Visuospatial deficits after stroke: Towards better classification, diagnostics, and rehabilitation.

中风后视觉空间缺陷：更好的分类、诊断和康复。

• 批准号: 10440965
• 负责人: Anna Greenwald
• 金额: $ 55.76万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-08 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10440965
• 关键词: Activities of Daily Living; Age; Agreement; Anatomy; Aphasia; Apraxias; Area; Attention; Attentional deficit; Behavior Therapy; Brain; Brain Injuries; Brain region; Characteristics; Classification; Clinical Trials; Cognition; Complement; Confounding Factors (Epidemiology); Contralateral; Control Groups; Custom; Data; Development; Diagnostic; Diagnostic Sensitivity; Education; Executive Dysfunction; Factor Analysis; Foundations; Functional Magnetic Resonance Imaging; Heterogeneity; Impairment; Inferior; Injury; Intervention; Judgment; Left; Length; Lesion; Linear Regressions; Link; Location; Long-Term Survivors; Magnetic Resonance Imaging; Manuals; Memory; Methods; Modeling; Motor; Nature; Neurologic; Outcome; Parietal; Participant; Patient Self-Report; Patients; Pattern; Perception; Performance; Persons; Predictive Value; Prognosis; Protocols documentation; Quality of life; Recovery; Regression Analysis; Rehabilitation therapy; Reporting; Research; Research Personnel; Resolution; Rest; Review Literature; Screening procedure; Site; Stimulus; Stress; Stroke; Survivors; Symptoms; Task Performances; Test Result; Testing; Translating; Visuospatial; aphasia rehabilitation; base; diagnostic tool; disability; eligible participant; functional outcomes; hemiparesis; improved; individualized medicine; language impairment; neuroimaging; noninvasive brain stimulation; novel; post stroke; public health relevance; rehabilitation strategy; relating to nervous system; spatial neglect; stroke outcome; stroke survivor; stroke symptom

Project Summary Non-primary visuospatial deficits are common after right-hemisphere (RH) injury, and they are known predictors of long-term disability after stroke. However, compared to impairments of language and motor function, they are less obvious and receive less attention in stroke research, diagnostics, and rehabilitation, resulting in underdiagnosis and undertreatment of RH stroke. Part of the problem is that these deficits and their neural bases are poorly understood, not least because of the heterogeneity of the tests used to assess them and a lack of agreement on their definition, which hamper comparison across studies. Based on our preliminary data and a review of the literature, we posit that these deficits, which are often subsumed under “spatial neglect”, reflect four core factors: lateralized perceptual-attentional, lateralized motor- intentional, non-lateralized attentional, and constructional. We further posit that they can be dissociated with appropriate assessments, are associated with different lesion sites, and respond to different treatments. To pave the way for better assessments and effective individualized treatments, the proposed research seeks to identify the core factors underlying visuospatial deficits, the assessments most sensitive and specific to them, their associations with functional outcomes after stroke, and their neural bases. SA1: Identify core visuospatial deficits and tests that are sensitive and specific to them and determine their association with long-term stroke outcomes. Assess long-term survivors of RH vs. LH stroke and matched Controls with a comprehensive battery of visuospatial tests. Use factor analysis to confirm that performance is better described by a model assuming multiple different rather than one unitary underlying deficit. Demonstrate that core deficits (captured as composite scores across battery subtests) are more severe in RH than LH stroke, and determine which best predict functional ability and self-reported quality of life. SA2: Identify neural bases of visuospatial deficits and their recovery. Acquire functional and anatomical magnetic resonance imaging (MRI) data from MRI-eligible participants of SA1. Using novel lesion-symptom and functional-anomaly mapping methods, test hypotheses regarding associations between specific lesion locations and deficits. Confirm that, in analogy to findings from aphasia research, stroke survivors with visuospatial deficits show increased contralesional task-evoked activation, and that it relates to performance. In addition to identifying the fundamental and dissociable components of visuospatial ability and their neural basis, the results will allow us to (1) improve RH stroke diagnostics of by identifying tests that are highly sensitive and specific to RH stroke, (2) provide more accurate outcome prognoses based on test results and lesion characteristics, and (3) customize rehabilitation based a patient’s visuospatial profile. They will also lay the basis for clinical trials evaluating noninvasive neurostimulation (rTMS, tDCS) for boosting rehabilitation of visuospatial deficits by modulating contralesional brain activation.

项目摘要 非主要视觉空间缺陷在右半球（RH）损伤后很常见，并且已知它们已知 但是，与语言和运动障碍相比，中风后的长期残疾人 功能，它们不太明显，并且在中风研究，诊断和康复中受到更少的关注， 导致诊断不足和RH中风不足。 神经碱很差，尤其是因为用于评估它们的测试的异质性 以及对其定义缺乏共识，这阻碍了整个研究的比较。 根据我们的初步数据和文献综述，我们认为这些缺陷通常是 属于“空间忽视”下，反映了四个核心因素：侧向感知型，侧向运动 有意的，非外边的同性恋和解释。 适当的评估，与不同的病变部位以及对不同信任的反应有关。 为了更好地评估和有效的个性化治疗铺平道路，支撑研究寻求 为了确定视觉空间缺陷的核心因素，评估最敏感和 对他们而言，他们与中风后的功能结果及其神经碱的联系。 SA1：确定核心视觉空间缺陷和测试测试对它们敏感并确定 他们与Loth-Lims中风结果的关联。 匹配的控件与全面的视觉效果测试相匹配。 假设多个不同而不是一个单一的下层的模型更好地描述了性能 赤字证明了核心赤字 在RH中，比LH中风，确定哪种最能预测功能能力和自我报告的生活质量。 SA2：确定视觉空间缺陷和恢复的神经基础。 来自SA1的MRI符合参与者的磁共振成像（MRI）数据 和功能性分析映射方法，关于特定病变之间关联的检验假设 位置和缺陷。 视觉空间赤字显示了触发任务诱发的激活增加，并且与性能有关。 除了确定视觉空间能力的基本和可分离的组成部分及其神经 基础，结果将使我们能够（1）通过识别高度测试来改善RH中风诊断 敏感和特定于RH中风，（2）提供了更准确的结果计划，以测试结果和 病变特征，（3）基于患者的视觉空间概况。 评估非侵入性神经刺激（RTMS，TDC）的临床基础 视觉空间缺陷通过调节脑大脑激活。