Mental Practice in Chronic, Stroke-Induced Hemiparesis

描述（由申请人提供）：尽管中风的发病率和患病率不断上升，但传统的患臂康复的疗效微不足道。较新的方法强调重复的，特定任务的练习（RTP）与受影响的手臂。虽然这些方法很有前途，但它们通常需要特殊的设备来管理，对患者和治疗师来说可能是密集的和/或繁重的，并且/或可能是侵入性的。上述许多方法所固有的策略也不能由保险计划报销。因此，仍然需要易于实施、廉价、无创的偏瘫RTP方法。心理练习（MP）是一种补充/替代医学（CAM）身心技术，在这种技术中，身体技能可以以一种廉价的、重复的方式进行演练。该实验室首次表明，与常规运动治疗相比，在RTP中加入MP可显著提高中风患者的手臂运动预后。PI随后的研究证实，MP改善了受影响手臂的运动学，增加了受影响手臂的使用和功能，这项工作在MP试验中达到了高潮。PI最近的工作也确定了最佳MP持续时间，其中最大的电机变化显示。下一个合乎逻辑的步骤是在IIb期多中心试验中确定MP的疗效。这项双中心研究将[100]名慢性卒中患者随机分为两组：(a) MP联合RTP训练；或(b)仅进行RTP培训。这将解决本应用的目的，即确定包括MP在内的RTP方案对慢性卒中的影响。结果包括功能限制（主要终点）、损伤、实验室和社区活动限制、生活质量和功能磁共振成像。中心假设是参与MP + RTP将减少功能限制。我们将通过以下具体目标来检验我们的中心假设并实现我们的目标：(1)确定与RTP相比，MP + RTP对受影响的手臂功能限制的疗效；(2)确定MP + RTP对受影响组结局的影响；(3) fMRI检测MP + RTP对皮质组织的影响。中风是美国致残的主要原因，其产生的运动障碍会影响有价值活动的表现。偏瘫特别致残，是中风相关残疾的主要损害，也是美国治疗师治疗的最常见的损害。这项研究将测试一种有前途的技术在减少残疾和增加功能方面的功效，从而改善社区居住的中风性偏瘫患者的预后和健康状况，并降低护理成本。

DESCRIPTION (provided by applicant): Despite increasing stroke incidence and prevalence, conventional affected arm rehabilitation offers negligible efficacy. Newer approaches emphasize repetitive, task-specific practice (RTP) with the affected arm. While these approaches are promising, they often require particular equipment to administer, can be intensive and/or taxing for the patient and therapist, and/or can be invasive. Strategies inherent in many of the above approaches are also not reimbursed by insurance plans. Thus, there remains a need for easily implemented, inexpensive, non-invasive RTP approaches for hemiparesis. Mental practice (MP) is a complementary/alternative medicine (CAM) mind-body technique in which physical skills can be rehearsed in an inexpensive, repetitive manner. This lab was the first to show that addition of MP to RTP yields significantly larger affected arm motor outcomes than conventional motor therapy in stroke. The PI's subsequent research confirmed that MP improves affected arm kinematics, and increases affected arm use and function, with this work culminating in a positive MP trial. The PI's recent work has also determined optimal MP duration at which the largest motor changes are exhibited. The next logical step is to determine MP efficacy in a Phase IIb, multicenter trial. This two-center study will randomize [100] chronic stroke patients to either: (a) MP sessions combined with RTP training; or (b) RTP training only. This will address the objective of this application, which is to determine the impact of a RTP regimen including MP in chronic stroke. Outcomes include functional limitation (primary endpoint), impairment, activity restriction in the lab and community, quality of life, and fMRI. The central hypothesis is that participation in MP + RTP will reduce functional limitation. We will test our central hypothesis and accomplish our objective by pursuing the following specific aims: (1) Determine efficacy of MP + RTP as compared to RTP on affected arm functional limitation; (2) Determine the impact of MP + RTP on affected arm outcomes; (3) Determin MP + RTP effects on cortical organization using fMRI. PUBLIC HEALTH RELEVANCE Stroke is the leading cause of disability in the United States, producing motor impairments that compromise performance of valued activities. Hemiparesis is particularly disabling, is the primary impairment underlying stroke-related disability, and the most frequent impairment treated by therapists in the United States. This study will test efficacy of a promising technique in reducing disability and increasing function, thereby improving outcomes and health, and reducing care costs, for community dwelling patients with stroke-induced hemiparesis.