Building a science for treatment of spatial neglect

描述（由申请人提供）：空间忽视，病理性不对称的空间行为导致脑损伤（Heilman, 1979），并导致功能性残疾（Barrett和Burkholder， 2006）可能发生在20-50%的中风中，每年多达35万美国人（Ringman等人，2004；美国中风协会）。, 2007)。在复杂的环境中，进食、穿衣和导航困难在这种疾病中会严重发生，但即使症状在慢性康复中有所改善，空间忽视患者也更有可能失去功能独立性（Katz et al., 1999）。目前的标准临床方法不是理论驱动的，广泛使用的治疗方法可能只是边际有效。在此建议中，我们提出了两种可以实施科学急性空间忽视治疗的方法。在现有的研究中，受试者的异质性可能会模糊治疗效果。在各种方法中，研究使用了单受试者、病例系列和群体分析设计，但没有试图调和个人分析方法与群体分析方法所提供的独特优势。不同的治疗方法可能会影响不同的空间认知恢复功能，但简单的全局结果测量可能无法反映这些变化。对特定主题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。我们将收集四年的空间忽视治疗反应数据，对两种有希望和可行的空间忽视治疗：棱镜适应训练和多巴胺能药物治疗。通过机制特异性结果评估和分层线性模型，我们将检查治疗是否会导致可预测的反应。我们还将研究是否控制特定主题的预测因子模型组恢复轨迹。最后，我们将研究目前标准的全球结果测量工具，这些工具尚未完全从心理测量学上发展起来，并试图预测这些变量的受试者和群体特定的恢复概况。我们希望这项研究能够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为、空间知识和注意力模型转化为在复杂环境中优化适应性运动的治疗方法的能力。公共卫生相关性：本研究探讨了比较脑卒中后功能视力隐藏障碍的两种治疗方法的结果分析新方法。我们希望这项研究能够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.