Early Post-Stroke Biomarkers for Motor Rehabilitation Outcomes

项目总结/摘要 该提案代表了一项为期五年的研究职业发展计划，重点是早期识别 中风后慢性运动控制障碍的预测因素。概述的建议建立在候选人的 先前的研究和经验，并将有助于候选人的发展，作为一个独立的 研究人员通过支持她在神经成像，经颅磁刺激， 中风后恢复研究中的先进生物统计分析。 中风是美国成人残疾的主要原因。在接受康复治疗的人中， 大约40%的人上肢运动功能长期受损，导致上肢运动功能下降。 生活质量和卒中的社会负担增加。目前，临床康复的重点是重复运动 运动，但干预措施不适用于个别中风病变位置或预测的轨迹， 复苏先前的研究已经确定了运动控制的明显障碍，这些障碍导致了在运动中的功能障碍。 慢性期可能取决于中风损伤的神经解剖结构，但 造成这些损害的原因和出现的时间尚不清楚。在 为了创建最佳的康复策略并最大限度地发挥每个患者的康复潜力， 我们需要更好的方法来预测和治疗这些运动控制障碍。 在这个建议中，我们的目标是使用肌电图计算机接口（ECI）来研究运动障碍， 控制腕关节屈曲和伸展的肌肉群，并进行纵向研究，以1）建立 中风后不同运动控制障碍的自然史和2）识别早期神经成像， 电生理学和临床标志物，预测在慢性阶段的特定运动障碍。然后我们 3)评估使用ECI提供早期强化生物反馈治疗的可行性， 预测个体患者的损伤。这些研究将奠定必要的基础， 神经康复中精确医学疗法的未来发展。此外，指导研究 和职业发展计划将为申请人提供进一步培训的机会， 纵向研究，先进的生物统计分析，以及功能和结构神经成像。的结果 这项研究和职业发展奖将促进她的临床研究计划的扩展， 致力于开发治疗中风后早期运动变化的新疗法。

Project Summary/Abstract This proposal represents a five-year research career development program focusing on identifying early predictors of chronic motor control impairments post-stroke. The outlined proposal builds on the candidate’s prior research and experience, and will contribute to the candidate’s development as an independent researcher by supporting her training in the application of neuroimaging, transcranial magnetic stimulation, and advanced biostatistical analysis in post-stroke recovery research. Stroke is the leading cause of adult disability in the US. Of those who receive rehabilitation therapy, approximately 40% have chronically impaired motor function of the upper extremity, contributing to decreased quality of life and increased societal burden of stroke. Currently, clinical rehabilitation focus on repetitive motor exercises, but interventions are not adapted for individual stroke lesion location or predicted trajectory of recovery. Prior studies have identified distinct impairments of motor control that contribute to poor function at the chronic stage and likely depend on neuroanatomical structures damaged by the stroke, but the details of what contributes to development of these impairments and timing of when they emerge remains unclear. In order to create optimal rehabilitation strategies and maximize each individual patient’s rehabilitation potential, we need better methods for predicting and treating these motor control impairments. In this proposal, we aim to use an electromyographic computer interface (ECI) to study motor impairments in the muscle groups that control wrist flexion and extension, and perform a longitudinal study to 1) establish the natural history of distinct motor control impairments post-stroke and 2) identify early neuroimaging, electrophysiologic, and clinical markers that predict specific motor impairments at the chronic stage. We then 3) evaluate the feasibility of using the ECI to provide early, intensive biofeedback therapy to target the predicted impairments of the individual patients. These studies will establish the necessary foundation for future development of precision-medicine therapies in neurorehabilitation. Furthermore, the mentored research and career development plan will provide the applicant with the opportunity for further training in leading longitudinal studies, advanced biostatistical analysis, and functional and structural neuroimaging. The results of this research and career development award will foster the expansion of her clinical research program, which is dedicated to developing novel therapies to treat early motor changes post-stroke.