Mechanistic and neuroanatomic bases of disparity between arm capacity and use in stroke

项目摘要 美国每年有超过75万人中风，多达94%的中风幸存者 表现出减少使用一只手臂，对残疾、照顾者负担和生活质量产生不良后果。 大约40%-80%在日常生活中不能使用患臂的人具有足够的感觉- 电动机的能力，这样做。武器使用和能力之间的差距（即，使用/能力差距- UCD） 发生在广泛的感觉运动严重程度，是一个令人困惑的和紧迫的问题，在神经， 康复活动.也许部分是因为UCD位于感觉运动处理的界面， 认知/情感现象，过去没有研究评估其潜在机制或神经解剖学 生物标志物。鉴于其普遍性，对各种严重程度的UCD机制的理解是 需要开发有针对性的治疗方法来改善这种疾病。此外，中风患者 很少评估UCD的存在，部分原因是这种评估具有挑战性。拟议研究 我将通过测试三个假设的预测来解决我们知识和能力上的这些差距。 UCD的潜在机制：感觉运动，注意力和冷漠/动机帐户。在目标1中， 管理一组有针对性的感觉运动和神经心理学测试，以测试每个人的预测。 在100名轻度至中度左半球和右半球慢性卒中患者的样本中进行3种假设。我们将 确定这些措施以及人口统计学和中风相关变量与UCD的关联。 AIM 2将使用先进的神经影像学方法，并从静息态功能磁共振中获得数据 成像以开发与UCD相关的成像生物标志物。在Aim 3中，我们将验证一种新的虚拟现实 评估工具，以快速，可靠地评估UCD。除了临床实用性外，该任务还可以内置 通过确定UCD是否受注意力任务的影响来评估注意力假设 要求。到资助期结束时，我们将确定人口统计学，感觉运动， 神经心理学和神经解剖学因素预测UCD并验证临床有用的VR 评估工具。鉴于这一领域的知识基础有限，这项全面的研究将为 开发针对潜在机制的治疗方法，并加强对风险的识别 个体

Project Summary More than 750,000 individuals in the U.S. have a stroke each year, and as many as 94% of stroke survivors exhibit reduced use of one arm, with adverse consequences for disability, caregiver burden, and quality of life. Approximately 40%-80% of individuals who fail to use the affected arm in daily life possess adequate sensory- motor capacity to do so. The disparity between arm use and capacity (i.e., Use/Capacity Disparity -- UCD) occurs across a broad spectrum of sensory-motor severity and is a perplexing and urgent problem in neuro- rehabilitation. Perhaps in part because UCD lies at the interface of sensory-motor processing and cognitive/affective phenomena, no past research has assessed its underlying mechanisms or neuroanatomic biomarkers. Given its prevalence, an understanding of the mechanisms of UCD across a range of severity is required to develop targeted treatments to ameliorate the disorder. Moreover, individuals with stroke are rarely assessed for the presence of UCD, in part because such assessment is challenging. The proposed research will address these gaps in our knowledge and capacity by testing the predictions of 3 hypotheses of the mechanisms underlying UCD: the sensorimotor, attention, and apathy/motivation accounts. In Aim 1 we will administer a targeted battery of sensorimotor and neuropsychological tests to test the predictions of each of the 3 hypotheses in a sample of 100 mild to moderate left- and right-hemisphere chronic stroke patients. We will determine the association of these measures as well as demographic and stroke-related variables with UCD. Aim 2 will use advanced neuroimaging methods with data from resting-state functional magnetic resonance imaging to develop imaging biomarkers associated with UCD. In Aim 3 we will validate a novel virtual reality assessment tool to rapidly and reliably evaluate UCD. In addition to its clinical utility, the task enables built-in assessment of the attention hypothesis by determining whether UCD is influenced by attentional task demands. By the end of the grant period, we will have determined the demographic, sensorimotor, neuropsychological, and neuroanatomical factors that predict UCD and validated a clinically-useful VR assessment tool. Given the limited knowledge base in this area, this comprehensive research will pave the way for development of treatments targeted to underlying mechanisms and enhanced identification of at-risk individuals.