Optimizing the Dose of Rehabilitation After Stroke

描述(由申请者提供)：由于每个中风后患者都有独特的损伤和功能，因此重要的是要脱离“一刀切”的康复方法。尽管现在有证据表明，运动疗法可以改善中、轻度损伤患者受影响较大的肢体的功能和使用，但在治疗后的几个月里，使用情况的变化是不同的：对一些患者来说，使用增加了，但对另一些患者来说，使用减少了。我们的长期目标是前瞻性地确定治疗剂量，从而在将成本保持在合理水平的同时，进一步改善个别患者的治疗后使用--我们称之为临界剂量。我们在这里的目标是调查作为治疗剂量和患者的神经和行为特征的函数的长期使用预测。我们的一般假设是，对于一部分患者，治疗后手臂和手的功能需要达到一个阈值水平，这样，如果治疗使功能超过这个阈值，自发使用和功能将在良性循环中相互促进。我们根据计算模型提出了我们的假设，这些模型证明了这样一个阈值，并解释了现有的数据。我们将解决我们的一般假设，并通过两个目标来实现我们的目标。目的1.确定分布剂量的治疗对上肢使用的即刻和长期收益的影响。目的2：开发一种计算个体患者临界剂量的方法。在第一个目标中，我们将检验我们的一般假设，并生成有关功能和用途的临床数据。然后，这些数据将被用于第二个目标，基于扩展卡尔曼滤波，开发作为治疗剂量以及行为和神经学数据的函数的手臂和手的长期使用的预测模型。我们建议的工作意义重大，因为这种中风恢复的预测模型，一旦在未来的临床试验中得到资助，就可以用来影响关于以合理的成本为越来越多的中风幸存者提供有效治疗的必要剂量的政策。这项工作还将做出重要的神经科学贡献，因为我们将对使用受影响手臂的决定与运动功能恢复之间的因果和适应性联系进行建模和行为测试。

DESCRIPTION (provided by applicant): Because each patient post stroke has unique impairments and function, it is important to depart from a "one size fits all" approach to rehabilitation. Although there is now evidence that motor therapy can improve function and use of the more affected limb for patients with moderate to mild impairments, change in use in the months following therapy is variable: for some patients there is an increase in use, but for others a decrease in use. Our long-term goal is to determine prospectively the dose of therapy that leads to further improvements of use after therapy for individual patients while keeping cost at reasonable levels - we call this dose critical dose. Our objective here is to investigate long-term predictions of use as a function of the dose of therapy and of the patient's neurological and behavioral characteristics. Our general hypothesis is that, for a subset of patients, there is a threshold level for arm and hand function to be achieved after therapy, such that if therapy brings function above this threshold, spontaneous use and function will reinforce each other in a virtuous circle. We formulated our hypothesis based on computational models that demonstrate such a threshold and account for existing data. We will address our general hypothesis and accomplish our objective with two aims. Aim 1. Determine the effect of a distributed dose of therapy on immediate and long-term gains in upper extremity use. Aim 2: Develop a means to compute the critical dose for individual patients. With the first aim, we will test our general hypothesis and generate relevant clinical data of function and use. The data will then be used in the second aim to develop a predictive model, based on the Extended Kalman Filter, of long-term arm and hand use as a function of the dose of therapy as well as behavioral and neurological data. Our proposed work is significant because such a predictive model of stroke recovery, once subjected under future funding to clinical trials, can be used to influence policy regarding the necessary dosage of effective treatments at a reasonable cost for the growing number of persons who have survived stroke. This work will also make an important neuro- scientific contribution as we will model, and test behaviorally, the causal and adaptive linkages between the decisions to use the affected arm and recovery of motor function.