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视了感觉缺陷，即使感觉缺陷阻碍了运动， 复苏因此，我们开发了一种新的感官刺激，Therabracelet，其中腕带适用于 对手腕皮肤产生不易察觉的振动，立即增强手部感觉和灵活性，促进可塑性， 并且使家庭使用能够增加治疗剂量，大大超过典型的诊所就诊。的目标 该提案旨在确定在家中连续使用TheraBracelet是否具有临床意义。 职业发展的目标是建立评估中风恢复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， 中度手部损伤的患者将每天在瘫痪手腕上佩戴TheraBracelet设备8小时， 每天在他们正常的日常活动，1个月，来实验室进行每周评估和1- 个月随访评价。器械将提供振动（治疗）或无振动（对照）。双- 由于治疗振动是察觉不到的（即，亚阈值）。目标1：确定 家庭使用TheraBracelet对神经可塑性的影响。假设：TheraBracelet诱导神经可塑性。 主要的测量是感觉输入调节初级运动皮层的程度，使用配对的 在正中神经电刺激之前立即使用TMS的联合刺激方案。 次要措施是皮质连接和使用EEG评估的抓握相关频谱功率变化。 次要分析将包括与TheraBracelet反应性相关的个体因素， 对结果进行纵向分析，以确定效应随时间积累的方式。目标2：确定 家庭使用TheraBracelet对手功能影响。假设：即时改善在手 TheraBracelet的功能导致在家中更多地使用受影响的手和手臂， 复苏将使用加速度计评估日常生活中的麻痹手臂使用量。临床 将使用Wolf运动功能、方块和动作研究手臂测试评估手功能。 此外，生物力学手握力控制将通过直接握力、过度握力 使用的，和动力学/运动学响应的扰动夹持对象来描述动态反馈控制。 影响：这项研究将阐明神经可塑性和行为的影响，通过穿着一种新的感觉 沿着确定可能响应者和治疗持续时间 方面的影响.本研究将指导未来R 01的设计，以研究TheraBracelet的临床效用， 中风后手部运动恢复这项研究是转化为中风幸存者可以很容易地使用这种低风险 震动腕带这项研究支持了COBRE的主要主题，即神经调节， 创新的治疗设备，并使用多学科数据集进行个性化干预。增强 手功能的改善应该会提高中风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.