Mental Imagery to reduce motor impairments in stroke

描述(由申请人提供)：许多中风幸存者在运动能力和生活质量方面存在局限性。旨在增强运动功能和促进中风后受损上肢独立使用的治疗干预措施有限。有必要将独特的行为和认知技术转化为实际的、基于证据的治疗干预措施，这些技术被证明对神经系统的可塑性有影响。一种名为强制诱导治疗(CIT)的技术已经产生了结果，可以显著减少许多中风患者的丧失能力缺陷，并可以增加他们的独立性。最近的研究表明，心理练习这一补充疗法可以提高运动技能的表现。研究人员建议在身体康复中使用心理练习，作为一种经济高效的手段，促进中枢神经系统受损后的运动恢复。这项拟议研究的主要目的是收集数据，以努力评估一种形式的CIT，即重复任务练习(RTP)与心理表象训练(MIT)相结合的临床效果，以改善慢性中风患者的上肢运动功能和生活质量。因此，我们假设，与单独使用RTP相比，运动任务与RTP相结合的心理想象可能会减少上肢(UE)损伤并改善UE功能结果，并且常见的神经结构可以用fMRI进行研究。具体目标将寻求评估：1)联合使用RTP和MIT对中风患者运动恢复的有效性，2)联合使用RTP和MIT对中风患者健康相关生活质量的有效性，以及3)与单独使用MIT相比，在执行特定任务(执行和想象的手指屈伸序列)期间皮质激活图的组织变化与中风患者临床运动功能改善之间的联系。

DESCRIPTION (provided by applicant): Many stroke survivors have limitations in motor ability and compromised quality of life. Therapeutic interventions designed to enhance motor function and promote independent use of an impaired upper extremity following stroke are limited. There is a need to translate unique behavioral and cognitive techniques shown to have an impact on plasticity in the nervous system into practical, evidence-based, therapeutic interventions. One technique, constraint induced therapy (CIT), has produced results that can substantially reduce the incapacitating deficits of many patients with stroke and can increase their independence. Recent studies have shown that a complementary treatment, mental practice, can improve the performance of motor skills. Investigators have proposed the use of mental practice in physical rehabilitation as a cost-efficient means to promote motor recovery after damage to the central nervous system. The primary purpose of the proposed study is to collect data in an effort to estimate the clinical effectiveness of implementing one form of CIT, repetitive task practice (RTP) in conjunction with mental imagery training (MIT) to improve upper extremity motor function and quality of life of chronic stroke patients. Therefore, we hypothesize that mental imagery of a motor task combined with RTP may lead to decreased upper extremity (UE) impairment and improved UE functional outcome compared to RTP alone, and that common neural structures can be investigated using fMRI. Specific aims will seek to estimate: 1) the effectiveness of using RTP in conjunction with MIT on motor recovery of patients with stroke, 2) the effectiveness of using RTP in conjunction with MIT on health related quality of life of patients with stroke and 3) the association between changes in the organization of cortical activation maps during the performance of a specific task (executed vs. imagined finger flexion-extension sequence) and improvement in clinical motor function of patients with stroke when receiving RTP + MIT compared to MIT alone.