Recovery of Affective Prosody after Stroke

关于中风预后的研究几乎完全集中在非常基本的功能的恢复上，例如 吃饭、洗澡、走路、说话。然而，社会功能受损，包括受损 认知和表达情绪，也是中风的常见后果。情感减退 韵律(通过声调、语速、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害，可能被误解为同理心的丧失， 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互动也是至关重要的。 尽管情感韵律的减少对社会生活质量和功能有影响，但这些障碍是 研究不足，几乎没有针对这些疾病的循证治疗。要设计出有效的和 有效的干预措施，将提高生活质量，促进充分参与社会，并规划 治疗试验要评估干预措施，首先需要做好基础工作。我们需要确定 会打乱情感韵律的知觉、认知和运动缺陷；描述 恢复和影响这些赤字恢复的变量；并确定支持 这些功能及其恢复。确定支持这些进程的网络将使我们能够选择 有助于招募这些网络的干预措施，以加强行为治疗。在这个项目中，我们将 整合：1)对受损的感知、认知和运动过程进行详细的纵向分析 每个患者在卒中后第一年的四个时间点的潜在韵律，以及(2)详细的 结构和功能损害的纵向分析(例如，在右腹和背侧流)和 每名患者在第一年相同的四个时间点的关键区域之间的功能连接 中风后，以及(3)变量(如抗抑郁药物的时间和剂量)和合并症的分析 (例如抑郁症)会影响经济复苏。通过整合这些方法，我们将拥有更好的 理解自然恢复的轨迹和损伤及其神经基础 恢复。结合这些数据集将允许我们测试关于感知、认知、 情感韵律背后的运动过程及其神经机制及其恢复 由于局灶性病变而中断后的处理。此外，通过建立线性混合效应模型来识别 独立变量对结果的潜在影响，我们将能够预测和识别变量 这会改变预后。这三组数据还将为设计 将行为疗法与药物或神经靶向干预相结合，如经颅直接治疗 电流刺激。这些数据集的整合还将为指导谁需要治疗提供证据， 何时治疗，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.