Mental Practice in Chronic, Stroke-Induced Hemiparesis

描述（由申请人提供）：尽管中风的发病率和患病率不断增加，但传统的受累手臂康复治疗的疗效可忽略不计。较新的方法强调对受影响的手臂进行重复的特定任务练习（RTP）。虽然这些方法很有前途，但它们通常需要特殊的设备来管理，对患者和治疗师来说可能是密集和/或繁重的，并且/或者可能是侵入性的。上述许多方法所固有的策略也不会得到保险计划的补偿。因此，仍然需要用于轻偏瘫的容易实施的、廉价的、非侵入性RTP方法。心理练习（MP）是一种补充/替代医学（CAM）身心技术，其中身体技能可以以廉价，重复的方式进行排练。该实验室首次表明，在RTP中添加MP比传统运动疗法在中风中产生更大的受影响手臂运动结果。PI随后的研究证实，MP改善了受影响的手臂运动学，并增加了受影响的手臂使用和功能，这项工作最终导致了积极的MP试验。PI最近的工作也确定了最佳的MP持续时间，在此期间，电机的变化最大。下一个合乎逻辑的步骤是在IIb期多中心试验中确定MP的疗效。这项双中心研究将随机分配100例慢性卒中患者：（a）MP治疗结合RTP训练;或（B）仅RTP训练。这将解决本申请的目的，即确定包括MP在内的RTP方案对慢性卒中的影响。结局包括功能限制（主要终点）、损伤、实验室和社区活动限制、生活质量和fMRI。中心假设是参与MP + RTP将减少功能限制。我们将检验我们的中心假设，并通过追求以下具体目标来实现我们的目标：（1）确定MP + RTP与RTP相比对受影响手臂功能限制的疗效;（2）确定MP + RTP对受影响手臂结局的影响;（3）使用fMRI确定MP + RTP对皮质组织的影响。公共卫生相关性中风是美国残疾的主要原因，它会导致运动障碍，影响重要活动的表现。轻偏瘫尤其致残，是卒中相关残疾的主要损害，也是美国治疗师治疗的最常见损害。这项研究将测试一种有前途的技术在减少残疾和增加功能，从而改善结果和健康，并降低护理成本，为社区居住的中风引起的轻偏瘫患者的有效性。

DESCRIPTION (provided by applicant): Despite increasing stroke incidence and prevalence, conventional affected arm rehabilitation offers negligible efficacy. Newer approaches emphasize repetitive, task-specific practice (RTP) with the affected arm. While these approaches are promising, they often require particular equipment to administer, can be intensive and/or taxing for the patient and therapist, and/or can be invasive. Strategies inherent in many of the above approaches are also not reimbursed by insurance plans. Thus, there remains a need for easily implemented, inexpensive, non-invasive RTP approaches for hemiparesis. Mental practice (MP) is a complementary/alternative medicine (CAM) mind-body technique in which physical skills can be rehearsed in an inexpensive, repetitive manner. This lab was the first to show that addition of MP to RTP yields significantly larger affected arm motor outcomes than conventional motor therapy in stroke. The PI's subsequent research confirmed that MP improves affected arm kinematics, and increases affected arm use and function, with this work culminating in a positive MP trial. The PI's recent work has also determined optimal MP duration at which the largest motor changes are exhibited. The next logical step is to determine MP efficacy in a Phase IIb, multicenter trial. This two-center study will randomize [100] chronic stroke patients to either: (a) MP sessions combined with RTP training; or (b) RTP training only. This will address the objective of this application, which is to determine the impact of a RTP regimen including MP in chronic stroke. Outcomes include functional limitation (primary endpoint), impairment, activity restriction in the lab and community, quality of life, and fMRI. The central hypothesis is that participation in MP + RTP will reduce functional limitation. We will test our central hypothesis and accomplish our objective by pursuing the following specific aims: (1) Determine efficacy of MP + RTP as compared to RTP on affected arm functional limitation; (2) Determine the impact of MP + RTP on affected arm outcomes; (3) Determin MP + RTP effects on cortical organization using fMRI. PUBLIC HEALTH RELEVANCE Stroke is the leading cause of disability in the United States, producing motor impairments that compromise performance of valued activities. Hemiparesis is particularly disabling, is the primary impairment underlying stroke-related disability, and the most frequent impairment treated by therapists in the United States. This study will test efficacy of a promising technique in reducing disability and increasing function, thereby improving outcomes and health, and reducing care costs, for community dwelling patients with stroke-induced hemiparesis.