Recovery of Affective Prosody after Stroke

对中风结局的研究几乎完全集中在非常基本的功能恢复上，例如 吃饭、洗澡、走路、说话。然而，社会功能障碍，包括 识别和表达情绪也是中风的常见后果。情感减弱 韵律学（通过声音的语调、速度、停顿和重音来理解和传达情感）是一种 尤其是右半球中风后常见的损伤，可能被误解为同情心的丧失， 冷漠或抑郁（这些问题也可能是中风的重要后果，但需要不同的 管理）。韵律的恰当表达和识别对于有效的社会交往也是至关重要的。 尽管情感韵律减弱对生活质量和社会功能有影响，但这些障碍 研究不足，并且这些疾病的循证治疗很少。设计有效的， 有效的干预措施，将提高生活质量，促进充分参与社会，并计划 为了评估干预措施，我们首先需要打好基础。我们需要找出 知觉，认知和运动缺陷，可以破坏情感韵律;表征的自然历史， 恢复和变量，影响这些赤字的恢复;并确定支持神经网络， 这些功能及其恢复。识别支持这些过程的网络将使我们能够选择 这些干预措施将有助于招募这些网络来增强行为治疗。在这个项目中，我们将 整合：1）对受损的知觉、认知和运动过程进行详细的纵向分析 中风后第一年内四个时间点每位患者的潜在韵律，以及（2）详细 结构和功能损伤的纵向分析（例如，在右腹侧和背侧流中）， 在第一年的相同四个时间点，每例患者关键区域之间的功能连接 中风后，和（3）变量（如抗抑郁药的时间和剂量）和合并症的分析 (such抑郁症）影响恢复。通过整合这些方法，我们将有一个更好的 理解自然恢复轨迹和损伤及其神经基础 复苏结合这些数据集将使我们能够测试关于感知，认知， 和运动过程及其神经机制的基础上的情感韵律和有关恢复这些 由于局灶性病变而破裂后的过程。此外，通过建立线性混合效应模型， 独立变量对结果的潜在影响，我们将能够解释和识别变量 改变预后。这三组数据也将为设计治疗方法提供基础， 联合收割机结合行为治疗与药物或神经靶向干预，如经颅直接 电流刺激这些数据集的整合也将提供证据，指导谁需要治疗， 什么时候治疗，以及在大脑的什么地方治疗这些功能。

Research on stroke outcomes has focused almost exclusively on recovery of very basic functions, such as feeding oneself, bathing, walking, and speaking. However, impairments in social function, including impaired recognition and expression of emotions, are also common consequences of stroke. Diminished affective prosody (understanding and conveying emotion through vocal intonation, rate, pauses, and stress), is a particularly common impairment after right hemisphere stroke, and can be misinterpreted as loss of empathy, apathy, or depression (problems that can also be important consequences of stroke, but require different management). Appropriate expression and recognition of prosody is also critical for effective social interaction. Despite the impact of diminished affective prosody on quality of life and function in society, these disorders are understudied, and there are few evidence-based treatments for these disorders. To design effective and efficient interventions that will improve quality of life and facilitate full participation in society, and to plan treatment trials to evaluate the interventions, we first need to lay the groundwork. We need to identify the perceptual, cognitive, and motor deficits that can disrupt affective prosody; characterize the natural history of recovery and variables that influence recovery of these deficits; and identify the neural networks that support these functions and their recovery. Identifying the networks that support these processes will allow us to select interventions that will help recruit these networks to augment behavioral therapy. In this project we will integrate: 1) detailed longitudinal analysis of the impaired perceptual, cognitive, and motor processes underlying prosody in each patient at four time points over the first year after stroke, and (2) detailed longitudinal analysis of the structural and functional lesions (e.g., in right ventral and dorsal streams) and functional connectivity between critical regions in each patient at the same four time points over the first year after stroke, and (3) analyses of variables (such as timing and doses of antidepressants) and co-morbidities (such as depression) that influence recovery. By integrating these methods, we will have a better understanding of the natural recovery trajectories and the neural basis of both the impairments and their recovery. Combining these datasets will allow us to test specific hypotheses about the perceptual, cognitive, and motor processes and their neural mechanisms underlying affective prosody and about recovery of these process after disruption due to focal lesions. Furthermore, by building linear mixed effect models to identify the potential impact of independent variables on outcomes, we will be able to prognosticate and identify variables that modify prognosis. These three sets of data will also provide a foundation for designing treatments that combine behavioral therapy with medications or neurally-targeted interventions such as transcranial direct current stimulation. Integration of these datasets will also provide evidence to guide who needs treatment, when to treat, and where in the brain to treat these functions.