Non-Invasive Brain-Signal Training To Induce Motor Control Recovery after Stroke

描述（由申请人提供）：问题。常规治疗不能使许多中风幸存者恢复正常的运动功能。大多数可用的干预措施直接治疗周围神经系统（手臂/腿）。由于中风发生在大脑中，导致脑神经损伤和功能障碍，更直接的方法是通过直接治疗控制运动的大脑信号的激活来重新训练大脑。目的：我们的目的是确定表面获得性脑信号（脑电图（EEG））是否可以被重新训练，以驱动中风幸存者更正常的功能伸手/抓握。我们将使用两种不同的互补的大脑信号，训练组件。对于第一个分量，我们将训练一个逐渐更正常的大脑信号（在上肢到达分量期间），根据四个大脑信号特征：信号的位置、信号的幅度、信号的波形和信号的频率内容。在第二个部分中，我们将把大脑信号与尽可能接近正常的期望运动配对。方法：假设一：脑信号训练将导致在功能性伸手/抓握任务中更正常的脑信号。(主要测量：α频段（8-12Hz） C3/4和C5/6电极位置的脑电信号幅度。次要测量将包括：脑信号，事件相关的去同步（ERD）在每个阵列的电极位置和1Hz的频率范围6- 30Hz。假设二：专门针对、调用和训练表面获得的脑电图脑信号，并将脑电图脑信号训练整合到上肢到达运动的运动学习训练中，与不进行脑电图脑信号训练的综合运动学习干预相比，将产生更大的运动恢复效果。（主要测量：上肢运动能力测试）。我们将招募16名中风患者（60 - 6个月），他们将接受脑信号训练和上肢运动学习（8名皮质中风患者；8名皮质下中风患者）。我们将另外招收8名对照受试者，接受类似的上肢运动学习，但不进行脑信号训练。根据先前建立的运动学习方案，两组治疗均为5小时/天，5天/周，共12周。对于大脑训练组的16名受试者，每天进行一次5小时的单次训练，包括：每天1.0小时的大脑信号训练；1.5小时/天，fes辅助和机器人辅助运动（不包括脑信号训练）；2.5小时/天，运动学习（无模式，无脑信号训练）。意义：通过直接重新训练脑信号，干预有可能更彻底地恢复严重患者的运动功能。公共卫生相关性：本研究的目的是确定是否可以重新训练非侵入性获得的脑信号（脑电图（EEG））来驱动中风幸存者更正常的运动功能。与传统运动相比，直接治疗脑信号异常可能对更多的中风幸存者更有益，并且比不进行直接大脑训练更有可能完全恢复正常功能。

DESCRIPTION (provided by applicant): Problem. Conventional treatment does not restore normal motor function to many stroke survivors. The majority of available interventions direct treatment at the peripheral nervous system (arms/legs). Since stroke occurs in the brain and results in brain neuronal damage and dysfunction, a more direct approach would be to re-train the brain by directly treating the activation of brain signals that control movement. Purpose: Our purpose is to determine whether the surface-acquired brain signal (electroencephalography (EEG)) can feasibly be re-trained to drive more normal functional reach/grasp in stroke survivors. We will use two different and complimentary brain signal, training components. For the first component, we will train a progressively more normal brain signal (during upper limb reach components), in terms of four brain signal features: location of the signal, amplitude of the signal, wave form of the signal, and frequency content of the signal. In the second component, we will pair brain signal with the desired movement that is performed as close-to-normal as possible. Methods: Hypothesis I: Brain signal training will result in a more normal brain signal during a functional reach/grasp task. (Primary measure: EEG signal amplitude at electrode locations, C3/4 and C5/6, in the alpha frequency band (8-12Hz). Secondary measures will include: brain signal, event related desynchronization (ERD) at each of an array of electrode locations and at 1Hz frequency bins across 6- 30Hz. Hypothesis II: Specifically targeting, invoking, and training the surface-acquired EEG brain signal, and integrating brain signal training into motor learning training of the upper limb reach movement, will result in greater motor restoration versus a comparable comprehensive motor learning intervention without EEG brain signal training. (Primary measure: Arm Motor Ability Test, upper limb function). We will enroll 16 subjects who had a stroke (>6 months) and who will receive brain signal training and upper limb motor learning (8 with cortical; 8 with sub-cortical stroke). We will enroll 8 additional control subjects receiving comparable upper limb motor learning, but no brain signal training. Treatment for both groups will be 5hrs/day, 5days/wk, for 12 wks, based on prior established motor learning protocols. For the 16 subjects in the brain training group, a single 5hr daily session, will be composed of: 1.0 hr/day, brain signal training; 1.5 hrs/day, FES-assisted and robotics-assisted movement (no brain signal training included); 2.5 hrs/day, motor learning (without modalities, without brain signal training). Significance: By directly re-training brain signal, the intervention has the potential to more completely restore motor function for more severely involved patients. PUBLIC HEALTH RELEVANCE: The purpose of this study is to determine whether non-invasively acquired brain signal (electroencephalography (EEG)) can feasibly be re-trained to drive more normal motor function in stroke survivors. Compared to conventional exercise, directly treating brain signal abnormality has the potential to be more beneficial for a greater number of stroke survivors and has the potential to more completely restore normal function, than is otherwise possible without direct brain training.