Driving Cortical Plasticity for Rehabilitation of Reaching After Stroke.

描述（由申请人提供）：中风是最常见的致残原因之一，在康复技术方面有很大的改进空间。虽然神经可塑性可能支持许多自然和实践相关的恢复，但这种自然发生的可塑性机制可能潜在地增强以改善功能结果。我们提出了一种混合方法，将经颅磁刺激（长期以来被视为神经康复的辅助方法）与上肢机器人治疗（另一种有前途的方法）相结合。我们的初步数据显示，脑刺激有可能测量和诱导运动皮层的可塑性。我们计划：1；确定增强正常志愿者可塑性的刺激时间参数；2. 确定增强正常志愿者可塑性的刺激位置参数；和3。确定慢性脑卒中患者有效性的可行性和试点数据。由此产生的方法将适用于中风幸存者中发现的广泛的运动障碍，以及将运动练习与其他刺激相结合的广泛方法，无论是自然的（如视觉提示）还是人工的（如磁刺激）。当我们完成这些目标时，我们将建立一种方法，可以用于更大的、多地点的联合刺激和上肢机器人康复的临床试验，并且还将揭示关于通过在正常和中风患者中精确定时的刺激和重复运动练习来诱导运动皮质可塑性的有价值的基本机制。完成这些目标所获得的数据将极大地影响未来卒中康复范式的设计。

DESCRIPTION (provided by applicant): Stroke is one of the most common causes of disability and there is tremendous room for improvement in rehabilitation techniques. While neural plasticity likely supports much natural and practice-related recovery, such naturally occurring mechanisms for plasticity could be potentially enhanced to improved functional outcomes. We propose a hybrid approach to combining transcranial magnetic stimulation, long seen as an adjunctive method in neurorehabilitation, with upper extremity robotic therapy, another promising method. Our preliminary data shows the potential of brain stimulation to measure and induce plasticity in the motor cortex. We plan to: 1. Determine parameters of stimulation timing that enhance plasticity in normal volunteers; 2. Determine parameters of stimulation location that enhance plasticity in normal volunteers; and 3. Determine feasibility and pilot data regarding effectiveness in chronic stroke patients. The resulting methods will be applicable to a wide range of motor disability found in stroke survivors and a wide range of methods that combine motor practice with other stimuli, whether natural (such as visual cuing) or artificial (such as magnetic stimulation.) When we have accomplished these aims, we will have established methods that can be used in a larger, multi-site clinical trial of combined stimulation and upper extremity robotic rehabilitation, and will also have uncovered valuable basic mechanisms regarding the induction of motor cortical plasticity through a precisely timed combination of stimulation and repetitive practice of movement in both normal and stroke affected populations. The data obtained by completing these aims will greatly impact future design of stroke rehabilitation paradigms.