Stroke Plasticity

描述（由申请人提供）：当大脑某些部位的血液供应受损并可导致局灶性运动、语言和日常生活中重要的一般功能缺陷时，就会发生中风。脑卒中患者脑缺损后的恢复与脑皮层可塑性随时间的变化有关。有证据表明，这些可塑性变化对功能恢复和康复可以是适应性的，也可以是不适应的，旨在促进适应网络和抑制不适应网络可能会加速中风的恢复。表征可塑性随时间变化的一种方法是利用功能磁共振成像（fMRI）方法对遭受侮辱（例如中风）的成年人进行研究，这些侮辱导致与特定语言或运动功能相关的区域受损。研究表明，随着时间的推移，这些患者在执行语言或运动功能时，通过大脑重组改变来显示恢复。有许多新颖的中风康复治疗旨在提高恢复。然而，目前还没有关于如何使用这些治疗方法的指导方针。有必要开发一套预后预测指标，以决定哪些患者适合哪种治疗，确定一个时间窗口，最好地预测中风恢复，从而理想的干预，以及表征适应和不适应的大脑可塑性变化，以促进更快，更有效的康复。本建议有三个目的：1)确定预后预测因子

DESCRIPTION (provided by applicant): Stroke occurs when blood supply to some part of the brain is compromised and can lead to focal motor, language, and general functional deficits important for activities of daily life. Recovery after deficits in stroke patients is linked to bran plasticity changes occurring over time. There is evidence that these plasticity changes can be adaptive as well as maladaptive towards functional recovery and rehabilitation aimed at facilitating adaptive networks and suppressing maladaptive networks may hasten stroke recovery. One way to characterize plasticity changes over time is by utilizing fMRI methods in adults who have suffered an insult (e.g., stroke) resulting in damage to an area typically associated with a specific language or motor function. Studies have shown that these patients show recovery through brain reorganization changes over time where a network of areas are recruited while performing the language or motor function. There are a number of novel stroke rehabilitation treatments aimed at improving recovery. Yet no set guidelines exist on how to utilize these treatments. There is an important need to develop a set of prognostic predictors to make decisions about which patients are appropriate for which treatment, identify a time window that best predicts stroke recovery and therefore ideal for intervention, as well as characterize adaptive and maladaptive brain plasticity changes in order to facilitate faster and more effective rehabilitation. This proposal has three aims: 1) Identify prognostic predictors of stroke recovery, 2) Identify a time window which best predicts stroke recovery, and 3) Identify adaptive and maladaptive brain plasticity changes involved in stroke recovery. Stroke patients will undergo through neuroimaging and behavioral testing at the acute, subacute and chronic stages. Neuroimaging measures (e.g., fMRI activation) along with clinical measures will be utilized to predict behavior. It is hypothesized that neuroimaging along with clinical measures will predict motor, language, and general functional stroke recovery more accurately than either measure. It is also hypothesized a subacute time window would best predict stroke recovery, given that the most robust plasticity changes occur at this time window. It is hypothesized that that brain plasticity changes assessed by brain measures over time will predict behavioral performance changes over time, characterizing adaptive and maladaptive plasticity networks essential for motor, language, and general functional stroke recovery. Overall this would lead to better prognostic prediction of recovery in stroke patients, identify a critical time window for intervention, identify adaptive and maladaptive networks involved in reorganization. Subsequently this would allow us to provide individualized treatments based on the prognostics, allow us to intervene at a particular time window for optimal effect, and expand the potential for a range of rehabilitation strategies aimed at facilitating adaptive and suppressing maladaptive networks hastening and maximizing functional recovery.