Deconstructing Post-Stroke Hemiparesis for Precision Neurorehabilitation

解构中风后偏瘫以实现精准神经康复

• 批准号: 10534787
• 负责人: David J Lin
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10534787
• 关键词: Acoustics; Acute; Anatomy; Area; Bilateral; Biomechanics; Biometry; Caring; Chronic; Clinical; Clinical Trials; Complement; Contralateral; Corticospinal Tracts; Cross-Sectional Studies; Data; Development; Development Plans; Diffusion Magnetic Resonance Imaging; Distal; Electroencephalography; Environment; Future; General Hospitals; Goals; Hand; Hand functions; Healthcare Systems; Impairment; Individual; Intervention; Ischemic Stroke; K-Series Research Career Programs; Knowledge; Laboratories; Lead; Lesion; Maps; Massachusetts; Mentors; Mentorship; Modeling; Motor; Motor Pathways; Natural History; Neurologic; Neurologist; Neurology; Neuronal Plasticity; Neurosciences; Pathway interactions; Pattern; Phenotype; Physicians; Physiologic pulse; Physiology; Prospective cohort; Randomized Clinical Trials; Recovery; Recovery of Function; Research; Research Project Grants; Resources; Science; Scientist; Spinal Cord; Stimulus; Stroke; Syndrome; System; Technology; Testing; Training; Transcranial magnetic stimulation; Translating; Translations; United States; Upper Extremity; Variant; Veterans; acute stroke; arm; arm function; base; brain computer interface; brain pathway; career; career development; chronic stroke; cohort; dexterity; disability; experience; hemiparesis; improved; insight; kinematics; medical schools; motor control; motor deficit; motor function improvement; motor impairment; motor recovery; multidisciplinary; neuroimaging; neurological rehabilitation; neurophysiology; neurorestoration; neurotechnology; noninvasive brain stimulation; novel; patient oriented research; post stroke; recruit; relating to nervous system; research study; response; skills; stroke hemiparesis; stroke patient; stroke recovery; stroke rehabilitation; stroke therapy; synergism; targeted treatment

PROJECT SUMMARY / ABSTRACT Dr. David Lin is a Neurocritical Care and Neurorehabilitation specialized Neurologist at VA Providence Health Care System whose career goal is to conduct mechanistic clinical trials of neurorehabilitation technologies, to maximize neuroplastic potential and functional recovery for Veterans with motor deficits after stroke. A critical step towards this goal is for Dr. Lin to perform research and acquire training in the phenotype of upper extremity stroke hemiparesis as well as its neuroanatomic and neurophysiologic underpinnings. Dr. Lin currently leads a natural history study of upper extremity stroke motor recovery in which he has demonstrated the feasibility of recruiting over 180 acute stroke patients with arm weakness into a research study and tracking their upper extremity impairments from the acute to chronic stages of recovery. Dr. Lin is completing an analysis of patterns of EEG cortical connectivity change after stroke in his VA CDA-1 project. In this Career Development Award-2 (CDA-2) project, Dr. Lin proposes to test specific systems neuroscience, model-driven hypothesis about the relationship between the phenotype of post-stroke upper extremity hemiparesis with anatomy (assessed by diffusion magnetic resonance imaging) and physiology (assessed by transcranial magnetic stimulation) of specific descending motor pathways (corticospinal and corticoreticulospinal). Specifically, he will (1) Deconstruct post-stroke hemiparesis into its individual components (2) Map descending motor tract anatomy onto distinct components of post-stroke hemiparesis and (3) Map descending motor tract physiology onto distinct components of post-stroke hemiparesis. To achieve these aims, Dr. Lin plans to conduct a new and dedicated cross-sectional study at Providence VA of N = 75 Veterans with chronic hemiparesis after stroke. The proposed CDA-2 project will provide Dr. Lin with fundamental training in motor control, structural neuroimaging, motor systems neurophysiology, and applied biostatistics for neurorehabilitation research as well as further experience with research skills necessary to lead an independent VA laboratory and clinical trials. Dr. Lin will achieve the science and training proposed with the support of a world-class and multidisciplinary mentorship team. Dr. Leigh Hochberg (primary mentor) and Dr. John Krakauer (primary co- mentor) will coordinate a panel of content mentors (neuroimaging- Dr. Jennifer Barredo, neurophysiology- Dr. Noah Philip, and kinematics and motor control - Dr. Steven Kautz) and subject advisors (neuroimaging- Dr. Sanes, motor systems physiology- Dr. Monica Perez, neurotechnology- Dr. Karunesh Ganguly, applied biostatistics- Dr. Jeff Goldsmith). Dr. Lin has developed a systematic mentoring and didactic plan to complement the scientific activities in his proposed project. All of these activities will leverage the extensive resources and world-class environment of VA RR&D Center for Neurorestoration and Neurotechnology (CfNN) at Providence VA and research affiliate, Massachusetts General Hospital, Harvard Medical School. Thus, the proposed VA patient-oriented research project, in concert with the mentorship and training plan, will provide Dr. Lin with the scientific insights and skills that are essential for him to develop into an independent VA physician-scientist career at the cutting edge of stroke neurorehabilitation and systems neuroscience.

项目概要/摘要 David Lin 博士是 VA Providence Health 的神经重症监护和神经康复专业神经科医生 护理系统，其职业目标是进行神经康复技术的机械临床试验，以 最大限度地提高中风后运动缺陷退伍军人的神经可塑性潜力和功能恢复。一个批评的 实现这一目标的一步是林博士进行上肢表型的研究和培训 中风偏瘫及其神经解剖学和神经生理学基础。林博士目前领导一个 上肢中风运动恢复的自然历史研究，他证明了以下方法的可行性： 招募了 180 多名手臂无力的急性中风患者参加一项研究，并追踪他们的上肢 肢体损伤从急性到慢性恢复阶段。林博士正在完成模式分析 在他的 VA CDA-1 项目中研究了中风后脑电图皮质连接的变化。本次职业发展奖-2 （CDA-2）项目中，林博士提出测试特定系统神经科学，关于模型驱动的假设 中风后上肢偏瘫的表型与解剖学之间的关系（通过评估 扩散磁共振成像）和生理学（通过经颅磁刺激评估） 特定的下行运动通路（皮质脊髓和皮质网状脊髓）。具体来说，他将 (1) 将中风后偏瘫分解为其各个组成部分 (2) 绘制下行运动束解剖图 中风后偏瘫的不同组成部分以及（3）将下行运动束生理学映射到 中风后偏瘫的不同组成部分。为了实现这些目标，林博士计划进行一项新的、 在弗吉尼亚州普罗维登斯对 75 名患有中风后慢性偏瘫的退伍军人进行了专门的横断面研究。 拟议的 CDA-2 项目将为林博士提供电机控制、结构 神经影像学、运动系统神经生理学以及神经康复研究的应用生物统计学 以及领导独立 VA 实验室和临床所需的研究技能的进一步经验 试验。林博士将在世界一流的专家的支持下实现所提出的科学和培训目标。 多学科导师团队。 Leigh Hochberg 博士（主要导师）和 John Krakauer 博士（主要合作者） 导师）将协调内容导师小组（神经影像学 - 詹妮弗·巴雷多博士，神经生理学 - 詹妮弗·巴雷多博士） Noah Philip 和运动学和运动控制 - Steven Kautz 博士）以及学科顾问（神经影像学 - Dr. Sanes，运动系统生理学 - Monica Perez 博士，神经技术 - Karunesh Ganguly 博士，应用 生物统计学 - 杰夫·戈德史密斯博士）。林博士制定了系统的指导和教学计划 补充他提议的项目中的科学活动。所有这些活动都将利用广泛的 VA RR&D 神经修复和神经技术中心 (CfNN) 的资源和世界一流的环境 弗吉尼亚州普罗维登斯和哈佛医学院马萨诸塞州总医院的研究附属机构。因此， 拟议的退伍军人事务部以患者为导向的研究项目，与指导和培训计划相结合，将提供 林博士拥有发展成为独立 VA 所必需的科学见解和技能 处于中风神经康复和系统神经科学前沿的医师科学家职业生涯。