Identifying and predicting subgroups related to function in individuals after stroke.

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PROJECT SUMMARY/ABSTRACT Two common, long-lasting deficits after stroke are impaired mobility and cognition. Impairments in mobility and cognition are associated with numerous negative health consequences, including falls, poor quality of life, and hospital readmissions. Recovery of mobility and cognition after stroke is highly variable and poorly understood. Therefore, rehabilitation professionals are unable to provide interventions that are tailored to each specific patients they treat, contributing to a “one size fits all” approach to post stroke rehabilitation that is characterized by incomplete recovery and high healthcare costs. A comprehensive characterization of recovery and models that predict recovery are essential to shifting towards interventions that are tailored to specific individuals after stroke. Thus, the overall objective of this proposal is to develop models that predict what recovery trajectory of mobility and cognition individuals after stroke will follow. Recovery trajectories completely describe patient recovery and are characterized both their extent (i.e., large, moderate, or limited) and temporal pattern (i.e., fast or slow). Both the extent and pattern of recovery can impact the type, timing, and dosing of rehabilitation interventions; however, the extent of recovery has been the focus of previous work. Models that predict the recovery trajectory, rather than just the extent of recovery, for mobility and cognition for individuals after stroke are essential to moving towards rehabilitation interventions that are targeted towards specific individuals after stroke. Past work related to upper extremity recovery after stroke suggest that there are subgroups related to recovery trajectories and that the characteristics of individuals can be used to develop predictive models. Therefore, the central hypothesis of this work is that we can 1) characterize recovery trajectories for mobility and cognition after stroke and 2) use characteristics of individuals after stroke to develop models to predict mobility and cognition recovery trajectories. The results of this proposal will provide a comprehensive understanding of the recovery of mobility and cognition after stroke and an accurate predictive model of the recovery trajectories of mobility and cognition. This will guide the development and delivery of interventions to the right person at the right time to optimize functional recovery and improve the efficiency of our healthcare system. Additionally, the proposed work serves as a first step towards the long-term goal of this fellowship applicant, which is to understand variability in patient recovery in order to move post-stroke rehabilitation towards the delivery of interventions that are tailored to each specific patient, thereby, improving patient outcomes within a more efficient healthcare system. By completing this fellowship proposal under the guidance of experienced mentors in a strong research environment, the applicant will receive the training needed to become a productive, independent scientist and to achieve her long term career goals.