Early Post-Stroke Biomarkers for Motor Rehabilitation Outcomes

项目摘要/摘要 该提案代表了一项为期五年的研究职业发展计划，重点是发现早期 中风后慢性运动控制障碍的预测因素。概述的提案建立在候选人的基础上 先前的研究和经验，并将有助于候选人作为独立人士的发展 研究人员通过支持她在神经成像、经颅磁刺激和 卒中后康复研究中的高级生物统计分析。 在美国，中风是导致成年人残疾的主要原因。在接受康复治疗的人中， 约40%的人患有慢性上肢运动功能障碍，导致上肢运动功能下降 生活质量和中风增加的社会负担。目前，临床康复的重点是重复运动 运动，但干预措施不适用于单个卒中病变位置或预测的轨迹 恢复。先前的研究已经发现了明显的运动控制障碍，这些障碍导致了老年人的功能低下 慢性期可能取决于中风造成的神经解剖结构损害，但细节 目前尚不清楚是什么因素导致了这些损伤的发展，以及它们何时出现的时间。在……里面 为了创造最佳的康复策略，最大限度地发挥每个患者的康复潜力， 我们需要更好的方法来预测和治疗这些运动控制障碍。 在这项建议中，我们的目标是使用肌电计算机接口(ECI)来研究运动障碍。 控制手腕屈曲和伸展的肌肉群，并进行纵向研究以1)建立 中风后明显的运动控制障碍的自然病史和2)确定早期神经成像， 预测慢性期特定运动损伤的电生理学和临床标记物。然后我们 3)评估使用ECI提供早期、密集的生物反馈治疗的可行性，以针对 对个别患者的损伤进行预测。这些研究将为以下工作奠定必要的基础 神经康复中精准医学疗法的未来发展。此外，指导性研究 和职业发展计划将为申请者提供进一步培训领导能力的机会 纵向研究，高级生物统计分析，以及功能和结构神经成像。结果是 这项研究和职业发展奖将促进她的临床研究计划的扩展， 致力于开发治疗中风后早期运动变化的新疗法。

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.