Prism adaptation treatment (PAT) for right brain stroke rehabilitation

用于右脑中风康复的棱镜适应治疗（PAT）

• 批准号: 10426803
• 负责人: A. M. Barrett
• 金额: --
• 依托单位: NORTHAMPTON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10426803
• 关键词: Address; Algorithms; Attention; Basal Ganglia; Behavioral; Biological; Biological Markers; Brain; Brain imaging; Brain scan; Caregivers; Caring; Characteristics; Classification; Clinical; Clinical Data; Clinical Treatment; Clinical Trials; Cognition Disorders; Cognitive; Communities; Data; Development; Diagnosis; Eating; Elements; Enrollment; Home; Hospitalization; Hospitals; Lateral; Left; Lesion; Life; Maps; Measures; Medical center; Modeling; Motor; Movement; Neurobiology; Neurology; Optics; Outcome; Paralysed; Parietal; Parietal Lobe; Pathologic; Pathway interactions; Patients; Perception; Prediction of Response to Therapy; Process; Prospective Studies; Quality of life; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Research; Research Personnel; Scientist; Self Care; Series; Side; Specificity; Sterile coverings; Stroke; Supervision; Symptoms; System; Techniques; Testing; Training; Treatment outcome; Uncertainty; Veterans; Visual; Wheelchairs; Work; behavior prediction; biomarker identification; biomarker validation; candidate identification; candidate marker; care systems; cognitive rehabilitation; effective therapy; evidence base; expectation; experience; fall risk; frontal lobe; frontal lobe cortex; functional disability; functional improvement; functional independence; functional outcomes; hospital readmission; imaging biomarker; improved; innovation; motor recovery; neuroimaging; neuroimaging marker; personalized approach; personalized health care; post stroke; precision medicine; predicting response; predictive marker; prevent; prognostic model; recruit; rehabilitation research; spatial neglect; stroke rehabilitation; stroke survivor; targeted treatment; treatment responders; treatment response; visual motor; white matter

Project Summary/Abstract The application addresses the formidable treatment gap for cognitive rehabilitation of spatial neglect (SN), defined as asymmetric orienting, perception, and responding to left space after right brain stroke, causing functional disability. Although veterans with SN are half as likely to return home, have one-third the community mobility, require 3x as much caregiver supervision, and have longer hospitalizations, increased fall risk and increased rehospitalization compared with similar right brain stroke survivors, a personalized approach to SN rehabilitation is not available in veteran-specific systems of care. We discovered that frontal lobe damage and “Aiming” SN both predict optimal recovery of functional independence after prism adaptation treatment (PAT). These findings argue for the development of an [objective, biomarker-based process to identify patients who should be administered PAT. The algorithm will be developed by identifying specific neurobiological features predictive of PAT treatment response. Thus, we expect this research will deliver a critical missing element to rehabilitation, eliminating clinician uncertainty about SN diagnosis and appropriateness of PAT, and allowing a more personalized health care approach to SN rehabilitation. Our team of researchers at three high-performing VA medical centers, distinguished in cognitive neurology analysis of brain imaging predictors, and stroke rehabilitation, from both advanced and clinical data, will develop the first biological parameter that can be used to assign SN rehabilitation. In 180 veterans (120 with SN, 60 without), we will define and validate brain imaging biomarkers that predict the presence of Aiming SN (Aim 1), a strong predictor of functional recovery after receiving PAT. Our expectation that disconnection of frontal regions with subcortical and parietal regions will predict Aiming SN. We will also examine the correlation between the brain imaging biomarkers predicting Aiming SN and improvements in daily life function after PAT (Aim 2).] Then, we will determine if adding behavioral predictors to biomarker predictors (Aim 3) accounts for additional variance in the trajectory of functional recovery. The overall impact of our work will be to establish the utility of a validated biomarker that routinely identifies veterans with SN after stroke who are the best candidates for PAT. Armed with a biomarker-based algorithm, we can then carry out a large-scale PAT clinical trial, and personalized SN care. This care pathway could reduce reliance on specialized SN assessment, [coordinate VA and community systems providing veteran stroke care,] and improve stroke care efficiency, to enhance outcomes and quality of life after stroke for thousands of veterans.

项目摘要/摘要 该申请解决了空间忽视的认知康复的强大治疗差距 （SN），定义为不对称方向，感知和右脑后左空间响应 中风，导致功能障碍。尽管SN的退伍军人返回家园的可能性是 拥有三分之一的社区流动性，需要3倍的护理人员监督，并且有更长的时间 与相似的右脑相比 中风存活，一种个性化的SN康复方法 护理系统。我们发现额叶损坏和“瞄准” SN都可以预测最佳 棱镜适应治疗后的功能独立性（PAT）。这些发现主张 开发[基于生物标志物的客观，基于生物标志物的过程，以识别应成为的患者 管理PAT。该算法将通过识别特定的神经生物学特征开发 预测PAT治疗反应。这是我们预计这项研究将带来严重的错过 康复的要素，消除有关SN诊断和适当性的临床不确定性 拍打，并允许采用更个性化的医疗保健方法进行SN康复。我们的团队 三个高绩效VA医疗中心的研究人员，在认知神经病学方面有特色 分析先进和临床数据的大脑成像预测因子和中风康复， 将开发第一个可用于分配SN康复的生物学参数。 180 退伍军人（120 sn，60，无），我们将定义和验证脑成像生物标志物预测的生物标志物 瞄准SN的存在（AIM 1），这是接收PAT后功能恢复的强有力预测指标。我们的 期望与皮层和顶部区域的额叶区域断开会预测 瞄准SN。我们还将检查脑成像生物标志物预测的相关性 瞄准SN和PAT之后的日常生活功能的改善（AIM 2）。然后，我们将确定是否是否 将行为预测因子添加到生物标志物预测因子（AIM 3），说明了 功能恢复的轨迹。我们工作的总体影响是建立一个 经过验证的生物标志物，通常会以中风后的SN识别退伍军人，谁是最好的 Pat的候选人。用基于生物标志物的算法武装，我们可以进行大规模进行 PAT临床试验和个性化的SN护理。这种护理途径可以减少对专业的缓解 SN评估，[协调VA和社区系统提供资深中风护理]，并改善 中风护理效率，以提高成千上万退伍军人的中风后的结果和生活质量。