Harcum Stacey, Conroy Susan S, Boos Amy, Ermer Elsa, Xu Huichun, Zhan Min, Chen Hegang, Whitall Jill, Dimyan Michael A, Wittenberg George F
VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland.
Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.
Arch Rehabil Res Clin Transl. 2019 Dec;1(3-4). doi: 10.1016/j.arrct.2019.100024. Epub 2019 Sep 10.
To demonstrate the feasibility of algorithmic prediction using a model of baseline arm movement, genetic factors, demographic characteristics, and multimodal assessment of the structure and function of motor pathways. To identify prognostic factors and the biological substrate for reductions in arm impairment in response to repetitive task practice.
This prospective single-group interventional study seeks to predict response to a repetitive task practice program using an intent-to-treat paradigm. Response is measured as a change of ≥5 points on the Upper Extremity Fugl-Meyer from baseline to final evaluation (at the end of training).
General community.
Anticipated enrollment of community-dwelling adults with chronic stroke (N = 96; onset≥6mo) and moderate to severe residual hemiparesis of the upper limb as defined by a score of 10-45 points on the Upper Extremity Fugl-Meyer.
The intervention is a form of repetitive task practice using a combination of robot-assisted therapy coupled with functional arm use in real-world tasks administered over 12 weeks.
Upper Extremity Fugl-Meyer Assessment (primary outcome), Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, magnetic resonance imaging, transcranial magnetic stimulation, arm kinematics, accelerometry, and a saliva sample for genetic testing.
Methods for this trial are outlined, and an illustration of interindividual variability is provided by example of 2 participants who present similarly at baseline but achieve markedly different outcomes.
This article presents the design, methodology, and rationale of an ongoing study to develop a predictive model of response to a standardized therapy for stroke survivors with chronic hemiparesis. Applying concepts from precision medicine to neurorehabilitation is practicable and needed to establish realistic rehabilitation goals and to effectively allocate resources.
证明使用基线手臂运动模型、遗传因素、人口统计学特征以及运动通路结构和功能的多模态评估进行算法预测的可行性。识别重复任务练习后手臂功能障碍减轻的预后因素和生物学基础。
这项前瞻性单组干预研究旨在使用意向性治疗范式预测对重复任务练习计划的反应。反应通过上肢Fugl-Meyer评分从基线到最终评估（训练结束时）变化≥5分来衡量。
普通社区。
预计招募患有慢性中风（发病≥6个月）且上肢中度至重度残余偏瘫的社区居住成年人（N = 96），上肢Fugl-Meyer评分为10 - 45分。
干预是一种重复任务练习形式，使用机器人辅助治疗与现实任务中的功能性手臂使用相结合，为期12周。
上肢Fugl-Meyer评估（主要结局）、Wolf运动功能测试、动作研究手臂测试、中风影响量表、疼痛和预期问卷、磁共振成像、经颅磁刺激、手臂运动学、加速度测量以及用于基因检测的唾液样本。
概述了该试验的方法，并通过2名在基线时表现相似但结局明显不同的参与者的例子说明了个体间差异。
本文介绍了一项正在进行的研究的设计、方法和基本原理，该研究旨在为慢性偏瘫中风幸存者开发一种标准化治疗反应的预测模型。将精准医学概念应用于神经康复是可行的，也是确立现实康复目标和有效分配资源所必需的。
