Translation of in-clinic Gains to Gains in Daily Life After Stroke

项目总结/摘要 中风康复研究已经产生了许多有效的和新兴的干预措施，以改善中风患者的生活质量。 运动、平衡和上肢功能。试验结果在功能能力水平上进行衡量，其中 能力被定义为一个人在诊所的结构化环境中能够做什么，或者 实验室长期以来，人们一直认为，容量的提高会导致现实世界的改善。 表现，其中表现被定义为一个人在日常生活中，在诊所外或 实验室我们上一个奖励周期的数据显示，干预后， 使用可穿戴传感器（即加速度计）测量的容量和性能。所示组平均数 能力和自我报告的业绩有所改善，但实际业绩没有改善。在 在个人层面上，没有人表现出表现的改善，即使是那些 能力的重大变化。鉴于提供中风后康复服务的一个关键目的是 在日常生活中，我们发现了一个值得研究的重大问题。 本项目将研究容量和性能之间的差异，长期目标是使用 所获得的知识，以开发新的或修改现有的康复干预措施，将改善 日常生活中的表现。我们将研究两个前瞻性纵向队列，以解决三个目标。目标1将 试图了解神经康复领域内问题的范围。我们将研究一组 人接受门诊服务，以确定是否有能力和性能之间的差异 是上肢介入和/或中风康复所特有的。目标2旨在了解何时，多少， 上肢能力的提高转化为表现的提高。我们将研究另一组 第一次中风的人绘制自然的表现轨迹及其与能力的关系， 中风恢复时间过程中的其他因素（2周至6个月内）。Aim 3采用 观点认为，上肢表现是一种健康的行为或习惯，可能会改变。我们 将利用与目标2相同的队列，探索卒中幸存者态度和障碍的时间进程 到性能。 来自这些队列的数据将改变目前的做法，了解何时以及与谁一起运动 康复干预可以改善日常生活中的表现。康复研究将通过 关于容量与性能的知识，以及何时以及如何将容量改进转化为 性能改进。我们的数据将为未来的研究设计提供信息，并作为开发 并测试性能水平的干预措施，以改善中风的结果在真实的世界，而不仅仅是在 诊所或实验室。

PROJECT SUMMARY/ABSTRACT Stroke rehabilitation research has produced a number of efficacious and emerging interventions for improving mobility, balance, and upper limb function. Trial outcomes are measured at the functional capacity level, where capacity is defined as what a person is capable of doing in the structured environment of the clinic or laboratory. It has long been assumed that improvements in capacity result in improvements in real-world performance, where performance is defined as what a person actually does in daily life, outside of the clinic or laboratory. Our data from the previous award cycle show a striking difference after intervention between capacity and performance measured with wearable sensors, i.e. accelerometers. Group averages indicated some improvement in capacity and in self-reported performance, but no improvement in actual performance. At the individual level, no one showed improvements in performance, even those individuals who made substantial changes in capacity. Given that a key purpose of providing rehabilitation services post stroke is to improve performance in daily life, we have uncovered a major problem that merits investigation. This project will examine the discrepancy between capacity and performance, with the long-term goal of using the knowledge gained to develop new or modify current rehabilitation interventions that will improve performance in daily life. We will study two prospective longitudinal cohorts to address three aims. Aim 1 will seek to understand the scope of the problem within the field of neurorehabilitation. We will study a cohort of people receiving outpatient services to determine whether the discrepancy between capacity and performance is unique to upper limb interventions and/or stroke rehabilitation. Aim 2 is designed to learn when, how much, and in whom, upper limb capacity gains translate to performance gains. We will study another cohort of persons with first time stroke to map the natural trajectory of performance and its relationships to capacity and other factors over the time course of stroke recovery (within 2 weeks out to 6 months). Aim 3 takes the viewpoint that upper limb performance is a health behavior, or habit, which may be amenable to change. We will capitalize on the same cohort as Aim 2 and explore the time course of stroke survivor attitudes and barriers to performance. Data from these cohorts will transform current practice with knowledge of when and with whom motor rehabilitation interventions can improve performance in daily life. Rehabilitation research will be advanced by knowledge about capacity vs. performance, and when and how capacity improvements can translate to performance improvements. Our data will inform future research design and serve as a basis for developing and testing of performance-level interventions to improve stroke outcomes in the real world, not just in the clinic or laboratory.