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.

项目概要/摘要 该应用解决了空间忽视认知康复的巨大治疗差距 (SN)，定义为右脑之后对左侧空间的不对称定向、感知和反应 中风，导致功能障碍。尽管患有 SN 的退伍军人回家的可能性只有一半， 拥有三分之一的社区流动性，需要三倍的护理人员监督，并且有更长的时间 与类似的右脑相比，住院次数、跌倒风险增加和再住院次数增加 对于中风幸存者来说，针对退伍军人的个性化 SN 康复方法不可用 护理系统。我们发现额叶损伤和“瞄准”SN 都预测最优 棱镜适应治疗（PAT）后恢复功能独立性。这些发现论证了 开发一种[客观的、基于生物标志物的流程来识别应该接受治疗的患者 实施 PAT。该算法将通过识别特定的神经生物学特征来开发 预测 PAT 治疗反应。因此，我们预计这项研究将提供一个关键的缺失 康复的要素，消除临床医生对 SN 诊断和适当性的不确定性 PAT，并为 SN 康复提供更加个性化的医疗保健方法。我们的团队 三个高性能退伍军人事务部医疗中心的研究人员在认知神经学领域表现出色 根据高级和临床数据分析脑成像预测因子和中风康复， 将开发第一个可用于分配 SN 康复的生物参数。 180年 退伍军人（120 名有 SN，60 名没有），我们将定义并验证预测的脑成像生物标志物 Aiming SN (Aim 1) 的存在，是接受 PAT 后功能恢复的有力预测因子。我们的 预期额叶区域与皮层下和顶叶区域的断开将预测 瞄准SN。我们还将检查预测大脑成像生物标志物之间的相关性 针对 PAT 后的 SN 和日常生活功能的改善（目标 2）。] 然后，我们将确定是否 将行为预测变量添加到生物标志物预测变量中（目标 3）可解释 功能恢复的轨迹。我们工作的总体影响将是建立一个 经过验证的生物标志物，可常规识别中风后患有 SN 的退伍军人谁是最好的 PAT 候选人。配备基于生物标记的算法，我们就可以进行大规模的 PAT 临床试验和个性化 SN 护理。这种护理途径可以减少对专业护理的依赖 SN 评估，[协调 VA 和社区系统提供退伍军人中风护理，] 并改进 中风护理效率，以提高数千名退伍军人中风后的结果和生活质量。