Mental Practice Dosing and Mechanisms in Stroke

描述(申请人提供)：在美国，中风是导致残疾的主要原因，导致运动障碍，危及生活质量。偏瘫是卒中残疾的主要损害，也是最常见的损害治疗方法，然而传统的卒中康复往往不成功。补充和替代医学(CAM)技术在卒中中的疗效尚未得到广泛的检验。此外，尽管美国有400万慢性中风患者，但人们对使用传统或CAM技术治疗这一人群的有效运动疗法知之甚少。心理练习(MP)，一种认知上排练身体技能的CAM心身技术，可以提高运动技能的学习和表现。在MP期间，同样的神经和肌肉结构被激活，就像在相同技能的物理练习中一样。该实验室的数据显示，与传统的运动疗法相比，MP显著减少了中风引起的偏瘫。然而，MP的作用机制和最佳MP剂量尚不清楚，需要在进行大规模MP临床试验之前进行鉴定。研究的目的是：(1)确定MP持续时间和运动结果之间的剂量-反应关系；(2)利用功能磁共振成像(FMRI)确定MP的作用机制。规划将包括制定和完善MP和功能磁共振成像方案，并为康复人员提供服务。随后将对33名慢性中风患者进行每日30、60和120分钟MP剂量对运动和神经影响的多基线研究。[另外11名患者将只接受运动疗法，没有MP。]结果测量将包括Fugi-Meyer评估、行动研究手臂测试、Wolf运动功能测试和卒中影响量表，以及定性测量，功能磁共振成像将检查MP诱导的皮质可能的重组。这项拟议的研究符合NCCAM和R21的优先事项，包括(1)改进有希望的CAM干预；(2)研究身心相互作用和CAM技术在包括中风在内的心血管疾病中的应用；以及(3)阐明CAM的作用机制。确定MP的作用机制和最佳剂量是经济有效、适当实施这一有希望的CAM心身技术的基础，并将使后续的MP临床试验成为可能。

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.