Home-Based Automated Therapy of Arm Function After Stroke Via Tele-Rehabilitation

描述（由申请人提供）：约束诱导运动疗法（CIMT）是为数不多的技术之一，在对照研究中显示，对轻度至中度偏瘫中风幸存者的实际手臂功能产生了很大的改善。标准治疗包括在诊所进行一对一的训练，每天3小时，连续10个工作日，并在另一只手上戴上手套，以阻止其使用。由于对治疗师时间的需求和患者每天前往诊所2周的要求，CIMT的相当大的成本对那些可能接受治疗的人施加了很大的限制。我们的实验室与Peter Lum博士一起开发了一种自动递送CIMT的设备，名为AutoCITE；它允许练习8个上肢任务，并提供频繁的图形性能反馈。两份报告表明，AutoCITE与标准CIMT一样有效，即使治疗师的努力减少了75%。第三份报告表明，AutoCITE在模拟远程康复条件下（即患者和治疗师在实验室的不同房间）也同样有效。我们建议修改AutoCITE，使其更适合在患者家中使用，并评估其在远程治疗基础上提供CIMT的功效。我们还将专门测试使AutoCITE软件更具互动性是否有助于患者在家中接受训练，因为家中有更多的干扰。为此，我们将87名慢性中风幸存者随机分为：AutoCITE在家中进行培训，由一名治疗师通过基于互联网的视听链接远程监督两名患者。2 .程序相同，只是互动性更强的软件将在AutoCITE上运行。剂量匹配的家庭标准CIMT。以家庭为基础的二对一远程AutoCITE组的运动结果和成本将与以家庭为基础的一对一体内CIMT组的结果和成本，以及先前以实验室为基础的AutoCITE组和标准CIMT组的结果和成本进行比较。如果成功的话，AutoCITE可能会成为远程治疗的平台，除了CIMT之外，它还可以作为其他上肢治疗的平台。AutoCITE只涉及实际物体的自动化任务练习，比目前流行的基于虚拟现实的方法便宜得多。每年约有30万新的中风幸存者患有运动障碍，降低成本并增加有效的上肢康复机会有可能显著减少残疾。我们的实验室与Peter Lum博士合作开发了一种名为AutoCITE的设备，用于自动提供约束诱导运动疗法（CI疗法）；它允许练习8个上肢任务，并提供频繁的图形性能反馈。最近发表的两项研究表明，AutoCITE与一对一CI疗法一样有效。我们提出的研究将测试AutoCITE装置在患者家中远程康复基础上提供CI治疗的功效。每年大约有30万新的中风幸存者伴有运动残障。降低成本并增加获得有效的上肢康复的机会，有可能显著减轻中风患者、其家庭和卫生保健系统的负担。

DESCRIPTION (provided by applicant): Constraint-Induced Movement therapy (CIMT) is one of few techniques that has been shown in controlled studies to produce large improvements in real-world arm function in stroke survivors with mild to moderate hemiparesis. The standard treatment involves one-on-one training of paretic arm use in the clinic for 3 hr/day for 10 consecutive weekdays and placing a mitt on the other hand to discourage its use. The considerable cost of CIMT, due to the demand on therapist time and requirement that patients travel daily to a clinic for 2 weeks, imposes substantial limits on those who might access the therapy. Our lab, with Peter Lum, Ph.D., has developed a device for automating the delivery of CIMT named AutoCITE; it permits practice of 8 upper- extremity tasks and provides frequent graphical performance feedback. Two reports indicate that AutoCITE is as efficacious as standard CIMT even with therapist effort reduced by 75%. A third report suggests that AutoCITE under simulated telerehabilitation conditions (i.e., patient and therapist were in different rooms in the lab) is also just as efficacious. We propose to modify AutoCITE so that it is more appropriate for use in patients' homes and evaluate its efficacy for providing CIMT on a telerehab basis. We will also specifically test whether making the AutoCITE software more interactive helps patients to comply with training at home, where there are more distractions. To this end, we will randomize 87 chronic stroke survivors to: 1. AutoCITE training in the home with two patients supervised concurrently by one therapist remotely via an Internet-based audio- visual link, 2. the same procedures except that the more interactive software will be run on AutoCITE, and 3. dose-matched, standard CIMT in the home. Motor outcomes and costs from the home-based, two-on-one, tele-AutoCITE groups will be compared to those from the home-based, one-on-one, in vivo CIMT group and to those from laboratory-based AutoCITE and standard CIMT groups run previously. If successful, AutoCITE, which involves simply automating task practice with actual objects and is much less expensive than prevailing virtual reality based approaches, might serve as a platform for delivering other upper-extremity therapies, in addition to CIMT, via telerehab. With about 300,000 new stroke survivors suffering motor disability annually, cutting the cost of and increasing access to efficacious upper-extremity rehabilitation has the potential to reduce disability significantly. PUBLIC HEALTH RELEVANCE Our laboratory, in collaboration with Peter Lum, Ph.D., has developed a device for automating the delivery of Constraint-Induced Movement therapy (CI therapy) named AutoCITE; it permits practice of 8 upper-extremity tasks and provides frequent graphical performance feedback. Two recently published studies suggest that AutoCITE is as efficacious as one-one-one CI therapy. Our proposed study will test the efficacy of the AutoCITE device to provide CI therapy on a tele-rehabilitation basis in patients' home. There are approximately 300,000 new strokes survivors with residual motor disability annually. Reducing the cost of and increasing access to efficacious upper-extremity rehabilitation has the potential to significantly reduce the burden of stroke on patients, their families and the healthcare system.