Ankle Tracking Training in Stroke

描述（由申请人提供）：广泛的目标是通过在受试者自己家中进行远程康复训练来改善卒中患者的行走能力。中风会破坏行走能力。通常，在中风后的急性期集中提供康复治疗，然后减少或完全取消。但是中风的急性期可能不是进行强化训练的最佳时间。在诊所进行初步培训后的另一种选择是在他们自己家中使用远程康复技术对受试者进行培训。此外，传统的康复强调重复简单的动作，但现在的研究表明，简单的动作可能不是促进神经变化的最佳刺激，从而导致康复。相反，需要熟练学习和认知处理的动作会产生更丰富的神经变化。因此，pi的目的是利用远程康复的优势来比较两种不同训练策略的有效性：跟踪训练，强调准确的动作，与运动训练，包括简单的动作。共有20名中风患者将被随机分配到跟踪组或移动组。两组人都将配发踝电测器、电脑、网络摄像头和在家使用的手机。两组在电脑的指导下，每天进行30组3次的脚踝训练，持续20天（4周）。对于跟踪组，计算机屏幕将显示目标波形，以便受试者尽可能准确地跟踪，并显示光标，以响应踝关节背屈/跖屈运动。对于Move组，不会显示目标线或响应线；实验对象只会做出简单的脚踝动作，电脑会记录下来，但不会在屏幕上看到，因此没有认知过程。受试者与治疗师之间的视频和音频远程会议将每隔一天进行一次，以保持受试者的积极性。预测试和后测试将测量1)踝关节运动范围，2)功能磁共振成像期间踝关节跟踪，3)膝关节跟踪（非功能磁共振成像期间），4)伯格平衡性能，以及5)红外摄像机步态参数。pi假设Track组在fMRI上表现出比Move组更大的行为改善和大脑重组变化。这项工作的相关性在于，它可能展示了一种创新的训练方法，它不仅具有成本和便利性优势，而且具有在更优化的时间加强治疗的科学优势。

DESCRIPTION (provided by applicant): The broad objective is to improve ambulation in subjects with stroke through telerehabilitation training in the subject's own home. Stroke can destroy walking ability. Usually, rehabilitation is offered intensively in the acute stage following stroke and then is curtailed or eliminated entirely. But the acute stage of stroke may not be the optimum time for intensive training. An alternative after initial training in the clinic is to train subjects in their own home using telerehabilitation technology. Also, traditional rehabilitation emphasizes much repetition of simple movements but studies now suggest that simple movement may not be the best stimulus to promote the neural changes leading to recovery. Instead, movements that require skillful learning with cognitive processing produce richer neural changes. So, the PIs' aim is to use the advantage of telerehabilitation in comparing the effectiveness of two different training strategies: tracking training, emphasizing accurate movements, versus movement training, involving simple movements. A total of 20 subjects with stroke will be randomly assigned to either the Track group or Move group. Both groups will be issued ankle electrogoniometers, a computer, web camera, and cell phone to be used at home. Both groups will be directed by the computer to perform 30 blocks of 3 trials of ankle training each day for 20 days (4 weeks). For the Track group, the computer screen will show target waveforms for the subject to track as accurately as possible with a displayed cursor that responds to ankle dorsiflexion/plantarflexion movements. For the Move group, no target or response line will be shown; subjects will merely produce simple ankle movements that will be recorded by the computer but not seen on the screen so that there is no cognitive processing. Visual and audio teleconferencing between subjects and a therapist will occur every other day to keep the subjects motivated. Pretests and posttests will measure 1) ankle range of motion, 2) ankle tracking during fMRI, 3) knee tracking (not during fMRI), 4) Berg Balance performance, and 5) gait parameters with infrared cameras. The PIs hypothesize that the Track group will show greater improvements in behavioral measures and greater changes in brain reorganization on fMRI than the Move group. The relevance of this work is that it may demonstrate an innovative training method that not only carries cost and convenience advantages but also the scientific advantage of intensifying treatment at a more optimal time.