Optimizing the Dose of Rehabilitation After Stroke

描述（由申请人提供）：由于每位卒中后患者都有独特的损伤和功能，因此远离“一刀切”的康复方法非常重要。虽然现在有证据表明，运动疗法可以改善功能和使用更多的患肢的中度至轻度障碍的患者，在治疗后的几个月内使用的变化是可变的：对于一些患者，有一个增加使用，但对于其他人的使用减少。我们的长期目标是前瞻性地确定导致个体患者治疗后使用进一步改善的治疗剂量，同时将成本保持在合理水平-我们称之为剂量关键剂量。我们的目标是研究长期使用的预测作为治疗剂量和患者的神经和行为特征的函数。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有一个阈值水平，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加强。我们根据计算模型制定了我们的假设，这些模型证明了这样一个阈值，并考虑了现有的数据。我们将讨论我们的一般假设，并通过两个目标实现我们的目标。目标1.确定分布式剂量治疗对上肢使用的即时和长期收益的影响。目标2：开发一种计算个体患者临界剂量的方法。第一个目标是，我们将测试我们的一般假设，并生成功能和用途的相关临床数据。然后，这些数据将用于第二个目标，以开发基于扩展卡尔曼滤波器的长期手臂和手部使用的预测模型，作为治疗剂量以及行为和神经数据的函数。我们提出的工作是重要的，因为这样的中风恢复的预测模型，一旦在未来的资金进行临床试验，可以用来影响政策的必要剂量的有效治疗，在合理的成本为越来越多的人谁幸存的中风。这项工作也将作出重要的神经科学贡献，因为我们将建模，并测试行为，因果关系和适应性之间的联系，决定使用受影响的手臂和恢复运动功能。

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.