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 非主要视觉缺陷在右半球（RH）损伤后很常见，并且已知它们已知 中风后长期残疾的预测指标。但是，与语言和电动机的损害相比 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。问题的一部分是这些缺陷及其 神经碱的理解很少，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。 基于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”，反映了四个核心因素：侧向性感知性，侧向运动 - 故意，非外边注意力和建设性。我们进一步确认它们可以与 适当的评估，与不同的病变部位相关，并对不同的治疗做出反应。 为了更好地评估和有效的个性化治疗铺平道路，拟议的研究寻求 为了确定视觉缺陷的核心因素，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关联。 SA1：识别核心视觉空间定义和对其特定的测试并确定 他们与长期中风结果的联系。评估RH与LH中风的长期风暴和 匹配的控件与全面的视觉测试。使用因子分析以确认 假设多个不同而不是一个统一的基础模型更好地描述了性能 赤字。证明核心定义（被捕获为电池子测验的复合分数）更严重 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：确定视觉缺陷的神经底部及其恢复。获取功能和解剖学 来自SA1的MRI资格参与者的磁共振成像（MRI）数据。使用新型病变症 和功能性分析映射方法，关于特定病变之间关联的测试假设 位置和定义。确认，与失语症研究的发现相比，中风生存 视觉缺陷显示出增加的对比任务引起的激活，并且与性能有关。 除了确定视觉能力的基本和可分离的组成部分及其中性 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 敏感且特定于RH中风，（2）根据测试结果提供了更准确的结果提示和 病变特征，（3）基于患者的视觉概况自定义康复。他们也会躺下 评估无创神经刺激（RTMS，TDC）的临床试验的基础 通过调节对比度大脑激活的视觉缺陷。