Prism adaptation treatment (PAT) for right brain stroke rehabilitation

项目总结/摘要 该应用程序解决了空间忽视认知康复的巨大治疗差距 (SN)，定义为不对称的定向，感知和反应，左空间后，右脑 中风，造成功能性残疾。虽然患有SN的退伍军人回家的可能性只有一半， 有三分之一的社区流动性，需要3倍的护理人员监督， 与类似的右脑相比， 中风幸存者，个性化的SN康复方法在退伍军人特定的 护理系统。我们发现，额叶损伤和“瞄准”SN都预测最佳 棱镜适应治疗（PAT）后恢复功能独立。这些发现表明， 开发一个[客观的，基于生物标志物的过程，以确定应该 管理PAT。该算法将通过识别特定的神经生物学特征来开发 预测PAT治疗反应。因此，我们希望这项研究将提供一个关键的失踪 康复要素，消除临床医生对SN诊断的不确定性， PAT，并允许更个性化的医疗保健方法来SN康复。我们的团队的 研究人员在三个高性能的退伍军人管理局医疗中心，在认知神经学杰出 分析脑成像预测因子和中风康复，从先进的和临床的数据， 将开发可用于指定SN康复的第一个生物参数。在180 退伍军人（120名有SN，60名没有），我们将定义和验证大脑成像生物标志物，预测 存在Aiming SN（Aim 1），这是接受PAT后功能恢复的强预测因素。我们 期望额叶与皮层下和顶叶区域的分离将预测 瞄准序列号我们还将研究脑成像生物标志物之间的相关性， PAT后针对SN和日常生活功能改善（目标2）。]然后，我们将确定， 将行为预测因子添加到生物标志物预测因子中（目标3）解释了生物标志物中的额外方差。 功能恢复的轨迹。我们工作的总体影响将是建立一个 经验证的生物标志物，常规识别卒中后SN的退伍军人， PAT的候选人。有了基于生物标记的算法，我们就可以进行大规模的 PAT临床试验和个性化SN护理。这种护理途径可以减少对专业护理人员的依赖。 SN评估，[协调VA和社区系统提供退伍军人中风护理，]并改善 中风护理效率，以提高成千上万的退伍军人中风后的结果和生活质量。

Project Summary/Abstract The application addresses the formidable treatment gap for cognitive rehabilitation of spatial neglect (SN), defined as asymmetric orienting, perception, and responding to left space after right brain stroke, causing functional disability. Although veterans with SN are half as likely to return home, have one-third the community mobility, require 3x as much caregiver supervision, and have longer hospitalizations, increased fall risk and increased rehospitalization compared with similar right brain stroke survivors, a personalized approach to SN rehabilitation is not available in veteran-specific systems of care. We discovered that frontal lobe damage and “Aiming” SN both predict optimal recovery of functional independence after prism adaptation treatment (PAT). These findings argue for the development of an [objective, biomarker-based process to identify patients who should be administered PAT. The algorithm will be developed by identifying specific neurobiological features predictive of PAT treatment response. Thus, we expect this research will deliver a critical missing element to rehabilitation, eliminating clinician uncertainty about SN diagnosis and appropriateness of PAT, and allowing a more personalized health care approach to SN rehabilitation. Our team of researchers at three high-performing VA medical centers, distinguished in cognitive neurology analysis of brain imaging predictors, and stroke rehabilitation, from both advanced and clinical data, will develop the first biological parameter that can be used to assign SN rehabilitation. In 180 veterans (120 with SN, 60 without), we will define and validate brain imaging biomarkers that predict the presence of Aiming SN (Aim 1), a strong predictor of functional recovery after receiving PAT. Our expectation that disconnection of frontal regions with subcortical and parietal regions will predict Aiming SN. We will also examine the correlation between the brain imaging biomarkers predicting Aiming SN and improvements in daily life function after PAT (Aim 2).] Then, we will determine if adding behavioral predictors to biomarker predictors (Aim 3) accounts for additional variance in the trajectory of functional recovery. The overall impact of our work will be to establish the utility of a validated biomarker that routinely identifies veterans with SN after stroke who are the best candidates for PAT. Armed with a biomarker-based algorithm, we can then carry out a large-scale PAT clinical trial, and personalized SN care. This care pathway could reduce reliance on specialized SN assessment, [coordinate VA and community systems providing veteran stroke care,] and improve stroke care efficiency, to enhance outcomes and quality of life after stroke for thousands of veterans.