Mental Practice Dosing and Mechanisms in Stroke

描述（由申请人提供）：中风是美国残疾的主要原因，导致运动障碍，影响生活质量。偏瘫是卒中致残的主要损害，也是最常治疗的损害，但传统的卒中康复往往不成功。补充和替代医学（CAM）技术在中风中的疗效还有待广泛研究。此外，尽管美国有超过400万的慢性中风患者，但对于使用传统或CAM技术的该人群的有效运动疗法方案知之甚少。心理练习（MP），一种CAM身心技术，其中身体技能是认知排练，增加运动技能的学习和表现。同样的神经和肌肉结构在MP过程中被激活，就像在相同技能的身体练习中一样。本实验室的数据表明，MP减少中风引起的轻偏瘫显着超过传统的运动疗法。然而，MP的作用机制和最佳MP剂量尚不清楚，需要在进行大型MP临床试验之前进行鉴定。研究目的是：（1）确定MP持续时间和运动结果之间的剂量-反应关系;（2）使用功能性磁共振成像（fMRI）确定MP的作用机制。计划将包括开发和完善MP和功能磁共振成像协议以及康复人员的服务。随后将在33名慢性卒中患者中进行一项多基线研究，研究每天30分钟、60分钟和120分钟MP剂量对运动和神经的影响。[11其他患者将仅接受运动疗法，而不接受MP。结果测量将包括FugI-Meyer评估，动作研究手臂测试，Wolf运动功能测试和中风影响量表，以及定性测量，fMRI将检查可能的MP诱导的皮质重组。拟议的研究符合NCCAM和R21的优先事项，包括（1）完善有前途的CAM干预措施;（2）研究身心相互作用和CAM技术在心血管疾病（包括中风）中的应用;（3）阐明CAM的作用机制。MP的作用机制和最佳剂量的识别是具有成本效益的，适当的实施这种有前途的，CAM，身心技术的基础，并将使随后的MP临床试验。

DESCRIPTION (provided by applicant): Stroke is the leading cause of disability in the United States, causing motor impairments that compromise quality of life. Hemiparesis is the primary impairment underlying stroke disability and the most frequent impairment treated, yet conventional stroke rehabilitation is often unsuccessful. The efficacy of Complementary and alternative medicine (CAM) techniques in stroke is yet to be extensively examined. Moreover, although > 4 million chronic stroke patients reside in the United States, little is known about efficacious motor therapy regimens for this population using either conventional or CAM techniques. Mental practice (MP), a CAM mind-body technique in which physical skills are cognitively rehearsed, increases motor skill learning and performance. The same neural and muscular structures are activated during MP as during physical practice of the same skill. Data from this laboratory suggest that MP reduces stroke-induced hemiparesis significantly more than conventional motor therapy. However, MP mechanisms of action and optimal MP dosing are unknown and require identification before a large MP clinical trial can be performed. Study aims are: (1) To determine the dose-response relationship between MP duration and motor outcomes; and (2) to determine the MP mechanisms of action using functional magnetic resonance imaging (fMRI). Planning would include development and refinement of MP and fMRI protocols and inservicing of rehabilitation personnel. This would be followed by a multiple baseline study of motor and neural effects of 30, 60 and 120-minute daily MP doses in 33 chronic stroke patients. [11 additional patients will receive motor therapy only with no MP.] Outcome measures would include the FugI-Meyer Assessment, the Action Research Arm Test, the Wolf Motor Function Test, and the Stroke Impact Scale, as well as qualitative measures, fMRI will examine possible MP-induced cortical reorganizations. The proposed study meets NCCAM and R21 priorities, including (1) refinement of promising CAM interventions; (2) study of mind-body interactions and application of CAM techniques to cardiovascular diseases, including stroke; and (3) elucidation of CAM mechanisms of action. Identification of MP mechanisms of action and optimal dosing is fundamental to cost-effective, appropriate implementation of this promising, CAM, mind-body technique, and will enable a subsequent MP clinical trial.