One treatment, multiple targets: Prism adaptation and left brain stroke rehabilitation

中风是导致美国成年人残疾的最常见原因，急性中风后护理是其中之一 增长最快的费用类别。退伍军人在退伍军人中经历的功能障碍 中风，以及有限的康复资源，突出了识别 对不止一个恢复目标起作用的可行治疗。目前，认知和运动 损伤和疼痛，通过单独的和特定于模式的治疗路径来解决。 因此，中风老兵幸存者很容易受到支离破碎的跨专业护理 过程，对一些失效条件处理不足，未能协调协同 干预措施。这种零散的护理过程导致住院时间更长，跌倒的风险更大 以及事故、未完全康复和糟糕的生活质量。我们在这个项目中的总体目标 是采用棱镜适应疗法(PAT)，据报道，这是一种为期10天的养生法，以增强空间 功能，运动恢复，并减少中风后疼痛。尽管空间运动感觉 功能障碍在左脑和右脑中风中都很常见，之前对帕特的研究只有 包括右脑中风幸存者。广泛实施PAT的潜在障碍 多靶点治疗在中风康复中的应用，缺乏可行性评估的证据 经常合并疾病的左脑中风患者的治疗程序 语言障碍(失语症)和记忆障碍。我们提出了第一个关于PAT的研究 亚急性左脑中风伴失语和记忆障碍患者的系统性治疗 研究使用适应的PAT程序(目标1)和适应的空间运动的可行性- 感觉评估(目标2)，这是进行全面临床试验的先决条件。 此外，以前的脑图研究表明，病变模式可以用来 确定对PAT有最佳反应的患者。因此，我们还试图在临床上建立一种 可访问的、可靠的病变位置分类方法(目标3)，这是广泛的 帕金森病患者选择的临床指南的实施。在建议的研究中，我们 将收集和分析关于可行性的四个关键领域的数据，包括可接受性， 执行、适应和有限的效力。我们的长期目标是在两者中实施PAT 左右脑中风康复同时改善认知和运动功能， 和痛苦。通过论证调整后的评估和治疗程序在 左脑卒中失语和记忆障碍患者的可行性和可靠性 对于临床上可获得的病变分类方法，我们将开辟一条全面的路径 PAT作为卒中康复多靶点治疗的研究。这一系列的研究已经 提高目前支离破碎的护理流程的效率和效果的潜力 并显著改善成千上万退伍军人的功能、独立性和生活质量 与中风相关的残疾。

Stroke is the most frequent cause of US adult disability, and post-acute stroke care is among the fastest-growing expense categories. The functional disability experienced by Veterans after stroke, and the limited rehabilitation resources available, highlight the importance of identifying feasible treatments acting on more than one recovery target. Currently, cognitive and motor impairments, and pain, are addressed with separate and modality-specific treatment pathways. As a result, Veteran stroke survivors are vulnerable to a fragmented interprofessional care process, with under-treatment of some disabling conditions and failure to coordinate synergistic interventions. This fragmented care process leads to longer hospital stays, greater risk of falls and accidents, incomplete recovery and poor quality of life. Our overall objective in this project is to employ prism adaptation treatment (PAT), a 10-day regimen reported to enhance spatial function, motor recovery, and reduce post-stroke pain. Although spatial-motor-sensory impairments are common in both left and right brain stroke, previous studies of PAT have only included right-brain stroke survivors. A potential barrier to broad implementation of PAT as a multi-target treatment in stroke rehabilitation, is lack of evidence for the feasibility of assessment and treatment procedures in patients with left-brain stroke who often experience co-morbid language disorder (aphasia) and memory impairments. We propose the first study of PAT in subacute left-brain stroke patients with aphasia and memory deficits to systematically investigate the feasibility of using adapted PAT procedures (Aim 1) and adapted spatial-motor- sensory assessments (Aim 2), which is a prerequisite to conducting a full-scale clinical trial. Additionally, previous brain-mapping studies have shown that lesion patterns can be used to identify patients who respond optimally to PAT. Thus, we also seek to establish a clinically accessible, reliable way of categorizing lesion location (Aim 3), a prerequisite for broad implementation of clinical guidelines about patient selection for PAT. In the proposed study, we will collect and analyze data on four key areas of feasibility, including acceptability, implementation, adaptation and limited efficacy. Our long-term goal is to implement PAT in both left and right-brain stroke rehabilitation to simultaneously improve cognitive and motor function, and pain. By demonstrating the feasibility of adapted assessment and treatment procedures in left-brain stroke patients with aphasia and memory impairment, and the feasibility and reliability of clinically accessible lesion categorization methods, we will open a path to a full-scale investigation of PAT as a multi-target treatment stroke rehabilitation. This line of research has the potential to increase the efficiency and effectiveness of currently fragmented care processes and significantly improve functioning, independence and quality of life in thousands of Veterans with stroke-related disabilities.