Rehabilitation of Reading Deficits in Subacute Stroke using fMRI Neurofeedback and Motor Imagery

使用功能磁共振成像神经反馈和运动想象康复亚急性中风患者的阅读缺陷

基本信息

批准号：
10301277
负责人：
Olga Boukrina
金额：
$ 13.48万
依托单位：
KESSLER FOUNDATION, INC.
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10301277
关键词：
Address Aphasia Area Award Base of the Brain Behavioral Research Binding Biological Biomedical Research Brain Brain imaging Cerebrum Chronic Clinical Clinical Trials Clinical Trials Design Cognitive Computer software Controlled Clinical Trials Coupled Data Disease Early Intervention Equilibrium Feasibility Studies Feedback Fingers Functional Magnetic Resonance Imaging Goals Hand Hearing Imagery Imaging Techniques Impairment Inferior Intervention Language Language Disorders Lead Learning Left Letters Life Linguistics Magnetic Resonance Imaging Mediating Mentored Research Scientist Development Award Mentors Methods Mission Modeling Motor National Institute on Deafness and Other Communication Disorders Neuronal Plasticity Neurosciences Orthography Outcome Parietal Parietal Lobe Participant Patients Pattern Perfusion Persons Population Procedures Process Property Psyche structure Quality of life Reading Reading Disorder Recovery Recovery of Function Rehabilitation Outcome Rehabilitation therapy Research Research Support Residual state Signal Transduction Smell Perception Speech Stroke Survivors Taste Perception Technology Testing Time Training Training Support Visual Voice Work base cognitive function cognitive rehabilitation design disability experience improved improved outcome innovation knowledge base language impairment learning strategy neural network neurobehavioral neurofeedback neurological rehabilitation neuromechanism novel novel strategies patient population phonology post stroke programs reading ability reading difficulties recruit relating to nervous system response skills sound stroke patient stroke recovery stroke survivor success treatment strategy

项目摘要

Stroke is the leading cause of long-term disability in the US and worldwide. Unilateral stroke of the left- hemisphere causes reading and language deficits in 21-58% of stroke survivors and these deficits persist chronically, despite participation in therapy. The majority of the available reading treatments show the clearest benefits on trained materials. Therefore, there is an urgent need for new treatment strategies that can generalize outside of the treatment context. Biologically-based interventions can meet this challenge by directly influencing beneficial post-stroke plasticity. For example, real-time functional Magnetic Resonance Imaging Neurofeedback (fMRI NFB) is an innovative approach allowing participants to regulate their own brain activity. It uses a combination of mental strategies and concurrent brain activity feedback. Studies have shown that repeated efforts to self-regulate brain activity lead to learning-induced neural changes. Preliminary evidence also suggests that real-time fMRI NFB can improve post-stroke motor and cognitive function. The main goal of the present proposal is to build on this success and to advance biologically-inspired interventions for reading. Strong preliminary data show that reduced recruitment of the intact left-hemisphere reading areas is associated with suboptimal reading outcomes after stroke. In addition, pilot data suggest that right hand finger tap imagery can effectively activate the left inferior parietal region thought to support binding of visual orthographic information with sound representations during reading. Given that difficulty with orthography- phonology conversion is the most common deficit among left-hemisphere stroke survivors, the current project proposes to use right hand finger tap imagery in combination with fMRI NFB to help re-instate left inferior parietal activity during reading. It is hypothesized that efforts to increase reading-related brain activation in the left-hemisphere will re-engage the impaired reading mechanisms and may alleviate reading deficits. Under this K01 award, the applicant will develop skills necessary to test this hypothesis, namely in carrying out clinical trials using fMRI NFB and motor imagery. This project has 3 specific aims. Under Aim 1, the applicant will become proficient in specific hardware, software, pre- and post-processing requirements of fMRI NFB, gain NFB research experience, and acquire critical skills in motor imagery and clinical trial design. In Aim 2, the applicant will apply this training to conduct a clinical trial feasibility study for a combined fMRI NFB and motor imagery rehabilitation of reading impairments in left-hemisphere stroke. Lastly, under Aim 3, the applicant will characterize the neural mechanisms of reading in subacute stroke. At the end of this award period, the applicant will develop a valid and reliable paradigm for a neuroscience-based reading intervention that has the potential to change how reading deficits are treated. The methods developed here could be extended to other domains and to other clinical populations to improve cognitive rehabilitation outcomes.

中风是美国和全球长期残疾的主要原因。左边的单侧中风半球会导致21-58％的中风幸存者的阅读和语言缺陷，这些缺陷持续存在尽管参与了治疗，但长期以来。大多数可用阅读治疗表明最清晰训练有素的材料的好处。因此，迫切需要新的治疗策略在治疗环境之外概括。基于生物学的干预措施可以直接应对这一挑战影响有益的中风后可塑性。例如，实时功能磁共振成像神经反馈（fMRI NFB）是一种创新的方法，允许参与者调节自己的大脑活动。它结合了心理策略和并发的大脑活动反馈。研究表明反复努力自我调节大脑活动会导致学习引起的神经变化。初步证据还表明实时fMRI NFB可以改善中风后运动和认知功能。主要目标目前的建议是基于这一成功并推进以生物学启发的阅读干预措施。强有力的初步数据表明，完整左 - 半球阅读区域的招募减少是与中风后的次优阅读结果相关。此外，飞行员数据表明右手指 TAP图像可以有效地激活左下顶部区域，以支持视觉的结合阅读过程中具有合理表示的拼字信息。鉴于拼字法的困难 - 语音转化是当前项目的左 - 半球中风幸存者中最常见的赤字建议将右手手指与fMRI NFB结合使用，以帮助重新加入左下阅读过程中的顶活动。假设为增加与阅读相关的大脑激活的努力左脊椎球将重新引起阅读机制受损的障碍，并可能减轻阅读缺陷。在此 K01奖，申请人将开发检验这一假设所需的技能，即进行临床使用fMRI NFB和运动图像进行试验。该项目具有3个具体目标。在AIM 1下，申请人将精通fMRI NFB的特定硬件，软件，预处理和后处理要求， NFB研究经验，并获得运动图像和临床试验设计方面的关键技能。在AIM 2中申请人将向fMRI NFB和电动机进行临床试验可行性研究进行临床试验可行性研究在左半球中风中阅读障碍的图像康复。最后，根据AIM 3，申请人将表征亚急性中风中阅读的神经机制。在这个奖励期结束时，申请人将为基于神经科学的阅读干预措施开发有效可靠的范式改变阅读缺陷的治疗方式的潜力。这里开发的方法可以扩展到其他领域和其他临床人群，以改善认知康复结果。