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

中风患者手臂能力和使用差异的机制和神经解剖学基础

• 批准号: 10670795
• 负责人: LAUREL J BUXBAUM
• 金额: $ 48.52万
• 依托单位: ALBERT EINSTEIN HEALTHCARE NETWORK
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670795
• 关键词: 3-Dimensional; Adopted; Affect; Affective; Age; Area; Assessment tool; Attention; Behavioral; Behavioral Mechanisms; Biological Markers; Brain; Caregiver Burden; Classification; Clinical; Clinical Treatment; Cognitive; Data; Data Analyses; Detection; Disease; Disparity; Exhibits; Functional Magnetic Resonance Imaging; Grant; Home; Individual; Investigation; Knowledge; Left; Life; Limb structure; Linear Models; Measures; Methods; Modeling; Modification; Monitor; Motivation; Motor; Movement; Neuroanatomy; Neuropsychological Tests; Neuropsychology; Neurosciences; Paresis; Predictive Factor; Prevalence; Property; Psychometrics; Quality of life; Randomized, Controlled Trials; Reality Testing; Research; Research Personnel; Rest; Rewards; Risk; Running; Sampling; Sensory; Severities; Stroke; Syndrome; Testing; Training; Upper Extremity; Work; adverse outcome; arm; base; chronic stroke; design; disability; experience; imaging biomarker; improved; knowledge base; neuroimaging; neurological rehabilitation; novel; psychologic; research clinical testing; stroke patient; stroke survivor; targeted treatment; therapy development; translational pipeline; virtual reality

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.

项目摘要 美国每年有75万人中风，多达94％的中风幸存者 表现出一只手臂的使用减少，对残疾，护理人员负担和生活质量产生不利影响。 在日常生活中未能使用受影响部门的人中，约有40％-80％具有足够的感觉 电动机能力这样做。手臂使用与容量之间的差异（即使用/容量差异 - UCD） 发生在各种感觉运动的严重程度上，是神经 - 康复。也许部分是因为UCD在于感觉运动处理的界面和 认知/情感现象，过去没有研究评估其潜在机制或神经解剖学 生物标志物。鉴于其患病率，对跨多个严重程度UCD机制的理解是 需要开发有针对性的治疗以改善疾病。而且，中风的人是 很少评估UCD的存在，部分原因是这种评估具有挑战性。拟议的研究 通过测试3个假设的预测，将以我们的知识和能力来解决这些差距 UCD的基础机制：感觉运动，注意力和冷漠/动机帐户。在目标1中，我们将 管理一个有针对性的感觉运动和神经心理学测试，以测试每个人的预测 3个假设在100个轻度至中度左和右半球慢性中风患者样本中。我们将 确定这些措施的关联以及与UCD的人口统计学和中风相关变量的关联。 AIM 2将使用先进的神经影像学方法以及来自静止状态功能磁共振的数据 成像以开发与UCD相关的成像生物标志物。在AIM 3中，我们将验证一个新颖的虚拟现实 评估工具快速可靠地评估UCD。除了临床实用程序外，该任务还可以实现内置 通过确定UCD是否受到注意任务的影响来评估注意力假设 需求。到赠款期结束时，我们将确定人口统计学，感觉运动， 神经心理学和神经解剖因素预测UCD并验证了临床使用的VR 评估工具。鉴于该领域的知识基础有限，这项全面的研究将为方式铺平道路 用于开发针对潜在机制的治疗方法，并增强了对处于危险的识别 个人。