Building a science for treatment of spatial neglect

描述（由申请人提供）：空间忽视，由脑损伤（Heilman，1979）引起的病理性不对称空间行为，并导致功能障碍（Barrett和Burkholder，2006），可能发生在20-50%的中风中，每年多达350，000名美国人（Ringman等人，2004年;美国中风协会，2007年）。在这种疾病中，在复杂环境中进食、穿衣和导航困难是急性发生的，但即使症状在慢性恢复中得到改善，患有空间忽视的人也更有可能失去功能独立性（Katz et al.，1999年）。目前的标准临床方法不是理论驱动的，并且广泛采用的疗法可能仅略微有效。在这个建议中，我们提出了两种方法，科学的急性空间忽视治疗可以实施。在现有研究中，受试者异质性可能掩盖了治疗效果。跨方法，研究使用单一主题，病例系列和组分析设计，但并没有试图调和个人与组分析方法提供的独特优势。不同的治疗可能会影响不同的空间认知恢复功能，但简单的，全球的结果可能无法反映这些变化。对受试者特异性和群体效应进行建模也是检查靶向治疗效果的一种非常有用的方法。我们将收集超过四年的空间忽视治疗反应数据，两个有前途的和可行的空间忽视治疗：棱镜适应训练和多巴胺能药物。通过机制特异性结局评估和分层线性模型，我们将检查治疗是否导致可预测的反应。我们还将研究是否控制特定于受试者的预测模型组恢复轨迹。最后，我们将研究目前的标准全球结果的措施，尚未完全心理测量开发的工具，并试图预测这些变量的主题和组特定的恢复配置文件。我们希望这项研究将提高我们设计认知康复治疗研究的能力。然而，它也可能提高我们将认知神经科学的行动模型，空间知识和注意力转化为治疗的能力，以优化复杂环境中的适应性运动。公共卫生相关性：本研究探讨了新的结果分析方法，比较两种治疗方法对中风后功能性视力的隐性残疾。我们希望这项研究将提高我们设计认知康复治疗研究的能力。然而，它也可能提高我们将基础脑科学带到床边的能力，优化中风幸存者在复杂环境中的适应性运动和平衡的视觉空间功能。

DESCRIPTION (provided by applicant): Spatial neglect, pathologically asymmetric spatial behavior resulting from a brain injury (Heilman, 1979) and causing functional disability (Barrett and Burkholder, 2006) may occur in 20-50% of strokes, up to 350,000 Americans annually (Ringman et al., 2004; American Stroke Assoc., 2007). Difficulty eating, dressing, and navigating in complex environments occurs acutely in this disorder, but even if symptoms improve in chronic recovery, people with spatial neglect are more likely to lose functional independence (Katz et al., 1999). Current standard clinical approaches are not theory driven, and widely-employed therapies may be only marginally effective. In this proposal, we suggest two means by which scientific acute spatial neglect treatment can be implemented. In available studies, subject heterogeneity may have obscured treatment effects. Across methods, studies used single subject, case series, and group analytic designs, but did not attempt to reconcile the distinct advantages offered by individual versus group analytic approaches. Different treatments might affect different spatial cognitive recovery functions, but simple, global outcome measures may not reflect these changes. Modeling both subject-specific and group effects is also an extremely useful method of examining targeted treatment effects. We will collect spatial neglect treatment response data over four years, for two promising and feasible spatial neglect treatments: prism adaptation training and dopaminergic medication. With mechanism-specific outcome assessment and hierarchical linear modeling, we will examine whether treatments result in predictable response. We will also examine whether controlling for subject-specific predictors models group recovery trajectory. Lastly, we will examine current standard global outcome measures instruments which have not been fully psychometrically developed, and attempt to predict subject- and group-specific recovery profiles for these variables. We hope this research will improve our ability to design cognitive rehabilitation treatment studies. It may also, however, improve our ability to translate cognitive neuroscience models of action, spatial knowledge, and attention, to treatments to optimize adaptive movement in complex environments. PUBLIC HEALTH RELEVANCE: This study investigates novel methods of outcome analysis for comparing two treatments for hidden disabilities in functional vision after stroke. We hope this research will improve our ability to design cognitive rehabilitation treatment studies. It may also, however, improve our ability to bring basic brain science to the bedside, to optimize stroke survivors' adaptive movement and balanced visual-spatial function in complex environments.