Home-Based Automated Therapy of Arm Function After Stroke Via Tele-Rehabilitation

描述(申请人提供)：强制诱导运动疗法(CIMT)是在对照研究中显示的为数不多的几种技术之一，可以大幅改善患有轻中度偏瘫的中风幸存者的真实手臂功能。标准治疗包括在诊所对瘫痪患者的手臂使用进行一对一的训练，连续10个工作日每天3小时，另一方面戴上手套以阻止其使用。CIMT的相当高的成本，由于对治疗师时间的要求，以及患者连续两周每天前往诊所的要求，对那些可能获得该疗法的人施加了很大的限制。我们的实验室与Peter Lum博士合作，开发了一种用于自动交付CIMT的设备，名为AutoCITE；它允许练习8项上肢任务，并提供频繁的图形性能反馈。两份报告表明，AutoCITE与标准CIMT一样有效，即使治疗师的工作量减少了75%。第三份报告表明，在模拟远程康复条件下(即，患者和治疗师在实验室的不同房间)的AutoCITE也同样有效。我们建议修改AutoCITE，使其更适合在患者家中使用，并评估其提供远程CIMT的效果。我们还将专门测试让AutoCITE软件更具互动性是否有助于患者在分心更多的家里接受培训。为此，我们将把87名慢性中风幸存者随机分为：1.在家中进行AutoCITE训练，由一名治疗师通过基于互联网的视听链接远程监督两名患者；2.相同的程序，只是更具互动性的软件将在AutoCITE上运行；以及3.在家中进行剂量匹配的标准CIMT。基于家庭的二对一远程AutoCITE组的运动结果和成本将与基于家庭的一对一体内CIMT组以及之前运行的基于实验室的AutoCITE组和标准CIMT组的运动结果和成本进行比较。如果成功，AutoCITE可能会成为除了CIMT之外，通过Telerehab提供其他上肢疗法的平台。AutoCITE只涉及用实际对象进行任务练习的自动化，而且比流行的基于虚拟现实的方法便宜得多。由于每年约有30万新的中风幸存者患有运动残疾，减少有效的上肢康复费用并增加获得有效上肢康复的机会有可能显著减少残疾。公共卫生相关性我们的实验室与Peter Lum博士合作，开发了一种自动提供强制诱导运动疗法(CI疗法)的设备，名为AutoCITE；它允许练习8项上肢任务，并提供频繁的图形性能反馈。最近发表的两项研究表明，AutoCITE与一对一脑梗塞疗法一样有效。我们建议的研究将测试AutoCITE设备在患者家中远程康复基础上提供CI治疗的有效性。每年大约有30万名新的中风幸存者残留运动障碍。减少有效上肢康复的成本和增加获得有效上肢康复的机会有可能显著减轻中风患者、他们的家人和医疗保健系统的负担。

DESCRIPTION (provided by applicant): Constraint-Induced Movement therapy (CIMT) is one of few techniques that has been shown in controlled studies to produce large improvements in real-world arm function in stroke survivors with mild to moderate hemiparesis. The standard treatment involves one-on-one training of paretic arm use in the clinic for 3 hr/day for 10 consecutive weekdays and placing a mitt on the other hand to discourage its use. The considerable cost of CIMT, due to the demand on therapist time and requirement that patients travel daily to a clinic for 2 weeks, imposes substantial limits on those who might access the therapy. Our lab, with Peter Lum, Ph.D., has developed a device for automating the delivery of CIMT named AutoCITE; it permits practice of 8 upper- extremity tasks and provides frequent graphical performance feedback. Two reports indicate that AutoCITE is as efficacious as standard CIMT even with therapist effort reduced by 75%. A third report suggests that AutoCITE under simulated telerehabilitation conditions (i.e., patient and therapist were in different rooms in the lab) is also just as efficacious. We propose to modify AutoCITE so that it is more appropriate for use in patients' homes and evaluate its efficacy for providing CIMT on a telerehab basis. We will also specifically test whether making the AutoCITE software more interactive helps patients to comply with training at home, where there are more distractions. To this end, we will randomize 87 chronic stroke survivors to: 1. AutoCITE training in the home with two patients supervised concurrently by one therapist remotely via an Internet-based audio- visual link, 2. the same procedures except that the more interactive software will be run on AutoCITE, and 3. dose-matched, standard CIMT in the home. Motor outcomes and costs from the home-based, two-on-one, tele-AutoCITE groups will be compared to those from the home-based, one-on-one, in vivo CIMT group and to those from laboratory-based AutoCITE and standard CIMT groups run previously. If successful, AutoCITE, which involves simply automating task practice with actual objects and is much less expensive than prevailing virtual reality based approaches, might serve as a platform for delivering other upper-extremity therapies, in addition to CIMT, via telerehab. With about 300,000 new stroke survivors suffering motor disability annually, cutting the cost of and increasing access to efficacious upper-extremity rehabilitation has the potential to reduce disability significantly. PUBLIC HEALTH RELEVANCE Our laboratory, in collaboration with Peter Lum, Ph.D., has developed a device for automating the delivery of Constraint-Induced Movement therapy (CI therapy) named AutoCITE; it permits practice of 8 upper-extremity tasks and provides frequent graphical performance feedback. Two recently published studies suggest that AutoCITE is as efficacious as one-one-one CI therapy. Our proposed study will test the efficacy of the AutoCITE device to provide CI therapy on a tele-rehabilitation basis in patients' home. There are approximately 300,000 new strokes survivors with residual motor disability annually. Reducing the cost of and increasing access to efficacious upper-extremity rehabilitation has the potential to significantly reduce the burden of stroke on patients, their families and the healthcare system.