Deconstructing Post-Stroke Hemiparesis for Precision Neurorehabilitation

解构中风后偏瘫以实现精准神经康复

• 批准号: 10701760
• 负责人: David J Lin
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10701760
• 关键词: Acoustics; Acute; Anatomy; Area; Bilateral; Biomechanics; Biometry; Caring; Chronic; Clinical; Clinical Trials; Complement; Contralateral; Corticospinal Tracts; Cross-Sectional Studies; Data; Dedications; Development; Development Plans; Diffusion Magnetic Resonance Imaging; Distal; Electroencephalography; Environment; Future; General Hospitals; Goals; Hand; Hand functions; Healthcare Systems; Impairment; Individual; Intervention; Ischemic Stroke; K-Series Research Career Programs; Knowledge; Laboratories; Lead; Lesion; Maps; Massachusetts; Mentors; Mentorship; Modeling; Motor; Motor Cortex; Motor Pathways; Natural History; Neuroanatomy; Neurologic; Neurologist; Neurology; Neuronal Plasticity; Neurosciences; Pathway interactions; Pattern; Phenotype; Physicians; Physiologic pulse; Physiology; Prospective cohort; Recovery; Recovery of Function; Research; Research Project Grants; Resources; Science; Scientist; Spinal Cord; Stimulus; Stroke; Syndrome; System; Technology; Testing; Training; Transcranial magnetic stimulation; Translating; Translations; United States; Upper Extremity; Variant; Veterans; acute stroke; arm; arm function; brain computer interface; brain pathway; career; career development; chronic stroke; cohort; dexterity; disability; experience; hemiparesis; improved; insight; kinematics; medical schools; motor control; motor deficit; motor function improvement; motor impairment; motor recovery; multidisciplinary; neural; neuroimaging; neurological rehabilitation; neurophysiology; neurorestoration; neurotechnology; noninvasive brain stimulation; novel; patient oriented research; post stroke; randomized, clinical trials; recruit; research study; response; skills; stroke hemiparesis; stroke patient; stroke recovery; stroke rehabilitation; stroke therapy; synergism; targeted treatment

PROJECT SUMMARY / ABSTRACT Dr. David Lin is a Neurocritical Care and Neurorehabilitation specialized Neurologist at VA Providence Health Care System whose career goal is to conduct mechanistic clinical trials of neurorehabilitation technologies, to maximize neuroplastic potential and functional recovery for Veterans with motor deficits after stroke. A critical step towards this goal is for Dr. Lin to perform research and acquire training in the phenotype of upper extremity stroke hemiparesis as well as its neuroanatomic and neurophysiologic underpinnings. Dr. Lin currently leads a natural history study of upper extremity stroke motor recovery in which he has demonstrated the feasibility of recruiting over 180 acute stroke patients with arm weakness into a research study and tracking their upper extremity impairments from the acute to chronic stages of recovery. Dr. Lin is completing an analysis of patterns of EEG cortical connectivity change after stroke in his VA CDA-1 project. In this Career Development Award-2 (CDA-2) project, Dr. Lin proposes to test specific systems neuroscience, model-driven hypothesis about the relationship between the phenotype of post-stroke upper extremity hemiparesis with anatomy (assessed by diffusion magnetic resonance imaging) and physiology (assessed by transcranial magnetic stimulation) of specific descending motor pathways (corticospinal and corticoreticulospinal). Specifically, he will (1) Deconstruct post-stroke hemiparesis into its individual components (2) Map descending motor tract anatomy onto distinct components of post-stroke hemiparesis and (3) Map descending motor tract physiology onto distinct components of post-stroke hemiparesis. To achieve these aims, Dr. Lin plans to conduct a new and dedicated cross-sectional study at Providence VA of N = 75 Veterans with chronic hemiparesis after stroke. The proposed CDA-2 project will provide Dr. Lin with fundamental training in motor control, structural neuroimaging, motor systems neurophysiology, and applied biostatistics for neurorehabilitation research as well as further experience with research skills necessary to lead an independent VA laboratory and clinical trials. Dr. Lin will achieve the science and training proposed with the support of a world-class and multidisciplinary mentorship team. Dr. Leigh Hochberg (primary mentor) and Dr. John Krakauer (primary co- mentor) will coordinate a panel of content mentors (neuroimaging- Dr. Jennifer Barredo, neurophysiology- Dr. Noah Philip, and kinematics and motor control - Dr. Steven Kautz) and subject advisors (neuroimaging- Dr. Sanes, motor systems physiology- Dr. Monica Perez, neurotechnology- Dr. Karunesh Ganguly, applied biostatistics- Dr. Jeff Goldsmith). Dr. Lin has developed a systematic mentoring and didactic plan to complement the scientific activities in his proposed project. All of these activities will leverage the extensive resources and world-class environment of VA RR&D Center for Neurorestoration and Neurotechnology (CfNN) at Providence VA and research affiliate, Massachusetts General Hospital, Harvard Medical School. Thus, the proposed VA patient-oriented research project, in concert with the mentorship and training plan, will provide Dr. Lin with the scientific insights and skills that are essential for him to develop into an independent VA physician-scientist career at the cutting edge of stroke neurorehabilitation and systems neuroscience.

项目摘要 /摘要 David Lin博士是VA Providence Health的神经严重护理和神经康复专业的神经科医生 护理系统的职业目标是进行神经康复技术的机械临床试验，以 中风后具有运动缺陷的退伍军人的神经塑性潜力和功能恢复。批判 朝着这一目标的一步是林博士在上肢的表型中进行研究和获取培训 中风偏瘫以及其神经解剖学和神经生理基础。林博士目前领导 上肢中风运动恢复的自然历史研究，他证明了 招募超过180名急性中风患者的手臂弱患者进入一项研究并跟踪其上部 从急性到慢性恢复阶段的肢体障碍。林博士正在完成模式的分析 在他的VA CDA-1项目中，中风后的EEG皮质连通性变化。在这个职业发展奖2中 （CDA-2）林博士提议测试特定系统神经科学，模型驱动的假设 势后末端偏瘫的表型与解剖学之间的关系（由 扩散磁共振成像）和生理学（通过经颅磁刺激评估） 特定的降落运动途径（皮质脊髓和皮质孔脊髓）。具体来说，他将（1） 将冲程后偏瘫分解为其各个成分（2）地图下降运动区解剖 进入势后半瘫痪的不同成分，（3）地图将运动道降落到 冲程后半瘫痪的不同成分。为了实现这些目标，林博士计划开展新的和 Providence VA的专用横断面研究N = 75名退伍军人，中风后具有慢性偏瘫。 拟议的CDA-2项目将为Lin博士提供运动控制，结构性的基本培训 神经影像学，运动系统神经生理学和应用生物统计学作为神经居住研究 以及领导独立VA实验室和临床所需的研究技能的进一步经验 试验。林博士将在世界一流的支持下实现提出的科学和培训 多学科指导团队。 Leigh Hochberg博士（主要导师）和John Krakauer博士（主要共同合作 导师将协调一个内容导师小组（神经影像学-Jennifer Barredo博士，神经生理学 - 博士 诺亚·菲利普（Noah Philip），运动学和运动控制 - 史蒂文·考茨（Steven Kautz）博士）和主题顾问（神经影像学 - 博士 Sanes，Motor Systems生理学 - 莫妮卡·佩雷斯（Monica Perez），神经技术 - 卡伦什·甘卢（Karunesh Ganguly）博士，申请 生物统计学 - 杰夫·戈德史密斯博士）。林博士已经制定了系统的指导和教学计划 补充他提议的项目中的科学活动。所有这些活动都将利用广泛的 VA RR＆D神经修养与神经技术中心的资源和世界一流环境（CFNN） 哈佛医学院马萨诸塞州综合医院的普罗维登斯VA和研究分支机构。因此， 拟议的VA面向患者的研究项目与指导和培训计划一致 林博士的科学见解和技能对于他发展成独立的VA至关重要 医师科学家职业在中风神经康复和系统神经科学的最前沿。