Visuospatial deficits after stroke: Towards better classification, diagnostics, and rehabilitation.

项目摘要 非原发性视觉空间缺陷是常见的右半球（RH）损伤后，他们是众所周知的， 中风后长期残疾的预测因素。然而，与语言和运动障碍相比， 功能，它们不太明显，在中风研究，诊断和康复中受到的关注较少， 导致RH卒中的诊断不足和治疗不足。部分问题在于，这些赤字及其 人们对神经基础的了解很少，尤其是因为用于评估它们的测试的异质性 对它们的定义缺乏一致意见，这妨碍了研究之间的比较。 根据我们的初步数据和文献回顾，我们认为，这些赤字，这往往是 包括在“空间忽视”，反映了四个核心因素：偏侧感知注意，偏侧运动， 有意的、非侧化的注意力和结构性的。我们进一步指出，它们可以与 适当的评估，与不同的病变部位相关，并对不同的治疗作出反应。 为了为更好的评估和有效的个性化治疗铺平道路，拟议的研究旨在 确定视觉空间缺陷的核心因素，最敏感的评估， 具体到他们，他们与中风后的功能结果的关联，以及他们的神经基础。 SA 1：确定核心视觉空间缺陷和对它们敏感和特异的测试，并确定 与长期中风预后的关系。评估RH与LH卒中的长期存活者， 将控制组与一组全面的视觉空间测试相匹配。使用因素分析来确认， 通过假设多个不同而不是一个单一的基础的模型来更好地描述性能 赤字证明核心缺陷（以组合分项测试的综合得分形式获得）更严重 RH比LH中风，并确定最好的预测功能能力和自我报告的生活质量。 SA 2：确定视觉空间缺陷的神经基础及其恢复。采集功能和解剖 SA 1的MRI合格受试者的磁共振成像（MRI）数据。使用新病变-症状 和功能异常映射方法，测试有关特定病变之间关联的假设 位置和赤字。证实，与失语症研究的结果类似， 视觉空间缺陷显示增加的对侧损伤任务诱发的激活，并且它与表现有关。 除了确定视觉空间能力的基本和可分离的组成部分及其神经功能外， 在此基础上，结果将使我们能够（1）通过识别高度相关的测试来改善RH中风诊断 对RH卒中敏感和特异，（2）基于测试结果提供更准确的结果分析， 损伤特征，以及（3）基于患者的视觉空间轮廓定制康复。他们也将奠定 评估无创神经刺激（rTMS，tDCS）促进康复的临床试验的基础 通过调节对侧脑激活来改善视觉空间缺陷。

Project Summary Non-primary visuospatial deficits are common after right-hemisphere (RH) injury, and they are known predictors of long-term disability after stroke. However, compared to impairments of language and motor function, they are less obvious and receive less attention in stroke research, diagnostics, and rehabilitation, resulting in underdiagnosis and undertreatment of RH stroke. Part of the problem is that these deficits and their neural bases are poorly understood, not least because of the heterogeneity of the tests used to assess them and a lack of agreement on their definition, which hamper comparison across studies. Based on our preliminary data and a review of the literature, we posit that these deficits, which are often subsumed under “spatial neglect”, reflect four core factors: lateralized perceptual-attentional, lateralized motor- intentional, non-lateralized attentional, and constructional. We further posit that they can be dissociated with appropriate assessments, are associated with different lesion sites, and respond to different treatments. To pave the way for better assessments and effective individualized treatments, the proposed research seeks to identify the core factors underlying visuospatial deficits, the assessments most sensitive and specific to them, their associations with functional outcomes after stroke, and their neural bases. SA1: Identify core visuospatial deficits and tests that are sensitive and specific to them and determine their association with long-term stroke outcomes. Assess long-term survivors of RH vs. LH stroke and matched Controls with a comprehensive battery of visuospatial tests. Use factor analysis to confirm that performance is better described by a model assuming multiple different rather than one unitary underlying deficit. Demonstrate that core deficits (captured as composite scores across battery subtests) are more severe in RH than LH stroke, and determine which best predict functional ability and self-reported quality of life. SA2: Identify neural bases of visuospatial deficits and their recovery. Acquire functional and anatomical magnetic resonance imaging (MRI) data from MRI-eligible participants of SA1. Using novel lesion-symptom and functional-anomaly mapping methods, test hypotheses regarding associations between specific lesion locations and deficits. Confirm that, in analogy to findings from aphasia research, stroke survivors with visuospatial deficits show increased contralesional task-evoked activation, and that it relates to performance. In addition to identifying the fundamental and dissociable components of visuospatial ability and their neural basis, the results will allow us to (1) improve RH stroke diagnostics of by identifying tests that are highly sensitive and specific to RH stroke, (2) provide more accurate outcome prognoses based on test results and lesion characteristics, and (3) customize rehabilitation based a patient’s visuospatial profile. They will also lay the basis for clinical trials evaluating noninvasive neurostimulation (rTMS, tDCS) for boosting rehabilitation of visuospatial deficits by modulating contralesional brain activation.