A biomarker for personalized care in post-stroke spatial neglect

该SPiRE提供了提高PI（Barrett）技术专业知识的机会， 为空间忽视（SN）的个性化康复护理提供了一个关键的缺失元素， 导致不对称的三维空间动作、运动、感知和 意识10多年来，PI及其同事通过广泛的 表征神经心理缺陷，记录对功能的不良影响， 自由，并制定可行的SN恢复协议。他们的研究报告约80%的SN 诊断不足和治疗不足;改善这种护理提供差距肯定会减少 与SN相关的毁灭性个人和社会损失。在这里，私家侦探从她的过去 工作推进传播，实施和康复，以获得神经影像学技能 并寻求一种新的生物学方法来改善SN护理提供。PI和同事 发现Aiming SN亚型，与运动故意缺陷相关，预测快速 日常生活功能改善，早期康复。然而，Aiming SN很难 在典型行为筛查中识别。然而，与其他SN亚型不同，Aiming SN是 与特定的神经解剖学特征密切相关：额叶分离。在这 由研究SN中白色物质破坏的专家支持的研究（卡特），白色物质 中断作为中风康复结果的预测因子（Cramer），以及新型脑成像 (Qiu)，PI将开发基于脑成像生物标志物的SN诊断新流程。 该团队将开发与Aiming SN相关的脑成像生物标志物，使用4种先进的 成像程序，并证明这些生物标志物可以预测日常生活功能 中风后3个月和6个月时改善（目标1）。支持PI的专家 将生物标志物分析快速转化为临床成像数据的经验， SPiRE还将包括高级成像（高分辨率和扩散率）的直接比较 与临床获得的数据相比（目标2）。研究小组将直接比较 从研究成像，与那些来自临床成像，以确定瞄准SN。他们将 还测试了研究与临床生物标志物预测功能的相对能力 3个月和6个月的独立性。在下一步的研究中， 为了瞄准SN和SN康复的功能增益，我们的团队将提出一个更大的， 生物标志物验证的多中心研究。我们的长期目标是带领SN研究朝着 定期识别受影响的退伍军人，并迅速提供个性化的认知， 康复，以改善社区中风退伍军人的功能结果。

This SPiRE provides the opportunity to raise the technical expertise of the PI (Barrett), and provide a critical missing element for personalized rehabilitation care in spatial neglect (SN), a disabling cognitive deficit causing asymmetric 3-D spatial action, movement, perception and awareness. For more than 10 years, the PI and colleagues addressed SN by extensively characterizing neuropsychological deficits, documenting the adverse impact on function and freedom, and developing feasible SN rehabilitation protocols. Their research reported ~80% SN underdiagnosis and undertreatment; improving this care delivery gap is certain to reduce the devastating personal and social losses associated with SN. Here, the PI moves from her past work advancing dissemination, implementation, and rehabilitation to gain neuroimaging skills and pursue a new, biological approach to improving SN care delivery. The PI and colleagues discovered that the Aiming SN subtype, associated with motor-intentional deficits, predicts rapid improvement of daily life function with early rehabilitation. However, Aiming SN is difficult to identify on typical behavioral screening. Unlike other SN subtypes, however, Aiming SN is strongly associated with specific neuroanatomic features: frontal lobe disconnection. In this study, supported by experts in studying white matter disruption in SN (Carter), white matter disruption as a predictor of stroke rehabilitation outcomes (Cramer), and novel brain imaging (Qiu), the PI will develop a new process of SN diagnosis based on brain imaging biomarkers. The team will develop brain imaging biomarkers associated with Aiming SN, using 4 advanced imaging procedures, and demonstrate that these biomarkers can predict daily life function improvement at 3 months and 6 months post-stroke (Aim 1). The experts supporting the PI have experience with rapidly translating biomarker analyses to clinical imaging data, and thus the SPiRE will also include a direct comparison of advanced imaging (high-resolution and diffusivity) versus clinically-acquired data (Aim 2). The team will directly compare the biomarkers derived from research imaging, with those derived from clinical imaging, to identify Aiming SN. They will also test the relative ability of research versus clinical biomarkers to predict functional independence at 3 and 6 months. At the next research step, armed with a potential biomarker for Aiming SN and for functional gains with SN rehabilitation, our team will propose a larger, multi-site study for biomarker validation. Our long-term goal is to lead SN research toward routinely identifying affected veterans, and rapidly providing personalized cognitive rehabilitation, to improve functional outcomes for veterans with stroke in the community.