Behavioral and Neural Correlates of Post-Stroke Fatigue

项目总结 高达85%的中风幸存者经历中风后疲劳(PSF)，定义为加重 在活动中感觉到的努力。PSF是充分参与康复的一个重大障碍 并对中风后的生活质量产生负面影响。尽管其影响是众所周知的，但有非常多的 对PSF的针对性干预很少，这主要是由于潜在的机制不清楚。几个大脑 刺激研究表明，初级运动皮质(M1)兴奋性与 和PSF。阳极式经颅直流电刺激治疗慢性阻塞性肺疾病的临床研究 调节脑兴奋性在降低PSF中的混合临床疗效 行动机制。拟议的研究将通过以下方式解决我们知识中的空白 使用实验设计和实验设计确定PSF的行为和神经相关性 多式联运方式。32名因中风而严重疲劳的人将被随机 被分配接受连续五个阳极或假TDC会话。前前后后 干预后，参与者将完成对PSF、大脑的临床和行为评估 使用经颅磁刺激和脑连接性评估兴奋性 使用静息状态功能磁共振成像进行评估。在目标1中，我们将确定是否上调M1 通过tDCs的兴奋性将降低临床和行为标记物评估的PSF。目标2将 利用脑刺激和脑成像技术探讨针刺的神经生理效应 PSF上的tdcs。目标3将探索行为变化和 神经生理学改变，以提供对PSF的神经相关性的进一步洞察。我们的 长期目标是开发基于证据的、理论驱动的干预措施来管理PSF。这个 拟议的研究是创新的，因为它调查了一种相对新颖的干预措施来缓解PSF 并采用多模式方法来研究潜在的机制。全面的 研究将指导针对PSF潜在机制的治疗的发展。 除了其科学和临床意义外，拟议的研究还将实现其 通过培养一批学生研究人员和促进严格的研究来实现教育目标 我们学院内的文化。

PROJECT SUMMARY Up to 85% stroke survivors experience post-stroke fatigue (PSF) defined as intensified perceived effort during activities. PSF is a significant barrier to full participation in rehabilitation and negatively affects quality of life after stroke. Despite its well-known impacts, there are very few targeted interventions for PSF largely due to unclear underlying mechanisms. A few brain stimulation studies have suggested a relationship between primary motor cortex (M1) excitability and PSF. Recent clinical trials using anodal transcranial direct current stimulation (tDCS) to modulate brain excitability reported mixed clinical efficacy in reducing PSF with unclear mechanisms of action. The proposed research will address the gaps in our knowledge by determining the behavioral and neural correlates of PSF using an experimental design and multimodal approach. Thirty-two individuals with significant fatigue due stroke will be randomly assigned to receive five consecutive sessions of anodal or sham tDCS. Before and after intervention, participants will complete clinical and behavioral assessments of PSF, brain excitability assessment using transcranial magnetic stimulation, and brain connectivity assessment using resting state functional MRI. In aim 1, we will determine if upregulating M1 excitability via tDCS will reduce PSF assessed by clinical and behavioral markers. Aim 2 will utilize brain stimulation and brain imaging techniques to probe the neurophysiological effect of tDCS on PSF. Aim 3 will explore the correlation between behavioral changes and neurophysiological changes to provide further insights into the neural correlates of PSF. Our long-term goal is to develop evidence based, theory-driven interventions to manage PSF. The proposed study is innovative in that it investigates a relative novel intervention to mitigate PSF and adopts a multimodal approach to examine the underlying mechanisms. The comprehensive research will guide the development of treatment targeted the underlying mechanisms of PSF. In addition to its scientific and clinical significances, the proposed research will achieve its educational goals by fostering a group of student researchers and promoting rigorous research cultures within our institute.