COMPELLED BODY WEIGHT SHIFT THERAPY IN INDIVIDUALS WITH STROKE RELATED

描述（由申请人提供）：严重的行动不便是中风的主要后果。因此，美国每年有超过70万人中风，他们的运动能力受到限制，生活质量受到影响。事实上，轻偏瘫患者经常通过未受累的下肢承受大部分体重。站立和负重的不对称性被认为是行走能力的预测指标。因此，实现站立和步态的对称被认为是康复的重要目标。然而，旨在提高运动功能和促进中风后的独立性的治疗干预是相当有限的。我们已经开发出一种新技术，初步研究表明，它可以大大改善步态模式，减少中风患者的失能运动缺陷，并提高他们的独立性。该技术被称为强迫体重转移（CBWS）疗法，包括在几周内通过使用鞋垫提升未受影响的下肢。在这段时间里，当患者参加物理治疗以及常规的日常活动时，更对称的负重是有利的。拟议的研究建立在一项试点研究的结果基础上，该研究表明CBWS治疗后慢性单侧卒中患者有显著的获益。实验设计将中风后超过1年的患者随机分配到两组。实验组接受CBWS治疗结合常规物理治疗，对照组仅接受常规物理治疗，疗程为6周。将比较两组的即刻和长期（4个月）结果。具体目标是：（1）测试CBWS治疗与单独常规治疗相比在改善步态和负重对称性方面的疗效;（2）评估CBWS治疗后改善是否持续。这项研究具有极其重要的意义，因为如果成功的话，这项研究的结果可以用来重新调整传统的康复策略，旨在帮助慢性中风患者在日常生活活动和活动中实现最大的独立性。

DESCRIPTION (provided by applicant): Profoundly impaired mobility is a major consequence of stroke. As a result, a large number of more than 700,000 people in America sustaining a stroke each year have limitations in motor ability and compromised quality of life. It is a fact that individuals with hemiparesis frequently bear the majority of their body weight through their uninvolved lower extremity. Asymmetry of stance and weight bearing has been recognized as a predictor of the ability to ambulate. Therefore, achieving symmetry of stance and gait is considered an important goal of rehabilitation. However, therapeutic interventions designed to enhance motor function and promote independence following stroke are quite limited. We have developed a new technique that preliminary studies suggest can substantially improve gait pattern, reduce the incapacitating motor deficit of stroke patients, and increase their independence. The technique, termed Compelled Body-Weight Shift (CBWS) therapy, involves lift of the nonaffected lower extremity through the use of a shoe insert over a period of several weeks. During this time, more symmetrical weight bearing is facilitated while patients participate in physical therapy as well as regular daily activities. The proposed research builds on findings from a pilot study that demonstrated significant gains in individuals with chronic unilateral stroke following CBWS therapy. The experimental design randomly assigns patients who are more than 1 year post-stroke to two groups. The experimental group will receive CBWS therapy combined with conventional physical therapy for a period of six weeks, the control group will only receive conventional physical therapy. Immediate and longer-term (four months out) results from both groups will be compared. The specific aims are: (1) to test the efficacy of CBWS therapy compared to conventional therapy alone in improving gait and symmetry of weight bearing; (2) to evaluate whether the improvement is sustained post-CBWS therapy. This research is of paramount significance because, if successful, the outcomes from the study could be used to refocus conventional rehabilitation strategies aimed at helping chronic stroke patients to achieve maximal independence in mobility and activities of daily living.