Modulation of interhemispheric interactions and arm activity after stroke

描述（由申请人提供）：本K23申请由马里兰大学医学院神经病学助理教授Michael A. Dimyan医学博士提交。我的长期目标是成为一名独立的临床研究者，专注于手臂运动控制的神经基质，作为开发干预措施以改善中风后神经康复的基础。这个K23奖将允许我在手臂运动控制及其神经生理基础方面进行高级训练。我将学习并行多模态神经生理学和成像技术。该训练将用于研究在手臂活动的整个时间过程中半球间抑制的动态调节，目的是确定干预目标，以增强中风后手臂康复。我将接受临床神经康复，手臂运动控制，神经生理学和多模态成像专家团队的指导包括George Wittenberg博士，Jill Whitall博士，Rao Gullapalli博士和Peter Gorman博士。即使在全面康复后，30%的中风幸存者仍有手臂无力。慢性偏瘫很重要，因为中风幸存者生活质量下降的50%是由于手臂无力。目前的治疗

DESCRIPTION (provided by applicant): This K23 application is submitted by Michael A. Dimyan, MD, Assistant Professor of Neurology at the University Of Maryland School Of Medicine. My long-term goal is to become an independent clinical investigator focusing on the neural substrates of arm motor control as a basis for developing interventions to improve neurorehabilitation after stroke. This K23 award will allow me to pursue advanced training in arm motor control and their neurophysiological substrates. I will train in the technique of concurrent multimodal neurophysiology and imaging. This training will be applied to investigating the dynamic modulation of interhemispheric inhibition throughout the time-course of arm activity, with a goal of identifying targets for intervention to enhance arm rehabilitation after stroke. I will be mentored by a team of experts in clinical neurorehabilitation, arm motor control, neurophysiology and multi-modal imaging including Dr. George Wittenberg, Dr. Jill Whitall, Dr. Rao Gullapalli and Dr. Peter Gorman. Even after comprehensive rehabilitation, 30% of stroke survivors are left with arm weakness. Chronic hemiparesis is significant because 50% of the reduction in quality of life for stroke survivors is due to arm weakness. Current treatments of hemiparesis are based on different models of how the two arms interact after stroke. However, these models are limited by an incomplete understanding of interhemispheric competition. In particular, we do not know how interactions between the two arms are dynamically modulated during arm activity. I will pursue this problem by 1) defining normal interhemispheric interactions between the two arms during unilateral arm activity 2) discovering how aging and stroke impair those dynamics and 3) determining how other brain areas influence the interaction between the two arms. This will be done by studying neurophysiological measures of corticospinal and interhemispheric interactions in hemiparetic patients and healthy controls performing an arm activity. I will also use multimodal neurophysiological and imaging techniques to examine brain network interactions and their influence on corticospinal activity. The proposed research is innovative conceptually in its elaboration and addition to the model of interhemispheric interactions during movement and after stroke. The results of this research may significantly contribute to our understanding of the interaction between the two arms. This is important because it will allow us to design therapies that take advantage of those interactions. The impact of this proposal is that it will allow us to design interventions that taret specific neurophysiological impairments at specific time-points during movement to enhance rehabilitation after stroke. This research proposal addresses the NIH missions to reduce the burden of neurological disorders and enhance the quality of life of people with disabilities. This proposal also addresses the goals of the NIH BRAIN initiative to develop a dynamic picture of the human brain describing how neural circuits interact in time and space.