Neuroplasticity with Daily Use of a Sensorimotor Priming Vibration System to Improve Hand Function After Stroke

目前的中风手康复忽略了感觉障碍，即使感觉障碍阻碍了运动 恢复。因此，我们开发了一种新的感官刺激，Therabraclet，其中应用了腕带 潜移默化地震动手腕皮肤，立即增强手感和灵巧度，促进可塑性， 并使家庭使用能够大大增加治疗剂量，大大超过典型的诊所就诊。的目标是 这项建议是为了确定在家中持续使用TheraBraclet是否具有临床意义的效果。 职业发展的目标是建立评估中风康复背后的神经可塑性的专业知识。 由感官增强引起的。在一项双盲随机对照试验中，慢性中风幸存者 有中度手部损伤的患者每天将在偏瘫手腕上佩戴TheraBraclet设备8小时 1个月的正常日常活动中的一天，每周来实验室进行评估和1- 一个月的随访评估。该装置将提供振动(治疗)或无振动(控制)。双倍- 致盲是可能的，因为治疗振动是不可察觉的(即，亚阈值)。目标1：确定 家庭使用TheraBraclet对神经可塑性的影响假设：TheraBraclet诱导神经可塑性。 主要的衡量标准是感觉输入对初级运动皮质的调节程度，使用配对的 TMS联合刺激方案，在此之前立即进行正中神经电刺激。 次要测量是使用EEG评估皮质连接性和GRIP相关频谱功率变化。 二次分析将包括与对TheraBraclet和 对结果进行纵向分析，以确定影响随时间积累的方式。目标2：确定 家庭使用TheraBraclet对手功能的影响假设：手部的即刻改进 佩戴TheraBraclet手环的功能会导致在家中更多地使用受影响的手和手臂，从而导致功能性 恢复。日常生活中偏瘫手臂的使用量将使用加速计进行评估。临床 手功能将使用沃尔夫运动功能、方框和方块以及行动研究手臂测试进行评估。 此外，生物力学的握力控制将通过直接握力的能力来评估，多余的握力 用于描述动态反馈控制，以及对被握持对象的扰动的运动学/运动学响应。 影响：这项研究将阐明佩戴新感官所引起的神经可塑性和行为影响 日常生活中的刺激装置，以及确定可能的应答者和治疗持续时间 效果。这项研究将指导未来R01的设计，以研究TheraBraclet的临床应用 中风后手部运动恢复。这项研究是转译的，因为中风幸存者可以很容易地使用这种低风险 振动腕带。这项研究支持科布雷关于神经调节的主要主题，翻译成 创新的治疗装置，并使用多学科数据集进行个性化干预。增强 手功能应提高卒中幸存者的独立性和生活质量。

Current stroke hand rehabilitation overlooks sensory deficits, even though sensory deficits hinder motor recovery. Thus, we have developed a novel sensory stimulation, Therabracelet, in which a wristband applies imperceptible vibration to wrist skin to immediately enhance hand sensation and dexterity, facilitate plasticity, and enable home use to increase the treatment dose substantially beyond typical clinic visits. The objective of this proposal is to determine if continuous use of TheraBracelet in the home has a clinically meaningful effect. The career development objective is to build expertise in assessing neural plasticity underlying stroke recovery induced by sensory enhancement. In a double-blinded randomized controlled trial, chronic stroke survivors with moderate hand impairment will wear the TheraBracelet device on the paretic wrist for 8 hours/day every day during their normal daily activity for 1 month, coming to the laboratory for weekly evaluation and for 1- month follow-up evaluation. The device will deliver vibration (treatment) or no vibration (control). Double- blinding is possible because the treatment vibration is imperceptible (i.e., subthreshold). Aim 1: Determine the effect of in-home use of TheraBracelet on neural plasticity. Hypothesis: TheraBracelet induces neural plasticity. The primary measure is the extent that sensory input modulates the primary motor cortex, using the paired associative stimulation protocol with TMS immediately preceded by electrical median nerve stimulation. Secondary measures are cortical connectivity and grip-related spectral power change assessed using EEG. Secondary analyses will include individual factors associated with responsiveness to TheraBracelet and longitudinal analysis of outcomes to determine the way effects accumulate over time. Aim 2: Determine the effect of in-home use of TheraBracelet on hand function. Hypothesis: The immediate improvement in hand function with TheraBracelet leads to more use of the affected hand and arm in the home, resulting in functional recovery. The amount of the paretic arm use in daily living will be assessed using accelerometers. Clinical hand function will be assessed using the Wolf Motor Function, Box and Block, and Action Research Arm Tests. In addition, biomechanical hand grip control will be assessed by the ability to direct grip force, excess grip force used, and kinetic/kinematic response to perturbation of a gripped object to describe dynamic feedback control. Impact: This research will elucidate neural plasticity and behavioral effects induced by wearing a novel sensory stimulation device throughout daily living, along with determining likely responders and treatment duration effects. This research will guide the design of a future R01 to investigate the clinical utility of TheraBracelet for post-stroke hand motor recovery. This research is translational as stroke survivors can easily use this low-risk vibrating wristband. This research supports the COBRE major themes of neuromodulation, translation of an innovative treatment device, and using multidisciplinary datasets toward individualized intervention. Enhancing hand function should increase stroke survivors’ independence and quality of life.