The Contribution of Eye-Hand Coordination Impairment to Functional Deficits in Stroke

眼手协调障碍对中风功能缺陷的影响

• 批准号: 10528018
• 负责人: John Ross Rizzo
• 金额: $ 22.62万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-13 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10528018
• 关键词: Abnormal coordination; Activities of Daily Living; Address; Affect; Area; Articular Range of Motion; Ataxia; Behavioral Paradigm; Brain; Caring; Clinical; Clinical assessments; Coupling; Data; Diffusion; Etiology; Eye; Eye Movements; Failure; Foundations; Future; Goals; Hand; Hand Strength; Hand functions; Impairment; Individual; Intervention; Knowledge; Lead; Lesion; Limb structure; Magnetic Resonance Imaging; Measurable; Measures; Mediating; Middle Cerebral Artery Infarction; Motor; Movement; Neuroanatomy; Paresis; Patients; Performance; Physical Rehabilitation; Process; Quality of life; Radial; Reaction Time; Recovery; Recovery of Function; Rehabilitation therapy; Research; Role; Saccades; Stroke; Survivors; System; Telephone; Testing; Time; Training; Translating; Translational Research; Upper Extremity; Visual; arm movement; base; direct application; disability; experience; eye hand coordination; functional independence; grasp; improved; limb movement; middle cerebral artery; motor deficit; motor impairment; motor recovery; neglect; neurological rehabilitation; oculomotor; post stroke; standard of care; stroke recovery; stroke rehabilitation; stroke survivor; tool

PROJECT SUMMARY Current standard of care in post-stroke upper-limb motor training has measurably reduced impairment and increased both active range of motion and movement quality. However, such improvements rarely generalize to performance gains for activities of daily living and functional independence. One of the hallmarks of functional arm movement is the seamless integration of visual inputs and limb control, mediated by the ocular motor system. However, this important foundation of functional performance and recovery has not been incorporated into stroke rehabilitation. This gap exists because not enough is known about basic eye-hand coordination (EHC), associated neuroanatomy, and how EHC is affected by stroke. Our preliminary data provide strong evidence that specific eye-hand coordination deficits can result from MCA stroke. The eye-hand coordination system is currently not addressed in neurorehabilitation research or clinical rehabilitation because of a lack of understanding of the mechanisms that underlie this coordination and how such mechanisms may be affected by stroke. This proposal will examine the neuroanatomical foundations of eye-hand coordination and how these networks are affected by middle cerebral artery stroke. The results are expected to provide a foundation for improved understanding of eye-hand coordination in functional deficits and functional recovery, post-stroke. This advanced understanding should provide the basis for a line of translational research that will lead to new clinical assessments and interventions to address eye-hand coordination deficits in stroke survivors. This knowledge may, in turn, address the current gap between motor recovery and functional recovery in stroke survivors with eye-hand coordination dyscoordination (EHdC). Our primary hypotheses are that MCA stroke can produce deficits in EHC through damage to specific frontoparietal circuits, and that changes in these circuits can predict functional recovery following stroke. We will address these hypotheses through the following two Aims. In Aim 1, we will determine the contribution of EHdC to motor recovery and function in MCA stroke. Hypothesis: MCA stroke produces EHC deficits that interfere with functional upper-limb recovery and functional independence. Aim 2: To identify microstructural changes to frontoparietal networks related to motor recovery and EHdC in MCA stroke. Hypothesis: Microstructural integrity in MCA stroke will relate to dyscoordination (mistiming). The findings from this proposal will detail the functional neuroanatomy underlying eye-hand coordination, and the functional implications of lesions in this system to functional performance. This foundation of knowledge will provide for a translational line of research to determine contributions of eye-hand coordination to functional deficits and functional stroke recovery.

项目概要 目前中风后上肢运动训练的护理标准已显着减少损伤和 增加主动运动范围和运动质量。然而，此类改进很少具有普遍性 日常生活活动和功能独立性的表现提升。的标志之一 功能性手臂运动是视觉输入和肢体控制的无缝集成，由眼部介导 电机系统。然而，这一功能表现和恢复的重要基础尚未得到重视。 纳入脑卒中康复治疗。存在这种差距是因为对基本的眼手了解不够 协调性 (EHC)、相关神经解剖学以及 EHC 如何受中风影响。我们的初步数据 提供强有力的证据表明，MCA 中风可能导致特定的眼手协调缺陷。眼手 协调系统目前在神经康复研究或临床康复中尚未得到解决，因为 对构成这种协调基础的机制以及这些机制如何发挥作用缺乏了解 受到中风的影响。该提案将研究眼手协调的神经解剖学基础 以及这些网络如何受到大脑中动脉卒中的影响。研究结果预计将提供 为提高对功能缺陷和功能恢复中眼手协调的理解奠定基础， 中风后。这种先进的理解应该为一系列转化研究提供基础， 导致新的临床评估和干预措施来解决中风中的眼手协调缺陷 幸存者。这些知识反过来可能会解决当前运动恢复和功能之间的差距 患有眼手协调障碍（EHdC）的中风幸存者的康复。我们的主要假设是 MCA 中风可通过损害特定额顶叶回路而导致 EHC 缺陷，并且 这些回路的变化可以预测中风后的功能恢复。我们将解决这些假设 通过以下两个目标。在目标 1 中，我们将确定 EHdC 对运动恢复的贡献和 MCA 中风的功能。假设：MCA 中风会产生 EHC 缺陷，从而干扰上肢功能 恢复和功能独立。目标 2：识别额顶网络的微观结构变化 与 MCA 中风的运动恢复和 EHdC 相关。假设：MCA 中风的微观结构完整性将 与协调失调（时机错误）有关。该提案的研究结果将详细介绍功能性神经解剖学 潜在的眼手协调能力，以及该系统中的病变对功能的功能影响 表现。这一知识基础将提供转化研究路线，以确定 眼手协调对功能缺陷和功能性中风恢复的贡献。