Mental Practice in Chronic, Stroke-Induced Hemiparesis

描述(由申请人提供)：尽管中风发病率和患病率增加，但传统的受影响手臂康复效果微乎其微。较新的方法强调对受影响的ARM进行重复的特定任务练习(RTP)。虽然这些方法很有希望，但它们通常需要特定的设备来管理，对患者和治疗师来说可能是密集和/或繁重的，和/或可能是侵入性的。上述许多办法所固有的战略也不会得到保险计划的补偿。因此，仍然需要易于实施的、廉价的、非侵入性的偏瘫RTP方法。心理练习(MP)是一种补充/替代医学(CAM)的心身技术，其中身体技能可以以一种廉价的、重复的方式进行排练。该实验室首次表明，与传统的运动疗法相比，在RTP中加入MP对中风患者手臂运动结果的影响明显更大。PI随后的研究证实，MP改善了受影响的手臂运动学，并增加了受影响的手臂的使用和功能，这项工作最终以MP阳性试验告终。PI最近的工作还确定了显示最大马达变化的最佳MP持续时间。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。这项双中心研究将把[100]名慢性中风患者随机分为两组：(A)MP联合RTP训练；或(B)仅RTP训练。这将解决这项应用的目标，即确定包括MP在内的RTP方案在慢性卒中中的影响。结果包括功能受限(主要终点)、损害、实验室和社区活动受限、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。我们将验证我们的中心假设，并通过追求以下具体目标来实现我们的目标：(1)确定MP+RTP与RTP对受影响手臂功能限制的疗效；(2)确定MP+RTP对受影响手臂结果的影响；(3)利用功能磁共振成像确定MP+RTP对皮质组织的影响。与公共健康相关中风是美国残疾的主要原因，会导致运动障碍，影响有价值的活动的表现。偏瘫尤其致残，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。这项研究将测试一项有前景的技术在减少残疾和增加功能，从而改善结果和健康，并降低护理费用，社区居住的中风导致的偏瘫患者的有效性。

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.