Mechanisms underlying loss of hand function after stroke

描述(由申请者提供)：这个指导式研究科学家发展奖的目标是允许申请者发展在康复研究中独立、富有成效的职业生涯所需的基础科学和临床研究技能。申请者是一名有执照的物理治疗师，在运动的神经控制方面接受过博士和博士后培训。该奖项将增强申请者研究中风患者上肢功能丧失和恢复的潜在机制的能力，方法是将申请者在研究运动控制方面的现有专业知识与1)躯体感觉的基础科学和测量，以及2)涉及不同患者群体的纵向临床研究的设计、统计分析和执行相结合。长期目标是开发一种基于上肢功能障碍的模型，用于指导卒中后患者的康复评估和治疗。拟议研究的具体目的是检验中风后手功能丧失是由于失去运动控制和躯体感觉丧失这一普遍假设。拟议的研究将调查：1)手近端孤立运动控制的障碍(即无法在空间中定位手)是否导致手功能下降，2)初级和中级躯体感觉模式中风后的障碍随时间恢复的程度，以及3)躯体感觉障碍是否导致中风后手功能下降。为了验证这些假说，将在单纯运动性偏瘫患者、单纯偏瘫患者和偏瘫合并偏瘫患者中采取单独上肢所有节段运动控制的纵向运动测量，上肢初级和中度躯体感觉模式的详细测量，以及上肢功能的临床测量。多元回归技术将被用来确定不同节段的运动控制障碍和不同躯体感觉模式的障碍如何导致手功能丧失。拟议的研究结果将深入了解中风后的损害如何导致上肢残疾，并将在中风患者的评估和治疗过程中对康复专业人员有用。

DESCRIPTION (provided by applicant): The goal of this Mentored Research Scientist Development Award is to allow the applicant to develop the basic science and clinical research skills needed to pursue an independent, productive career in rehabilitation research. The applicant is a licensed physical therapist with doctoral and postdoctoral training in the neural control of movement. This award will enhance the applicant's ability to investigate mechanisms underlying loss and recovery of upper extremity function in people with stroke by combining the applicant's existing expertise in studying motor control with additional training in 1) the basic science and measurement of somatosensation, and 2) the design, statistical analyses, and execution of longitudinal clinical studies involving heterogeneous patient populations. The long-term objective is to develop an impairment-based model of upper extremity function that can be used to guide rehabilitation evaluation and treatment of people post stroke. The specific aims of the proposed studies are designed to test the general hypothesis that loss of hand function after stroke is due to loss of motor control and to loss of somatosensation. The proposed studies will investigate: 1) whether or not impairments in isolated motor control at segments proximal to the hand (i.e. the inability to position the hand in space) contribute to reduced hand function, 2) the extent to which impairments after stroke in elementary and intermediate somatosensory modalities recover with time, and 3) whether or not impairments in somatosensation contribute to reduced hand function in people post stroke. To test these hypotheses, longitudinal kinematic measures of isolated motor control of all the segments of the upper extremity, detailed measures of elementary and intermediate somatosensory modalities in the upper extremity, and clinical measures of upper extremity function will be taken in people with pure motor hemiparesis, people with pure hemianesthesia, and people with hemiparesis plus hemianesthesia. Multiple regression techniques will be used to determine how impairments in motor control at the different segments and impairments in the different somatosensory modalities contribute to loss of hand function. Results of the proposed studies will provide insight into how impairments post stroke contribute to disability of the upper extremity and will be useful for rehabilitation professionals during the evaluation and treatment of people with stroke.