A biomarker for personalized care in post-stroke spatial neglect

中风后空间忽视个性化护理的生物标志物

• 批准号: 10447653
• 负责人: A. M. Barrett
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10447653
• 关键词: 3-Dimensional; Address; Affect; American Heart Association; Atlases; Awareness; Behavioral; Biological; Biological Markers; Brain; Brain imaging; Cardiac; Caregivers; Caring; Characteristics; Clinical; Cognition Disorders; Cognitive deficits; Cohort Studies; Communities; Consumption; Counseling; Data; Diagnosis; Diffuse; Diffusion Magnetic Resonance Imaging; Disabled Persons; Dissemination and Implementation; Elements; Ensure; Failure; Family Caregiver; Freedom; Gender; Goals; Home; Hour; Image; Imaging Techniques; Injury; Lead; Left; Lesion; Life; Magnetic Resonance Imaging; Measurable; Measures; Methods; Motor; Movement; Neurocognitive; Neuropsychology; Outcome; Pathologic; Patient Care; Perception; Persons; Process; Protocols documentation; Quality of life; Race; Recovery; Recovery of Function; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Research; Research Personnel; Resolution; Rest; Self Care; Serum; Site; Speed; Stroke; Structure; Supervision; Technical Expertise; Testing; Time; Translating; Troponin; Veterans; Work; acute stroke; anatomic imaging; associated symptom; base; biomarker validation; brain magnetic resonance imaging; care costs; care delivery; care seeking; clinical biomarkers; clinical imaging; clinical predictors; cognitive rehabilitation; comparative; connectome; design; experience; frontal lobe; functional disability; functional gain; functional improvement; functional independence; functional outcomes; high resolution imaging; imaging biomarker; improved; improved outcome; motor deficit; neural correlate; neuroimaging; novel; novel strategies; personalized care; post stroke; potential biomarker; predicting response; rehabilitative care; response; screening; skills; social; spatial neglect; statistics; stroke outcome; stroke rehabilitation; stroke survivor; treatment planning; treatment response; white matter; white matter damage

This SPiRE provides the opportunity to raise the technical expertise of the PI (Barrett), and provide a critical missing element for personalized rehabilitation care in spatial neglect (SN), a disabling cognitive deficit causing asymmetric 3-D spatial action, movement, perception and awareness. For more than 10 years, the PI and colleagues addressed SN by extensively characterizing neuropsychological deficits, documenting the adverse impact on function and freedom, and developing feasible SN rehabilitation protocols. Their research reported ~80% SN underdiagnosis and undertreatment; improving this care delivery gap is certain to reduce the devastating personal and social losses associated with SN. Here, the PI moves from her past work advancing dissemination, implementation, and rehabilitation to gain neuroimaging skills and pursue a new, biological approach to improving SN care delivery. The PI and colleagues discovered that the Aiming SN subtype, associated with motor-intentional deficits, predicts rapid improvement of daily life function with early rehabilitation. However, Aiming SN is difficult to identify on typical behavioral screening. Unlike other SN subtypes, however, Aiming SN is strongly associated with specific neuroanatomic features: frontal lobe disconnection. In this study, supported by experts in studying white matter disruption in SN (Carter), white matter disruption as a predictor of stroke rehabilitation outcomes (Cramer), and novel brain imaging (Qiu), the PI will develop a new process of SN diagnosis based on brain imaging biomarkers. The team will develop brain imaging biomarkers associated with Aiming SN, using 4 advanced imaging procedures, and demonstrate that these biomarkers can predict daily life function improvement at 3 months and 6 months post-stroke (Aim 1). The experts supporting the PI have experience with rapidly translating biomarker analyses to clinical imaging data, and thus the SPiRE will also include a direct comparison of advanced imaging (high-resolution and diffusivity) versus clinically-acquired data (Aim 2). The team will directly compare the biomarkers derived from research imaging, with those derived from clinical imaging, to identify Aiming SN. They will also test the relative ability of research versus clinical biomarkers to predict functional independence at 3 and 6 months. At the next research step, armed with a potential biomarker for Aiming SN and for functional gains with SN rehabilitation, our team will propose a larger, multi-site study for biomarker validation. Our long-term goal is to lead SN research toward routinely identifying affected veterans, and rapidly providing personalized cognitive rehabilitation, to improve functional outcomes for veterans with stroke in the community.

该尖峰提供了提高PI（Barrett）的技术专业知识的机会， 为空间忽视（SN）中的个性化康复护理提供关键的缺失元素， 禁用认知赤字，导致不对称的3-D空间作用，运动，感知和 意识。十多年来，PI及其同事通过广泛地讲话 表征神经心理缺陷，记录对功能的不利影响和 自由，并制定可行的SN康复方案。他们的研究报告了约80％SN 诊断不足和治疗不足；改善此护理交付差距肯定会减少 与SN相关的个人和社会损失。在这里，PI从她的过去移动 促进传播，实施和康复的工作以获得神经影像学技能 并采用一种新的生物学方法来改善SN护理的交付。 PI和同事 发现与运动型缺陷相关的瞄准SN亚型预测了快速 通过早期康复改善日常生活功能。但是，瞄准SN很难 识别典型的行为筛查。与其他SN子类型不同，瞄准SN是 与特定的神经解剖特征密切相关：额叶断开。在这个 研究，在研究白质中断（卡特），白质专家的支持下 作为中风康复结果的预测指标（Cramer）和新型脑成像 （QIU），PI将基于脑成像生物标志物开发新的SN诊断过程。 该团队将使用4个高级 成像程序，并证明这些生物标志物可以预测日常生活功能 冲程后3个月零6个月的改善（AIM 1）。支持PI的专家有 迅速转化生物标志物分析的经验将分析转化为临床成像数据，因此 Spire还将直接比较高级成像（高分辨率和扩散率） 相对于临床获得的数据（AIM 2）。团队将直接比较生物标志物得出的生物标志物 从研究成像（从临床成像中得出的成像）来识别瞄准SN。他们会的 还测试研究与临床生物标志物预测功能的相对能力 3和6个月的独立性。在下一个研究步骤中，拥有潜在的生物标志物 为了瞄准SN和SN康复的功能收益，我们的团队将提出一个更大的，更大的 生物标志物验证的多站点研究。我们的长期目标是领导SN研究 常规确定受影响的退伍军人，并迅速提供个性化的认知 康复，以改善社区中风的退伍军人的功能结果。