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.

项目概要 美国每年有超过 750,000 人中风，其中高达 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。 大约 40%-80% 在日常生活中无法使用受影响手臂的人拥有足够的感觉 这样做的电机能力。武器使用和容量之间的差异（即使用/容量差异 - UCD） 发生在广泛的感觉运动严重程度中，是神经系统中一个令人困惑和紧迫的问题。 康复。也许部分是因为 UCD 位于感觉运动处理和 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。鉴于其普遍性，了解 UCD 不同严重程度的机制是有必要的。 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 很少评估是否存在 UCD，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学测试，以测试每个人的预测 100 名轻度至中度左半球和右半球慢性中风患者样本中的 3 种假设。我们将 确定这些措施以及人口统计和中风相关变量与 UCD 的关联。 目标 2 将使用先进的神经影像方法和静息态功能磁共振数据 成像开发与 UCD 相关的成像生物标志物。在目标 3 中，我们将验证一种新颖的虚拟现实 快速可靠地评估 UCD 的评估工具。除了临床实用性之外，该任务还可以内置 通过确定 UCD 是否受到注意力任务的影响来评估注意力假设 需求。到资助期结束时，我们将确定人口统计、感觉运动、 预测 UCD 并验证临床有用 VR 的神经心理学和神经解剖学因素 评估工具。鉴于该领域的知识基础有限，这项综合研究将为我们铺平道路 开发针对潜在机制的治疗方法并加强对高危人群的识别 个人。