Moderating Post-Stroke Hemiparesis with the Cross Education Phenomenon

描述(申请人提供)：中风后偏瘫带来的残疾对中风幸存者和美国经济都有负面影响。有证据为基础的运动再培训计划已被证明可以促进运动恢复。然而，如果受影响的上肢瘫痪太严重，个人就无法参与。拟议项目的目标是调查干预措施的潜力，以解决严重偏瘫潜在的神经功能障碍。交叉教育效应是运动科学文献中的一种既定现象，它解释了高强度、单侧阻力训练在未训练的对侧肢体中引起的力量增加。虽然还没有得出明确的结论，但目前的共识是，慢性的大脑半球间和皮质脊髓适应是观察到的未经训练的肢体获得力量的基础。这些适应与偏瘫后通常观察到的情况相反，可能是对非瘫痪肢体进行高强度的单侧阻力训练，可能会驱动瘫痪肢体运动恢复所需的神经适应。采用前瞻性队列、重复测量设计，受试者将接受16次高强度、单侧阻力的非偏瘫腕伸肌训练。会议将以每周四次的频率进行，为期四周。拟议的项目将采取多层次的方法来研究神经和行为功能的变化。主要目的是测试干预是否会改变皮质脊髓的兴奋性。假设皮质脊髓投射到偏瘫的指总伸肌的兴奋性会增强。第二个目标将检验干预是否会导致未经训练的偏瘫腕伸肌主动活动范围的假想增加。第三个目标将评估干预是否导致瘫痪上肢功能能力的假想增加。该项目的预期结果是一种干预措施，可以提高中风后严重偏瘫患者的上肢运动能力。这种干预的最终目标是使严重瘫痪患者能够充分地参与经验性的运动再训练计划。该项目还将促进实现博士培训和职业目标所需的经验。 乌尔宾。

DESCRIPTION (provided by applicant): The disability brought about by post-stroke hemiparesis has negative consequences for the stroke survivor and the U.S. economy. There are evidence-based motor retraining programs that have been shown to promote movement recovery. If paresis in the affected upper extremity is too severe, however, individuals are not able to participate. The goal of the proposed project is to investigate the potential of an intervention that addresses the neural dysfunction underlying severe hemiparesis. The cross education effect is an established phenomenon in the exercise science literature that accounts for strength gains high-intensity, unilateral resistance training evokes in the contralateral, untrained limb. Though no definitive conclusions have been reached, the current consensus is that chronic interhemispheric and corticospinal adaptations underlie the strength gains observed in the untrained limb. These adaptations are the inverse of what is typically observed following hemiparetic stroke, inviting the possibility that high-intensity, unilateral resistance training ofthe non-paretic limb may drive the neural adaptations needed for movement restoration in the paretic limb. Using a prospective cohort, repeated-measures design, subjects will undergo 16 sessions of high-intensity, unilateral resistance training of the non-paretic wrist extensors. Sessions will take place at a frequency of four times per week over four weeks. The proposed project will take a multilevel approach to investigate changes in neural and behavioral function. The primary aim will test whether the intervention alters corticospinal excitability. It is hypothesized that there will be enhanced excitability of corticospinal projections to the paretic extensor digitorum communis. The secondary aim will examine whether the intervention elicits a hypothesized increase in active range of motion in the untrained, paretic wrist extensors. The third aim will evaluate whether the intervention leads to a hypothesized increase in functional capacity of the paretic upper extremity. The expected outcome of this project is an intervention that enhances paretic upper extremity movement production in persons with severe post-stroke hemiparesis. The ultimate goal is for this intervention to moderate paresis sufficiently for severely affected patients to participate in empirically-supported motor retraining programs. This project also will facilitate the experiences needed to achieve the training and career goals of Dr. Urbin.