New Directions in Stroke Neurorehabilitation (RMI)

描述(由申请人提供)： 中风是美国成年人长期严重残疾的主要原因，给国家的私人和公共卫生资源带来了巨大的负担。在由中风引起的所有损害中，最需要进行有效康复研究的是上肢偏瘫，它严重影响中风幸存者的功能独立性和健康。一种在上肢残疾康复中显示出希望的方法是约束性诱导运动疗法(CIMT)，它强调通过特定任务的训练重复使用受损的肢体，同时限制较好的肢体的运动。然而，使用CIMT治疗上肢轻瘫的“最佳实践”策略仍然不清楚，也很少知道治疗的重点(熟练学习与运动活动)、治疗的强度和时机、患者的动机、初始损伤以及康复过程中的神经机制等关键因素如何相互作用来影响康复治疗的有效性。 为了在中风康复领域取得重大进展，我们认为需要生物学、工程学、计算机和临床科学之间的协调一致的跨学科方法来解决这个复杂的问题。这项计划拨款中建议的研究旨在应对这一挑战，并将检验神经可塑性与促进中风引起的脑损伤后上肢运动功能恢复的治疗策略之间的协同作用。参与者包括生物、行为、计算和工程科学的教员，他们在分子和细胞生物学、行为神经科学、生物信息学、计算建模、虚拟环境技术、触觉、生物统计学和物理康复等方法方面拥有专业知识。我们这项研究的长期目标是：1)扩大我们对脑损伤后神经可塑性和功能恢复的关键因素的了解；2)建立可用于开发创新和更有效的治疗干预措施的跨学科科学知识基础，以促进中风后残疾人的健康和独立；以及3)为(基础科学和临床)研究生和博士后学生提供跨学科的培训机会，使他们能够成为能够在科学学科范围内及跨科学学科工作的独立研究科学家。

DESCRIPTION (provided by applicant): Stroke is the leading cause of serious, long-term disability among American adults and places a tremendous burden on both the private 'and public health resources of the nation. Of all impairments that result from stroke, one of the most in need of effective rehabilitation studies is hemiparesis of the upper limb, which significantly impacts functional independence and health of stroke survivors. One approach that has shown promise in rehabilitation of upper limb disabilities is Constraint Induced Movement Therapy (CIMT), which emphasizes repetitive use of the impaired limb using task-specific training, while restricting movement of the better limb. However, the "best practice" strategy for the rehabilitation of upper limb paresis using CIMT is still unclear, and little is known about how critical factors such the focus of therapy (skilled learning vs. motor activity), the intensity and timing of therapy, patient motivation, initial impairment and the neural mechanisms that underlie the recovery process interact to impact the effectiveness of rehabilitation therapy. In order to make significant advances in the field of stroke rehabilitation we believe that a concerted interdisciplinary approach among the biological, engineering, computer, and clinical sciences will be needed to solve this complex problem. The studies proposed in this planning grant are designed to meet this challenge and will examine the synergy between neural plasticity and treatment strategies that promote the recovery of upper limb motor function after stroke-induced brain injury. Participants include faculty from the biological, behavioral, computational and engineering sciences with expertise in methods encompassing molecular and cell biology, behavioral neuroscience, bioinformatics, computational modeling, virtual environment technology, haptics, biostatistics and physical rehabilitation. The long-term goals of our study are: 1) to broaden our understanding of the key factors that modulate neuroplasticity and the recovery of function after brain injury, 2) build a foundation of interdisciplinary scientific knowledge that can be used in the development of innovative and more effective therapeutic interventions to enhance the health and independence of persons with post-stroke disabilities; and 3) provide an interdisciplinary training opportunity for (basic science and clinical) graduate and post-doctoral students to develop as independent research scientists equipped to work both within and across scientific disciplines.