Mechanistic and neuroanatomic bases of disparity between arm capacity and use in stroke

项目摘要 在美国，每年有超过75万人中风，多达94%的中风幸存者 减少一只手臂的使用，对残疾、照顾者负担和生活质量造成不利后果。 在日常生活中不使用受影响手臂的人中，约有40%-80%拥有足够的感觉- 这样做的马达能力。ARM使用和能力之间的差距(即使用/能力差距-UCD) 发生在感觉-运动严重程度的广泛范围内，是神经-运动的一个令人困惑和紧迫的问题 康复。也许部分原因是UCD位于感觉-运动加工的交界处 认知/情感现象，过去的研究没有评估其潜在的机制或神经解剖学 生物标志物。鉴于UCD的流行，对各种严重程度的UCD机制的理解是 需要开发有针对性的治疗方法来改善这种疾病。此外，中风患者还包括 很少对UCD的存在进行评估，部分原因是这种评估具有挑战性。拟议的研究 将通过测试3个假设的预测来解决我们知识和能力上的这些差距 UCD的潜在机制：感觉运动、注意力和冷漠/动机。在目标1中，我们将 进行一系列有针对性的感觉运动和神经心理测试，以测试每个人的预测 3对100例轻中度左右半球慢性卒中患者的研究。我们会 确定这些测量以及人口统计学和中风相关变量与UCD的关联。 AIM 2将使用先进的神经成像方法和来自静息状态功能磁共振的数据 成像以开发与UCD相关的成像生物标记物。在目标3中，我们将验证一种新的虚拟现实 快速、可靠地评估UCD的评估工具。除了其临床用途外，该任务还支持内置 通过判断UCD是否受注意任务的影响来评估注意假说 要求。到授权期结束时，我们将确定人口统计、感觉运动、 预测UCD和验证临床有用VR的神经心理学和神经解剖学因素 评估工具。鉴于这一领域的知识基础有限，这项全面的研究将为 开发针对潜在机制的治疗方法，并加强风险识别 个人。

Project Summary More than 750,000 individuals in the U.S. have a stroke each year, and as many as 94% of stroke survivors exhibit reduced use of one arm, with adverse consequences for disability, caregiver burden, and quality of life. Approximately 40%-80% of individuals who fail to use the affected arm in daily life possess adequate sensory- motor capacity to do so. The disparity between arm use and capacity (i.e., Use/Capacity Disparity -- UCD) occurs across a broad spectrum of sensory-motor severity and is a perplexing and urgent problem in neuro- rehabilitation. Perhaps in part because UCD lies at the interface of sensory-motor processing and cognitive/affective phenomena, no past research has assessed its underlying mechanisms or neuroanatomic biomarkers. Given its prevalence, an understanding of the mechanisms of UCD across a range of severity is required to develop targeted treatments to ameliorate the disorder. Moreover, individuals with stroke are rarely assessed for the presence of UCD, in part because such assessment is challenging. The proposed research will address these gaps in our knowledge and capacity by testing the predictions of 3 hypotheses of the mechanisms underlying UCD: the sensorimotor, attention, and apathy/motivation accounts. In Aim 1 we will administer a targeted battery of sensorimotor and neuropsychological tests to test the predictions of each of the 3 hypotheses in a sample of 100 mild to moderate left- and right-hemisphere chronic stroke patients. We will determine the association of these measures as well as demographic and stroke-related variables with UCD. Aim 2 will use advanced neuroimaging methods with data from resting-state functional magnetic resonance imaging to develop imaging biomarkers associated with UCD. In Aim 3 we will validate a novel virtual reality assessment tool to rapidly and reliably evaluate UCD. In addition to its clinical utility, the task enables built-in assessment of the attention hypothesis by determining whether UCD is influenced by attentional task demands. By the end of the grant period, we will have determined the demographic, sensorimotor, neuropsychological, and neuroanatomical factors that predict UCD and validated a clinically-useful VR assessment tool. Given the limited knowledge base in this area, this comprehensive research will pave the way for development of treatments targeted to underlying mechanisms and enhanced identification of at-risk individuals.