Mental Practice Clinical/Neural Effects/Subacute Stroke

描述（由申请人提供）：中风引起的轻偏瘫是美国治疗师治疗的最常见的损伤。虽然每年花费数百万美元用于中风运动康复，但用于轻偏瘫的常规治疗无效，使患者具有实质性运动残疾并继续依赖医疗保健和其他。治疗这种致残性疾病的最佳方法可能是以一种新的替代方式将现有学科中有前途的元素联合收割机结合起来。本培训计划应用了临床试验设计、神经科学和康复的既定原则，以非传统的方式更好地治疗和理解卒中引起的轻偏瘫。近期目标是获得中风临床试验设计和神经影像学方面的正式强化培训和经验，并获得额外的补充/替代医学（CAM）经验。这些活动将实现长期的职业目标，即通过组织试验检查CAM干预中风的作用机制和疗效，改善中风后的运动功能。该培训计划提供了来自公认的领导者的特殊指导，以及杰出的跨学科环境中的教学法。 心理练习（MP）是一种CAM身心技术，其中身体技能是认知排练，增加运动学习和非残疾人的表现。我们的初步数据表明，MP显着减少轻偏瘫亚急性中风患者。然而，使用随机对照方法的MP疗效和MP作用机制尚不清楚。本文提出的研究目的是：（1）使用卒中特异性、已建立的结局指标测量MP对亚急性卒中患者受影响手臂功能的影响;（2）使用功能性磁共振成像（fMRI）确定MP的作用机制。中心研究假设是MP将显著改善亚急性卒中患者的受累臂功能，并且这些改善的结局伴随着皮质重组。将使用一项多基线、随机对照研究检验中心假设并实现目标，其中30例亚急性卒中患者在受累组治疗后接受MP或对照干预。结果测量包括FugI-Meyer运动评估、行动研究手臂测试、Wolf运动功能测试和卒中影响量表。功能磁共振成像将检查可能的MP诱导的皮质重组。作为拟议研究的结果，将确定MP在亚急性中风中的疗效和机制，从而制定一个经过验证的改善运动功能的方案。这项研究还将增加对中风中神经和功能结局之间关系的理解，并为RO 1提交提供试点数据。拟议的研究符合NCCAM的优先事项，包括：（1）身心相互作用的研究;（2）CAM对心血管疾病，包括中风的应用;（3）CAM的作用机制的阐明。该研究将推动申请人实现其长期目标，即测试CAM干预中风的疗效和机制。

DESCRIPTION (provided by applicant): Stroke-induced hemiparesis is the most frequent impairment treated by therapists in the United States. Although millions of dollars are spent annually on stroke motor rehabilitation, conventional treatments for hemiparesis are ineffective, leaving patients with substantial motor disability and continued reliance on healthcare and others. The best approach to treat this disabling condition may be to combine promising elements from established disciplines in a new and alternative way. This training plan applies established principles from clinical trial design, neuroscience, and rehabilitation in a nontraditional way to better treat and understand stroke-induced hemiparesis. The immediate objective is to acquire formal, intensive training and experiences in stroke clinical trial design and neuroimaging, and to obtain additional complementary/alternative medicine (CAM) experiences. These activities will fulfill the long-term career objective, which is improving motor function after stroke by organizing trials examining mechanisms of action and efficacy of CAM interventions in stroke. The training plan provides exceptional mentoring from recognized leaders, and didactics in outstanding interdisciplinary environments. Mental practice (MP), a CAM mind-body technique in which physical skills are cognitively rehearsed, increases motor learning and performance in nondisabled individuals. Our pilot data suggest that MP significantly reduces hemiparesis in subacute stroke patients. However, MP efficacy using randomized controlled methods, and MP mechanisms of action, are unknown. Aims of the research study herein proposed are to: (1) measure the impact of MP on affected arm function in subacute stroke patients using stroke-specific, established, outcome measures; and (2) determine MP mechanisms of action using functional magnetic resonance imaging (fMRI). The central study hypothesis is that MP will significantly improve affected arm function in subacute stroke patients, and that these improved outcomes are accompanied by cortical reorganization. The central hypothesis will be tested and aims fulfilled using a multiple baseline, randomized controlled study, in which 30 subacute stroke patients receive either MP or a control intervention, both after affected arm therapy. Outcome measures include the FugI-Meyer Motor Assessment, the Action Research Arm Test, the Wolf Motor Function Test, and the Stroke Impact Scale. fMRI will examine possible MP-induced cortical reorganizations. As an outcome of the proposed study, MP efficacy and mechanisms in subacute stroke will be determined, producing a validated protocol that improves motor function. This study will also increase understanding of relationships among neural and functional outcomes in stroke, and provide pilot data for a RO1 submission. The proposed study meets NCCAM priorities, including: (1) study of mind-body interactions; (2) application of CAM to cardiovascular diseases, including stroke; and (3) elucidation of mechanisms of action of CAM. The study will propel the applicant toward fulfillment of his long-term goal of testing efficacy and mechanisms of CAM interventions in stroke.