Rehabilitation of Reading Deficits in Subacute Stroke using fMRI Neurofeedback and Motor Imagery

中风是美国和全球长期残疾的主要原因。单方面的左击- 在21-58%的中风幸存者中，大脑半球导致阅读和语言缺陷，并且这些缺陷持续存在 长期，尽管参与治疗。大多数可用的阅读治疗显示最清晰的 培训材料的好处。因此，迫切需要新的治疗策略， 在治疗背景之外进行概括。基于生物的干预措施可以通过直接 影响有益的中风后可塑性例如，实时功能性磁共振成像 神经反馈（fMRI NFB）是一种创新的方法，允许参与者调节自己的大脑活动。 它结合了心理策略和并发的大脑活动反馈。研究表明 反复的自我调节大脑活动的努力会导致学习引起的神经变化。初步证据 也表明实时fMRI NFB可以改善卒中后运动和认知功能。的主要目标 目前的建议是在这一成功的基础上，推进生物启发的阅读干预。 强有力的初步数据表明，完整的左半球阅读区域的募集减少是 与中风后的次优阅读结果相关。此外，试验数据表明，右手手指 敲击想象可以有效地激活左下顶叶区域，该区域被认为支持视觉的结合， 在阅读过程中用声音表达正字法信息。考虑到正字法的困难- 语音转换是左半球中风幸存者中最常见的缺陷， 建议使用右手手指敲击成像结合fMRI NFB，以帮助恢复左下 在阅读时顶叶的活动。据推测，努力增加阅读相关的大脑激活， 左半球将重新参与受损的阅读机制，并可能减轻阅读缺陷。根据本 K 01奖，申请人将发展必要的技能，以测试这一假设，即在开展临床 使用fMRI NFB和运动想象的试验。该项目有三个具体目标。根据目标1，申请人须 精通fMRI NFB、增益的特定硬件、软件、预处理和后处理要求 NFB研究经验，并获得运动想象和临床试验设计的关键技能。在目标2中， 申请人将应用此培训进行临床试验可行性研究的组合功能磁共振NFB和电机 左脑卒中阅读障碍的表象康复最后，根据目标3，申请人将 描述亚急性卒中患者阅读的神经机制。在本奖励期结束时， 申请人将为基于神经科学的阅读干预开发一个有效和可靠的范例， 改变阅读缺陷治疗方式的潜力。这里开发的方法可以扩展到其他 领域和其他临床人群，以改善认知康复结果。

Stroke is the leading cause of long-term disability in the US and worldwide. Unilateral stroke of the left- hemisphere causes reading and language deficits in 21-58% of stroke survivors and these deficits persist chronically, despite participation in therapy. The majority of the available reading treatments show the clearest benefits on trained materials. Therefore, there is an urgent need for new treatment strategies that can generalize outside of the treatment context. Biologically-based interventions can meet this challenge by directly influencing beneficial post-stroke plasticity. For example, real-time functional Magnetic Resonance Imaging Neurofeedback (fMRI NFB) is an innovative approach allowing participants to regulate their own brain activity. It uses a combination of mental strategies and concurrent brain activity feedback. Studies have shown that repeated efforts to self-regulate brain activity lead to learning-induced neural changes. Preliminary evidence also suggests that real-time fMRI NFB can improve post-stroke motor and cognitive function. The main goal of the present proposal is to build on this success and to advance biologically-inspired interventions for reading. Strong preliminary data show that reduced recruitment of the intact left-hemisphere reading areas is associated with suboptimal reading outcomes after stroke. In addition, pilot data suggest that right hand finger tap imagery can effectively activate the left inferior parietal region thought to support binding of visual orthographic information with sound representations during reading. Given that difficulty with orthography- phonology conversion is the most common deficit among left-hemisphere stroke survivors, the current project proposes to use right hand finger tap imagery in combination with fMRI NFB to help re-instate left inferior parietal activity during reading. It is hypothesized that efforts to increase reading-related brain activation in the left-hemisphere will re-engage the impaired reading mechanisms and may alleviate reading deficits. Under this K01 award, the applicant will develop skills necessary to test this hypothesis, namely in carrying out clinical trials using fMRI NFB and motor imagery. This project has 3 specific aims. Under Aim 1, the applicant will become proficient in specific hardware, software, pre- and post-processing requirements of fMRI NFB, gain NFB research experience, and acquire critical skills in motor imagery and clinical trial design. In Aim 2, the applicant will apply this training to conduct a clinical trial feasibility study for a combined fMRI NFB and motor imagery rehabilitation of reading impairments in left-hemisphere stroke. Lastly, under Aim 3, the applicant will characterize the neural mechanisms of reading in subacute stroke. At the end of this award period, the applicant will develop a valid and reliable paradigm for a neuroscience-based reading intervention that has the potential to change how reading deficits are treated. The methods developed here could be extended to other domains and to other clinical populations to improve cognitive rehabilitation outcomes.