) Movement Therapy, involve motor restriction of the less affected upper extremity for a period of two or three weeks while at the same time training the more affected upper limb. This gives rise to massed or repetitive use of the more affected extremity and to a large increase in use-dependent cortical reorganization involving the recruitment of substantial new regions of the brain in the innervation of more-affected extremity movement. One of the main aims of the proposed research is to determine if Cl Therapy can be used with therapeutic success for increasing the amount of real work extremity use in patients with chronic stroke who have a greater level of motor impairment than those previously worked with in this laboratory (i.e., patients who are approximately in the next to lowest quartile of motor functioning). Another aim is to ascertain whether the locus of the lesion and its size as determined by MRI, are factors influencing the extent to which motor function can be recovered through the use of CI Therapy. This prospective, 4-year randomized trial, including 18-month follow-up will use a crossover design. Eight patients with chronic stroke from the next to lowest quartile of motor functioning will be randomly assigned to receive either Cl therapy (40 subjects) or a General Fitness placebo control intervention (40 subjects). Two years after intake the control patients will be crossed over to receive Cl Therapy. Primary outcome measures will be a laboratory motor function test and amount of extremity use in the real world setting. Changes in psychosocial functioning will also be measured.