Movement perception in Functional Neurological Disorder (FND)

功能性神经疾病 (FND) 的运动感知

• 批准号: MR/Y004000/1
• 负责人: Paul Warren
• 金额: $ 79.74万
• 依托单位: University of Manchester
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FY004000%2F1
• 关键词: Movement; perception; Functional; Neurological; Disorder

Functional Neurological Disorder (FND) is a common, debilitating condition often causing problems with movement and balance. It is second only to headaches as a reason for referral to a neurologist, however, it is little understood and treatments are limited, leaving people with FND with few options. In this project we will study FND from a new perspective, suggesting movement symptoms might arise due to problems with the brain systems that help us to: i) Perceive movement in our environment from the motion arising on the back of the eye (the retina) ii) Control our movement through the environment. The second of these activities obviously requires the brain to estimate how we are moving, which involves combining self-movement information appropriately from a range of senses (including vision together with balance information from the inner ear). However, the first activity also relies on knowing about self-movement - the brain cannot assess how other parts of the environment are moving without taking into account our own movement first. For example, a traffic cone that is stationary in the environment will be moving on the retina if we drive past it. To establish that the cone is, in fact, 'world stationary' the brain needs to factor in and compensate for our own movement. The brain solves this this problem by rapidly predicting/estimating the motion on the retina due to self-movement and then compensating for this before interpreting the movement of other parts of the environment. Without this ability we would incorrectly interpret motion on the retina - stationary parts of the environment would seem to move and problems with balance and movement similar to those experienced in FND would follow. With these issues in mind, we will test theories suggesting that FND movement symptoms arise from inappropriate combination of sensory information about self-movement and/or estimation and compensation for our self-movement when interpreting how other parts of the world are moving. We will focus on a subgroup of FND patients with Persistent Postural-Perceptual Dizziness (3PD), who experience particularly pronounced movement symptoms and use established experimental approaches to test our hypotheses. Crucially we will also use Virtual Reality (VR) technology, which allows us to break the relationship between self-movement and the retinal movement that normally accompanies it. Using well-established methods from sensory science we will measure (for each individual) the ability to: i) estimate self-movement and movement of other parts of the environment ii) compensate for self-movement; iii) combine different sensory information sources about self-movement. We can then consider how these measures differ in those with and without 3PD and how they might predict 3PD symptoms and problems in everyday movement tasks.Having better understanding of the factors causing 3PD/FND movement symptoms, will then allow us to investigate novel VR-based therapies to reduce symptoms. For example, our pilot data suggest less compensation for self-movement in 3PD and we could counteract this by temporarily placing patients in VR environments where motion on the retina is slightly increased relative to what should normally accompany self-movement, gradually reducing this to normal over a period of time. Similarly, if we find that combination of self-movement information is altered in FND (e.g. too much emphasis placed on visual information) we could use VR to direct more attention towards the overlooked information source. Crucially, such approaches could be tailored to the individual.We anticipate that our research will lead to significantly better understanding of the causes of FND/3PD and, subsequently, better and more targeted therapies. As a consequence we are confident that this work could rapidly translate into future studies demonstrating direct benefit for a large patient group with limited treatment options.

功能性神经系统障碍（FND）是一种常见的，使人衰弱的状况，通常导致运动和平衡问题。它仅次于头痛是转介给神经科医生的原因，但是，它几乎没有理解，而治疗却是有限的，这使人们有很少的选择。在这个项目中，我们将从新的角度研究FND，这表明可能会出现运动症状，这是由于大脑系统的问题可以帮助我们：i）从眼睛背面的运动（视网膜）中感知到环境中的运动，ii）控制着我们通过环境的运动。这些活动中的第二个显然要求大脑估计我们的移动方式，这涉及从一系列感官（包括视觉以及内耳的平衡信息）中适当地结合自动移动信息。但是，第一个活动也依赖于了解自动运动 - 大脑无法首先考虑我们自己的运动，无法评估环境的移动方式。例如，如果我们经过环境，则在环境中固定的交通锥将在视网膜上移动。为了确定锥体实际上是“世界固定”的大脑需要考虑并弥补我们自己的运动。大脑通过快速预测/估计因自动移动而在视网膜上的运动，然后在解释环境其他部分运动之前对此进行补偿来解决这个问题。如果没有这种能力，我们将错误地解释在视网膜上的运动 - 环境的固定部分似乎会移动，而平衡和运动的问题与FND中经历的相似。考虑到这些问题，我们将测试理论，表明FND运动症状是由有关自动移动和/或估计以及对我们自动化的估算以及解释世界其他地区如何移动时的感觉信息的不适当组合产生的。我们将专注于持续的姿势感知头晕（3pd）的FND子组，他们经历了特别明显的运动症状，并使用既定的实验方法来检验我们的假设。至关重要的是，我们还将使用虚拟现实（VR）技术，这使我们能够打破自动移动与通常伴随的视网膜运动之间的关系。使用感官科学的完善方法，我们将（对于每个人）衡量以下能力：i）估计环境其他部分的自动移动和运动ii）弥补自动化； iii）结合有关自动运动的不同感官信息。然后，我们可以考虑这些措施在有和没有3PD的情况下如何有所不同，以及它们如何预测日常运动任务中的3PD症状和问题。对导致3PD/FND运动症状的因素有更好的了解，然后将使我们能够研究基于VR的新型疗法以减轻症状。例如，我们的飞行员数据表明​​，在3PD中为自动移动的赔偿较少，我们可以通过将患者暂时放置在视网膜上的运动环境中暂时增加相对于通常伴随自动运动的情况略有增加，从而逐渐将其逐渐减少到正常的时间。同样，如果我们发现自动移动信息的组合在FND中发生了变化（例如，对视觉信息过多强调），我们可以使用VR将更多的注意力引向被忽视的信息源。至关重要的是，这种方法可以量身定制为个人。我们预计我们的研究将使人们对FND/3PD的原因有了更大的了解，随后，更好，更有针对性的疗法。结果，我们相信这项工作可以迅速转化为未来的研究，证明了一个有限治疗方案的大型患者群体的直接利益。