New York Columbia Collaborative SPOTRIAS

纽约哥伦比亚合作 SPOTRIAS

• 批准号: 8135879
• 负责人: Randolph S Marshall
• 金额: $ 88.05万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8135879
• 关键词: New; York; Columbia; Collaborative; SPOTRIAS

DESCRIPTION (provided by applicant): We have recently argued that stroke recovery is best defined as the process of improvement of the initial impairment rather than as the recovered endpoint itself (for example, change in Fugl-Meyer motor score (AFM) from baseline to 90 days post-stroke). This perspective facilitates the investigation of the biological mechanisms involved with recovery rather than simply looking at the result of the process once it has occurred. In the first SPOTRIAS grant three important discoveries were made that altered the landscape of the investigation of stroke recovery, and which provide the scientific groundwork for our current proposed line of investigation. The first discovery was the principle of proportional recovery, in which we showed that all stroke patients with mild-to-moderate deficits tend to recover a specific proportion (-70%) of their maximum potential recovery with a high degree of predictability (R=.90). Initially described with regard to motor function, the same principle also appears to hold for recovery of language function. Second, in patients with severe initial impairment there is much greater variability in recovery - some follow proportional recovery, and some recover negligibly. These non-recoverers, indistinguishable clinically from proportional recoverers in the first week post-stroke, represent an important class of patient to characterize further; The third discovery, which satisfied the primary specific aim of the original SPOTRIAS grant, was that there is a significant correlation between functional magnetic resonance imaging (fMRI)-measured brain activation acquired at an average 2 days after stroke onset and the degree of motor recovery of the neurological impairment over the subsequent 3 months. The overall goal of this grant is to derive a clinically relevant tool for predicting spontaneous recovery in individual patients within the first few days after stroke, and through this process investigate the mechanistic role of 3 variables that we hypothesize are important correlates of AFM: initial impairment, DWI lesion load on the corticospinal tract (CST), and expression of the fMRI "recovery pattern." This goal will be achieved by first validating the principle of proportional recovery with explicit examination of the influence of rehabilitation, then determining the correlation between degree of disruption of the CST and the patient's initial impairment and subsequent recovery, and finally by selecting the model that best predicts AFM using the 3 variables alone and in combination. The second goal, which will draw on additional imaging expertise from the MGH SPOTRIAS site, is an important guide to further research into interventions, and will be studied by testing hypotheses from the extant literature about the necessity and sufficiency of corticospinal tract (CST) pathways in recovery. Sixty acute stroke patients from the stroke services at Columbia and the MGH will be studied with this multi-modal approach. RELEVANCE: Stroke is the third leading cause of mortality and the leading cause of disability in adults in the US. A better understanding of the mechanisms of stroke recovery will allow us to predict who is likely to recover well and to target specific interventions for development that will enhance the recovery process.

描述（由申请人提供）： 我们最近认为，中风恢复最好定义为改善初始损害的过程，而不是恢复的端点本身（例如，FUGL-MEYER运动评分（AFM）的变化从基线到势后90天）。这种观点促进了对恢复涉及的生物学机制的研究，而不仅仅是一旦发生过程的结果。在第一批斑点中，提出了三个重要发现，改变了中风恢复调查的景观，并为我们当前提议的调查局提供了科学的基础。第一个发现是比例恢复的原则，在其中我们表明，所有轻度至中度缺陷的中风患者倾向于恢复其最大潜在恢复的特定比例（-70％），具有高度可预测性（r = .90）。最初描述的是关于运动功能的，同样的原理似乎也可以恢复语言功能。其次，在严重初始障碍的患者中，恢复的变化更大 - 有些遵循比例恢复，有些恢复却忽略了。这些非恢复的人在扫率后第一周与比例恢复器在临床上无法区分，代表了一类重要的患者，可以进一步表征。满足原始点批准的主要特定目的的第三个发现是，功能磁共振成像（fMRI）在中风发作后2天平均获得的脑激活与在随后3个月内平均获得了神经系统损伤的运动恢复程度之间存在显着相关性。这项赠款的总体目标是得出中风后的头几天的最初几天内自发恢复的临床相关工具，并且通过这一过程调查了3个变量的机械作用，我们假设我们假设是AFM的重要相关性：初始损害，DWI病变负荷在皮质脊髓骨骼（CST）上（CST）和FMRI的表达。该目标将通过首先验证比例恢复的原理，并明确检查康复的影响，然后确定CST中断程度与患者的初始障碍以及随后的恢复之间的相关性，并最终选择使用3个变量物和结合使用3个变量的模型。第二个目标将借鉴MGH Spotrias站点的其他成像专业知识，是对干预措施进行进一步研究的重要指南，并将通过测试现有文献中有关恢复中皮质脊髓区（CST）途径的必要性和充分性的假设来研究。将通过这种多模式方法对哥伦比亚中风服务的60名急性中风患者进行研究。 相关性：中风是美国成年人死亡率的第三主要原因和残疾的主要原因。更好地了解中风恢复机制将使我们能够预测谁可能恢复良好，并针对特定的开发干预措施，以增强恢复过程。