One treatment, multiple targets: Prism adaptation and left brain stroke rehabilitation

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Stroke is the most frequent cause of US adult disability, and post-acute stroke care is among the fastest-growing expense categories. The functional disability experienced by Veterans after stroke, and the limited rehabilitation resources available, highlight the importance of identifying feasible treatments acting on more than one recovery target. Currently, cognitive and motor impairments, and pain, are addressed with separate and modality-specific treatment pathways. As a result, Veteran stroke survivors are vulnerable to a fragmented interprofessional care process, with under-treatment of some disabling conditions and failure to coordinate synergistic interventions. This fragmented care process leads to longer hospital stays, greater risk of falls and accidents, incomplete recovery and poor quality of life. Our overall objective in this project is to employ prism adaptation treatment (PAT), a 10-day regimen reported to enhance spatial function, motor recovery, and reduce post-stroke pain. Although spatial-motor-sensory impairments are common in both left and right brain stroke, previous studies of PAT have only included right-brain stroke survivors. A potential barrier to broad implementation of PAT as a multi-target treatment in stroke rehabilitation, is lack of evidence for the feasibility of assessment and treatment procedures in patients with left-brain stroke who often experience co-morbid language disorder (aphasia) and memory impairments. We propose the first study of PAT in subacute left-brain stroke patients with aphasia and memory deficits to systematically investigate the feasibility of using adapted PAT procedures (Aim 1) and adapted spatial-motor- sensory assessments (Aim 2), which is a prerequisite to conducting a full-scale clinical trial. Additionally, previous brain-mapping studies have shown that lesion patterns can be used to identify patients who respond optimally to PAT. Thus, we also seek to establish a clinically accessible, reliable way of categorizing lesion location (Aim 3), a prerequisite for broad implementation of clinical guidelines about patient selection for PAT. In the proposed study, we will collect and analyze data on four key areas of feasibility, including acceptability, implementation, adaptation and limited efficacy. Our long-term goal is to implement PAT in both left and right-brain stroke rehabilitation to simultaneously improve cognitive and motor function, and pain. By demonstrating the feasibility of adapted assessment and treatment procedures in left-brain stroke patients with aphasia and memory impairment, and the feasibility and reliability of clinically accessible lesion categorization methods, we will open a path to a full-scale investigation of PAT as a multi-target treatment stroke rehabilitation. This line of research has the potential to increase the efficiency and effectiveness of currently fragmented care processes and significantly improve functioning, independence and quality of life in thousands of Veterans with stroke-related disabilities.