Mechanisms underlying loss of hand function after stroke

描述（由申请人提供）：本指导研究科学家发展奖的目标是允许申请人发展基础科学和临床研究技能，以追求独立的，富有成效的康复研究事业。申请人是一名有执照的物理治疗师，在运动的神经控制方面受过博士和博士后培训。该奖项将通过将申请人在运动控制研究方面的现有专业知识与1)基础科学和体感测量方面的额外培训相结合，以及2)涉及异质患者群体的纵向临床研究的设计、统计分析和执行，提高申请人研究中风患者上肢功能丧失和恢复机制的能力。长期目标是开发一个基于损伤的上肢功能模型，可用于指导中风后患者的康复评估和治疗。所提出的研究的具体目的是为了检验中风后手部功能丧失是由于运动控制丧失和躯体感觉丧失的一般假设。拟议的研究将调查：1)手部近端孤立运动控制的损伤（即无法在空间中定位手）是否会导致手功能下降，2)中风后初级和中级体感模式损伤随时间恢复的程度，以及3)体感损伤是否会导致中风后手功能下降。为了验证这些假设，将对纯运动性偏瘫患者、纯半麻醉患者和偏瘫+半麻醉患者进行上肢所有节段孤立运动控制的纵向运动学测量、上肢初级和中级体感模式的详细测量以及上肢功能的临床测量。多元回归技术将用于确定不同节段的运动控制损伤和不同体感模式的损伤如何导致手功能丧失。拟议研究的结果将为中风后损伤如何导致上肢残疾提供深入的见解，并将为康复专业人员在评估和治疗中风患者时提供有用的信息。

DESCRIPTION (provided by applicant): The goal of this Mentored Research Scientist Development Award is to allow the applicant to develop the basic science and clinical research skills needed to pursue an independent, productive career in rehabilitation research. The applicant is a licensed physical therapist with doctoral and postdoctoral training in the neural control of movement. This award will enhance the applicant's ability to investigate mechanisms underlying loss and recovery of upper extremity function in people with stroke by combining the applicant's existing expertise in studying motor control with additional training in 1) the basic science and measurement of somatosensation, and 2) the design, statistical analyses, and execution of longitudinal clinical studies involving heterogeneous patient populations. The long-term objective is to develop an impairment-based model of upper extremity function that can be used to guide rehabilitation evaluation and treatment of people post stroke. The specific aims of the proposed studies are designed to test the general hypothesis that loss of hand function after stroke is due to loss of motor control and to loss of somatosensation. The proposed studies will investigate: 1) whether or not impairments in isolated motor control at segments proximal to the hand (i.e. the inability to position the hand in space) contribute to reduced hand function, 2) the extent to which impairments after stroke in elementary and intermediate somatosensory modalities recover with time, and 3) whether or not impairments in somatosensation contribute to reduced hand function in people post stroke. To test these hypotheses, longitudinal kinematic measures of isolated motor control of all the segments of the upper extremity, detailed measures of elementary and intermediate somatosensory modalities in the upper extremity, and clinical measures of upper extremity function will be taken in people with pure motor hemiparesis, people with pure hemianesthesia, and people with hemiparesis plus hemianesthesia. Multiple regression techniques will be used to determine how impairments in motor control at the different segments and impairments in the different somatosensory modalities contribute to loss of hand function. Results of the proposed studies will provide insight into how impairments post stroke contribute to disability of the upper extremity and will be useful for rehabilitation professionals during the evaluation and treatment of people with stroke.