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: 10721298
• 负责人: A. M. Barrett
• 金额: --
• 依托单位: NORTHAMPTON VA MEDICAL CENTER
• 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 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10721298
• 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 SPiRE 提供了提高 PI（Barrett）技术专业知识的机会，以及 为空间忽视（SN）的个性化康复护理提供一个关键的缺失要素， 失能认知缺陷导致不对称的 3D 空间动作、运动、感知和 意识。十多年来，PI 和同事通过广泛地解决 SN 问题 描述神经心理缺陷的特征，记录对功能的不利影响和 自由，并制定可行的 SN 康复方案。他们的研究报告称 SN 约为 80% 诊断不足和治疗不足；改善这种护理服务差距肯定会减少 与 SN 相关的毁灭性个人和社会损失。在这里，PI 摆脱了她的过去 努力推进传播、实施和康复，以获得神经影像技能 并寻求一种新的生物学方法来改善 SN 护理服务。 PI 和同事 发现与运动意图缺陷相关的 Aiming SN 亚型可以预测快速 通过早期康复改善日常生活功能。然而，瞄准SN却很难 通过典型的行为筛查进行识别。然而，与其他 SN 亚型不同，瞄准 SN 是 与特定的神经解剖学特征密切相关：额叶断开。在这个 研究得到了研究 SN 中白质破坏的专家的支持（卡特）、白质 中断作为中风康复结果的预测因子（Cramer），以及新颖的脑成像 (Qiu)，PI 将开发一种基于脑成像生物标志物的 SN 诊断新流程。 该团队将使用 4 种先进技术开发与 Aiming SN 相关的脑成像生物标志物 成像程序，并证明这些生物标志物可以预测日常生活功能 中风后 3 个月和 6 个月的改善（目标 1）。支持 PI 的专家有 将生物标志物分析快速转化为临床影像数据的经验，因此 SPiRE 还将包括先进成像的直接比较（高分辨率和扩散率） 与临床获得的数据比较（目标 2）。该团队将直接比较衍生的生物标志物 通过研究成像和临床成像来识别 Aiming SN。他们会 还测试研究与临床生物标志物预测功能的相对能力 3个月和6个月独立。在下一步的研究中，配备了潜在的生物标志物 为了瞄准 SN 和通过 SN 康复实现功能增益，我们的团队将提出一个更大的、 生物标志物验证的多中心研究。我们的长期目标是引领 SN 研究走向 定期识别受影响的退伍军人，并快速提供个性化认知 康复，以改善社区中中风退伍军人的功能结果。