CUped: An Approach to Motor Recovery Post-Stroke, not Compensation

项目摘要 卒中后肢体康复的目标是恢复家庭和家庭的独立行走。 社区。很少有中风幸存者能实现这一目标。次优结果是由于严重和 中风引起的运动障碍的顽固性以及缺乏可行和有效的 恢复因中风而失去的运动的疗法。 我们的团队开发了一种名为CUPed的新型运动干预措施(发音为丘比特，就像罗马的神一样) 以解决康复障碍和改善中风后的行走。CUPed之所以被称为CUPed，是因为它强制使用 在类似于脚踏板的运动中偏瘫的肢体。该项目将检查安全性、可接受性、 以及对CUPED的耐受性，表征其治疗效果，并确定剂量-反应关系。结果 将为R01提供初步数据，以支持随机对照试验(RCT)。 CUPED旨在帮助中风幸存者恢复因中风而失去的肢体运动，从而改善 走路。它的目的是作为步态训练的辅助工具。CUPed使用一种机器人技术， 消除干扰康复的代偿性运动，强迫使用瘫痪的下肢，以及 目标3中风造成的关键运动障碍：瘫痪肢体的肌肉输出减少， 偏瘫肌肉时机不当，四肢间协调异常。锻炼是在坐着的时候进行的， 实现高重复练习。和走路一样，CUPed也需要双腿持续、相互使用； 这种影响很可能会转移到步行上。 这项提案的风险回报概况对于R21来说是理想的，这是NIH的一个融资机会，旨在 通过为早期和概念阶段提供支持，鼓励探索性/发展性研究 项目开发。CUPED是一种基于生理前提和先验知识的新型疗法 我们实验室的观察结果。我们有试点数据表明CUPed达到了它的设计规范， 这项研究将是第一次测试其治疗效果。在第一阶段康复试验中，我们将支持或 迅速驳斥这样的假设，即CUPED是安全、可接受的，并且能够在 中风幸存者。我们还将检查对CUPED的耐受性和剂量反应效应。如果我们的假设是 支持下，我们将准备运行RCT，以隔离CUPed的影响并将其与标准进行比较 关心。未来的工作将研究CUPED作用的生理机制。

Project Summary The goal of lower limb rehabilitation after stroke is recovery of independent walking at home and in the community. Few stroke survivors achieve this goal. Suboptimal outcomes are due to the serious and intransigent nature of movement impairments caused by stroke and the scarcity of feasible and effective therapies that restore movement lost to stroke. Our team has developed a novel exercise intervention called CUped (pronounced cupid, like the Roman god) to address barriers to recovery and improve walking after stroke. CUped is so called because it compels use of the paretic limb during a movement that resembles pedaling. This project will examine safety, acceptability, and tolerance to CUped, characterize its therapeutic effects, and identify dose-response relationships. Results will provide preliminary data for an R01 to support a randomized controlled trial (RCT). CUped is designed to help stroke survivors recover lower limb movement lost to stroke, thereby improving walking. It is intended to be used as an adjunct to gait training. CUped uses a robotic technology that eliminates compensatory movements that interfere with recovery, compels use of the paretic lower limb, and targets 3 key movement impairments caused by stroke: decreased muscle output from the paretic limb, inappropriate paretic muscle timing, and abnormal interlimb coordination. Exercise is done in sitting which enables high repetition practice. Like walking, CUped requires continuous, reciprocal use of both lower limbs; effects are likely to transfer to walking. The risk-reward profile of this proposal is ideal for an R21, which is an NIH funding opportunity intended to encourage exploratory/developmental research by providing support for the early and conceptual stages of project development. CUped is a novel therapy grounded in a physiologic premise and based on prior observations from our laboratory. We have pilot data suggesting that CUped fulfills its design specifications, and this study will be the first to test its therapeutic effects. In this Stage 1 rehabilitation trial, we will support or quickly refute the hypothesis that CUped is safe, acceptable, and capable of eliciting a therapeutic response in stroke survivors. We will also examine tolerance to CUped and dose-response effects. If our hypotheses are supported, we will be poised to run an RCT to isolate the effects of CUped and compare them to standard care. Future work will investigate physiologic mechanisms underlying the effects of CUped.