Building a science for treatment of spatial neglect

描述(申请人提供)：空间忽视，由脑损伤引起的病理性不对称空间行为(海尔曼，1979)和引起功能障碍(Barrett和Burkhold，2006)可能发生在20%-50%的中风中，每年多达350,000美国人(Ringman等人，2004；美国中风协会，2007)。在复杂的环境中进食、穿衣和导航困难在这种疾病中发生得很严重，但即使症状在慢性康复中得到改善，空间忽视的人也更有可能失去功能独立性(Katz等人，1999)。目前的标准临床方法不是理论驱动的，广泛使用的治疗方法可能只有轻微的效果。在这项建议中，我们提出了两种方法来实施科学的急性空间忽视治疗。在现有的研究中，受试者的异质性可能会掩盖治疗效果。在方法上，研究使用了单一受试者、病例系列和群体分析设计，但没有试图协调个体分析方法与群体分析方法所提供的明显优势。不同的治疗方法可能会影响不同的空间认知恢复功能，但简单的全局结果测量可能不会反映这些变化。对特定受试者和群体效应进行建模也是检查靶向治疗效果的一种非常有用的方法。我们将在四年内收集空间忽视治疗的反应数据，用于两种有前景和可行的空间忽视治疗：棱镜适应训练和多巴胺能药物治疗。通过特定机制的结果评估和分层线性建模，我们将检查治疗是否产生可预测的反应。我们还将研究控制特定主题的预测因素是否会影响群体的复苏轨迹。最后，我们将检查目前尚未完全开发出心理测量学的标准全球结果测量工具，并试图预测这些变量的特定于受试者和特定群体的恢复情况。我们希望这项研究将提高我们设计认知康复治疗研究的能力。然而，它也可能提高我们将认知神经科学的行动、空间知识和注意力模型转化为治疗方法以优化复杂环境中的适应性运动的能力。公共卫生相关性：这项研究调查了结果分析的新方法，以比较两种治疗中风后隐匿性视力障碍的方法。我们希望这项研究将提高我们设计认知康复治疗研究的能力。然而，它也可能提高我们将基础脑科学带到床边的能力，优化中风幸存者在复杂环境中的适应性运动和平衡的视觉空间功能。

DESCRIPTION (provided by applicant): Spatial neglect, pathologically asymmetric spatial behavior resulting from a brain injury (Heilman, 1979) and causing functional disability (Barrett and Burkholder, 2006) may occur in 20-50% of strokes, up to 350,000 Americans annually (Ringman et al., 2004; American Stroke Assoc., 2007). Difficulty eating, dressing, and navigating in complex environments occurs acutely in this disorder, but even if symptoms improve in chronic recovery, people with spatial neglect are more likely to lose functional independence (Katz et al., 1999). Current standard clinical approaches are not theory driven, and widely-employed therapies may be only marginally effective. In this proposal, we suggest two means by which scientific acute spatial neglect treatment can be implemented. In available studies, subject heterogeneity may have obscured treatment effects. Across methods, studies used single subject, case series, and group analytic designs, but did not attempt to reconcile the distinct advantages offered by individual versus group analytic approaches. Different treatments might affect different spatial cognitive recovery functions, but simple, global outcome measures may not reflect these changes. Modeling both subject-specific and group effects is also an extremely useful method of examining targeted treatment effects. We will collect spatial neglect treatment response data over four years, for two promising and feasible spatial neglect treatments: prism adaptation training and dopaminergic medication. With mechanism-specific outcome assessment and hierarchical linear modeling, we will examine whether treatments result in predictable response. We will also examine whether controlling for subject-specific predictors models group recovery trajectory. Lastly, we will examine current standard global outcome measures instruments which have not been fully psychometrically developed, and attempt to predict subject- and group-specific recovery profiles for these variables. We hope this research will improve our ability to design cognitive rehabilitation treatment studies. It may also, however, improve our ability to translate cognitive neuroscience models of action, spatial knowledge, and attention, to treatments to optimize adaptive movement in complex environments. PUBLIC HEALTH RELEVANCE: This study investigates novel methods of outcome analysis for comparing two treatments for hidden disabilities in functional vision after stroke. We hope this research will improve our ability to design cognitive rehabilitation treatment studies. It may also, however, improve our ability to bring basic brain science to the bedside, to optimize stroke survivors' adaptive movement and balanced visual-spatial function in complex environments.