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

描述（由申请人提供）：约束诱导运动疗法（CIMT）是对照研究中显示的少数几种技术之一，可大幅改善轻度至中度轻偏瘫卒中幸存者的真实手臂功能。标准治疗包括在诊所进行一对一的麻痹手臂使用训练，每天3小时，连续10个工作日，另一方面戴上手套以阻止其使用。CIMT的相当大的成本，由于对治疗师时间的需求和要求，患者每天前往诊所2周，对那些可能获得治疗的人施加了很大的限制。我们的实验室，与彼得林博士，开发了一种名为AutoCITE的CIMT自动化设备，它允许练习8个上肢任务，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，即使治疗师的努力减少了75%。第三份报告表明，AutoCITE在模拟远程康复条件下（即，病人和治疗师在实验室的不同房间）也同样有效。我们建议修改AutoCITE，使其更适合在患者家中使用，并评估其在远程康复基础上提供CIMT的疗效。我们还将专门测试是否使AutoCITE软件更具交互性有助于患者在家中遵守培训，那里有更多的分心。为此，我们将87名慢性卒中幸存者随机分为：1. AutoCITE培训在家中进行，两名患者同时由一名治疗师通过基于互联网的视听链接远程监督，2.相同的程序，只是更多的交互式软件将在AutoCITE上运行，以及3.剂量匹配的标准CIMT将家庭2对1远程AutoCITE组的运动结果和成本与家庭1对1体内CIMT组以及之前运行的实验室AutoCITE和标准CIMT组的结果和成本进行比较。如果成功的话，AutoCITE，它涉及简单地自动化任务实践与实际对象，比流行的基于虚拟现实的方法便宜得多，可以作为一个平台，提供其他上肢治疗，除了CIMT，通过远程康复。每年约有30万新的中风幸存者患有运动残疾，削减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着减少残疾。 我们的实验室与Peter Lum博士合作，开发了一种用于自动提供约束诱导运动疗法（CI疗法）的设备，名为AutoCITE;它允许练习8种上肢任务，并提供频繁的图形表现反馈。最近发表的两项研究表明，AutoCITE与一对一CI疗法一样有效。我们提出的研究将测试AutoCITE设备在患者家中远程康复基础上提供CI治疗的有效性。每年约有300，000名新的中风幸存者患有残余运动残疾。降低有效上肢康复的成本并增加获得有效上肢康复的机会，有可能显著减轻中风对患者、其家庭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.