HOME-BASED TRACKING TRAINING TO STIMULATE NEUROPLASTICITY AND FUNCTION IN STROKE

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。本项目的目的有两个：1）确定基于家庭的关节运动跟踪训练是否能有效促进慢性中风受试者的手部功能和大脑重组的改善，2）确定任何此类改善的机制是否是学习依赖性与使用依赖性。我们实验室最近的工作表明，慢性中风受试者在手指运动跟踪任务中使用麻痹的手进行重复努力，可以显着改善手功能和大脑重组。这种训练技术要求患者学习如何创建食指的精确运动，以跟踪计算机屏幕上的目标波形。这个项目将研究是否以家庭为基础的跟踪治疗使用笔记本电脑和远程通信技术可以作为我们的早期工作与诊所为基础的治疗有效。同样重要的是，这个项目将研究是否是运动学习或重复运动，作为改善的机制。两组慢性卒中受试者将被随机分配到自己家中接受跟踪治疗或运动治疗，由远程治疗师定期指导。追踪组将接受一个前测、一个月的追踪治疗、一个后测，三个月后进行保持测试。运动组将接受前测，一个月的运动治疗，仅涉及简单的手指运动，没有运动学习，后测，然后交叉接受一个月的跟踪，最后交叉测试。将通过功能测试评价行为变化。将在磁共振研究中心（CMRR）使用3特斯拉磁体通过功能性磁共振成像（fMRI）评价脑重组。这项研究有可能揭示一种新的具有成本效益的中风治疗方法，并揭示中风的恢复是依赖于学习还是依赖于使用。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The purpose of this project is twofold: 1) determine whether home-based Joint Movement Tracking Training is effective in promoting improved hand function and brain reorganization in subjects with chronic stroke, and 2) determine whether the mechanism of any such improvements is learning-dependent vs. use-dependent. Recent work from our laboratory has shown that repetitive efforts by subjects with chronic stroke using their paretic hand at a finger movement tracking task produced significant improvements in hand function and brain reorganization. The training technique requires patients to learn how to create precision movemnts of the index finger to track target waveforms on a computer screen. This project will examine whether home-based tracking treatment using a laptop computer and tele-communication technology can be as effective as our earlier work with clinic-based treatment. Equally important, this project will examine whether it is the motor learning or the repetitive movement taht serves as the mechanism of improvement. Two groups of subjects with chronic stroke will be randomly assigned to receive either the tracking treatment or movement treatment in their own home, periodically guided by a remote therapist. The tracking group will receive a pretest, one month of tracking treatment, a posttest, and three months later a retention test. The movement group will receive a pretest, one month of movemtn treatment involving only simple finger movements with no motor learning, a posttest, then cross over to receive one month of tracking, and finally crossover test. Change in behavior will be evaluated with functional tests. Brain reorganization will be evaluated with functional magnetic resonance imaging (fMRI) using a 3 Tesla magnet at the Center for Magnetic Resonance Research (CMRR). This study has the potential of revealing a new form of cost-effective treatment for stroke and also uncovering whether recovery from stroke is learning - dependent or use-dependent.