Early Post-Stroke Biomarkers for Motor Rehabilitation Outcomes

点击翻译按钮获取中文摘要

Project Summary/Abstract This proposal represents a five-year research career development program focusing on identifying early predictors of chronic motor control impairments post-stroke. The outlined proposal builds on the candidate’s prior research and experience, and will contribute to the candidate’s development as an independent researcher by supporting her training in the application of neuroimaging, transcranial magnetic stimulation, and advanced biostatistical analysis in post-stroke recovery research. Stroke is the leading cause of adult disability in the US. Of those who receive rehabilitation therapy, approximately 40% have chronically impaired motor function of the upper extremity, contributing to decreased quality of life and increased societal burden of stroke. Currently, clinical rehabilitation focus on repetitive motor exercises, but interventions are not adapted for individual stroke lesion location or predicted trajectory of recovery. Prior studies have identified distinct impairments of motor control that contribute to poor function at the chronic stage and likely depend on neuroanatomical structures damaged by the stroke, but the details of what contributes to development of these impairments and timing of when they emerge remains unclear. In order to create optimal rehabilitation strategies and maximize each individual patient’s rehabilitation potential, we need better methods for predicting and treating these motor control impairments. In this proposal, we aim to use an electromyographic computer interface (ECI) to study motor impairments in the muscle groups that control wrist flexion and extension, and perform a longitudinal study to 1) establish the natural history of distinct motor control impairments post-stroke and 2) identify early neuroimaging, electrophysiologic, and clinical markers that predict specific motor impairments at the chronic stage. We then 3) evaluate the feasibility of using the ECI to provide early, intensive biofeedback therapy to target the predicted impairments of the individual patients. These studies will establish the necessary foundation for future development of precision-medicine therapies in neurorehabilitation. Furthermore, the mentored research and career development plan will provide the applicant with the opportunity for further training in leading longitudinal studies, advanced biostatistical analysis, and functional and structural neuroimaging. The results of this research and career development award will foster the expansion of her clinical research program, which is dedicated to developing novel therapies to treat early motor changes post-stroke.