Stroke Plasticity

描述(申请人提供)：中风发生时，大脑某一部分的血液供应受到影响，可能导致对日常生活活动重要的局部运动、语言和一般功能障碍。中风患者缺陷后的恢复与随着时间的推移发生的麸皮可塑性变化有关。有证据表明，这些可塑性变化对于功能恢复既可以是适应性的，也可以是非适应性的，旨在促进适应性网络和抑制不良适应网络的康复可能会加速中风的恢复。一种表征可塑性随时间变化的方法是，在遭受侮辱(如中风)导致通常与特定语言或运动功能相关的区域受损的成年人中使用fMRI方法。研究表明，随着时间的推移，这些患者通过大脑重组的变化显示出康复的迹象，在执行语言或运动功能的同时，大脑中招募了一个区域网络。有许多新的中风康复治疗旨在改善康复。然而，关于如何利用这些治疗方法，目前还没有一套指导方针。有必要开发一套预后预测指标，以决定哪些患者适合哪些治疗，确定最能预测中风恢复的时间窗口，从而理想地进行干预，以及表征适应性和非适应性大脑可塑性变化，以促进更快、更有效的康复。这项建议有三个目标：1)确定预测 卒中恢复，2)确定最能预测卒中恢复的时间窗口，以及3)确定与卒中恢复有关的适应性和非适应性大脑可塑性变化。中风患者将在急性期、亚急性期和慢性期接受神经成像和行为测试。神经成像测量(例如，功能磁共振成像激活)以及临床测量将用于预测行为。据推测，神经成像和临床测量相结合将比任何一种测量更准确地预测运动、语言和一般功能性中风的恢复。还假设亚急性时间窗口将最好地预测中风的恢复，因为最强劲的可塑性变化发生在这个时间窗口。假设随着时间的推移，由大脑测量评估的大脑可塑性变化将预测行为表现随时间的变化，表征对运动、语言和一般功能性中风恢复至关重要的适应性和非适应性可塑性网络。总体而言，这将导致更好的预后预测中风患者的康复，确定一个关键的时间窗口 干预，确定参与重组的适应性和非适应性网络。随后，这将使我们能够根据预后提供个体化治疗，允许我们在特定的时间窗口进行干预以获得最佳效果，并扩大旨在促进和抑制适应不良网络加速和最大化功能恢复的一系列康复策略的潜力。

DESCRIPTION (provided by applicant): Stroke occurs when blood supply to some part of the brain is compromised and can lead to focal motor, language, and general functional deficits important for activities of daily life. Recovery after deficits in stroke patients is linked to bran plasticity changes occurring over time. There is evidence that these plasticity changes can be adaptive as well as maladaptive towards functional recovery and rehabilitation aimed at facilitating adaptive networks and suppressing maladaptive networks may hasten stroke recovery. One way to characterize plasticity changes over time is by utilizing fMRI methods in adults who have suffered an insult (e.g., stroke) resulting in damage to an area typically associated with a specific language or motor function. Studies have shown that these patients show recovery through brain reorganization changes over time where a network of areas are recruited while performing the language or motor function. There are a number of novel stroke rehabilitation treatments aimed at improving recovery. Yet no set guidelines exist on how to utilize these treatments. There is an important need to develop a set of prognostic predictors to make decisions about which patients are appropriate for which treatment, identify a time window that best predicts stroke recovery and therefore ideal for intervention, as well as characterize adaptive and maladaptive brain plasticity changes in order to facilitate faster and more effective rehabilitation. This proposal has three aims: 1) Identify prognostic predictors of stroke recovery, 2) Identify a time window which best predicts stroke recovery, and 3) Identify adaptive and maladaptive brain plasticity changes involved in stroke recovery. Stroke patients will undergo through neuroimaging and behavioral testing at the acute, subacute and chronic stages. Neuroimaging measures (e.g., fMRI activation) along with clinical measures will be utilized to predict behavior. It is hypothesized that neuroimaging along with clinical measures will predict motor, language, and general functional stroke recovery more accurately than either measure. It is also hypothesized a subacute time window would best predict stroke recovery, given that the most robust plasticity changes occur at this time window. It is hypothesized that that brain plasticity changes assessed by brain measures over time will predict behavioral performance changes over time, characterizing adaptive and maladaptive plasticity networks essential for motor, language, and general functional stroke recovery. Overall this would lead to better prognostic prediction of recovery in stroke patients, identify a critical time window for intervention, identify adaptive and maladaptive networks involved in reorganization. Subsequently this would allow us to provide individualized treatments based on the prognostics, allow us to intervene at a particular time window for optimal effect, and expand the potential for a range of rehabilitation strategies aimed at facilitating adaptive and suppressing maladaptive networks hastening and maximizing functional recovery.