One treatment, multiple targets: Prism adaptation and left brain stroke rehabilitation

一种治疗，多个目标：棱镜适应和左脑中风康复

• 批准号: 10016838
• 负责人: Amy D Rodriguez
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10016838
• 关键词: Accidents; Acute; Address; Adherence; Adult; Aphasia; Area; Base of the Brain; Brain; Brain Mapping; Caring; Categories; Chronic; Classification; Clinic; Clinical; Clinical Trials; Cognitive; Data; Diagnosis; Effectiveness; Ensure; Evaluation; Failure; Family; Foundations; Future; Goals; Guidelines; Impaired cognition; Impairment; Intervention; Investigation; Knowledge; Language Disorders; Lead; Left; Length of Stay; Lesion; Location; Measurement; Memory Disorders; Memory impairment; Methods; Modality; Motor; Outcome; Outpatients; Pain; Pain Measurement; Pain management; Pathway interactions; Patient Selection; Patients; Pattern; Procedures; Process; Protocols documentation; Quality of life; Radiology Specialty; Recovery; Regimen; Rehabilitation therapy; Reporting; Research; Research Personnel; Resources; Sensory; Signal Transduction; Societies; Stroke; Veterans; Wolves; acute stroke; care fragmentation; career; clinical implementation; comorbidity; cost; disability; effective therapy; experience; fall risk; functional disability; functional outcomes; high reward; high risk; improved; improved functioning; innovation; language impairment; motor impairment; motor recovery; patient health information; post stroke; post stroke pain; spatial neglect; stroke patient; stroke rehabilitation; stroke survivor; stroke therapy; tool; treatment response

Stroke is the most frequent cause of US adult disability, and post-acute stroke care is among the fastest-growing expense categories. The functional disability experienced by Veterans after stroke, and the limited rehabilitation resources available, highlight the importance of identifying feasible treatments acting on more than one recovery target. Currently, cognitive and motor impairments, and pain, are addressed with separate and modality-specific treatment pathways. As a result, Veteran stroke survivors are vulnerable to a fragmented interprofessional care process, with under-treatment of some disabling conditions and failure to coordinate synergistic interventions. This fragmented care process leads to longer hospital stays, greater risk of falls and accidents, incomplete recovery and poor quality of life. Our overall objective in this project is to employ prism adaptation treatment (PAT), a 10-day regimen reported to enhance spatial function, motor recovery, and reduce post-stroke pain. Although spatial-motor-sensory impairments are common in both left and right brain stroke, previous studies of PAT have only included right-brain stroke survivors. A potential barrier to broad implementation of PAT as a multi-target treatment in stroke rehabilitation, is lack of evidence for the feasibility of assessment and treatment procedures in patients with left-brain stroke who often experience co-morbid language disorder (aphasia) and memory impairments. We propose the first study of PAT in subacute left-brain stroke patients with aphasia and memory deficits to systematically investigate the feasibility of using adapted PAT procedures (Aim 1) and adapted spatial-motor- sensory assessments (Aim 2), which is a prerequisite to conducting a full-scale clinical trial. Additionally, previous brain-mapping studies have shown that lesion patterns can be used to identify patients who respond optimally to PAT. Thus, we also seek to establish a clinically accessible, reliable way of categorizing lesion location (Aim 3), a prerequisite for broad implementation of clinical guidelines about patient selection for PAT. In the proposed study, we will collect and analyze data on four key areas of feasibility, including acceptability, implementation, adaptation and limited efficacy. Our long-term goal is to implement PAT in both left and right-brain stroke rehabilitation to simultaneously improve cognitive and motor function, and pain. By demonstrating the feasibility of adapted assessment and treatment procedures in left-brain stroke patients with aphasia and memory impairment, and the feasibility and reliability of clinically accessible lesion categorization methods, we will open a path to a full-scale investigation of PAT as a multi-target treatment stroke rehabilitation. This line of research has the potential to increase the efficiency and effectiveness of currently fragmented care processes and significantly improve functioning, independence and quality of life in thousands of Veterans with stroke-related disabilities.

中风是美国成人残疾的最常见原因，急性中风后护理是其中之一 增长最快的支出类别。退伍军人经历的功能障碍 中风以及可用的康复资源有限，凸显了识别中风的重要性 针对多个恢复目标的可行治疗方法。目前，认知和运动 损伤和疼痛可以通过单独的、特定方式的治疗途径来解决。 因此，退伍军人中风幸存者很容易受到支离破碎的跨专业护理的影响 过程中，对一些致残情况处理不足并且未能协调协同作用 干预措施。这种分散的护理过程导致住院时间更长，跌倒的风险更大 以及事故、不完全康复和生活质量差。我们在这个项目中的总体目标 是采用棱镜适应治疗（PAT），据报道，这是一种为期 10 天的治疗方案，可增强空间 功能、运动恢复并减轻中风后疼痛。尽管空间运动感觉 左脑和右脑中风的损伤都很常见，之前的 PAT 研究仅 包括右脑中风幸存者。广泛实施 PAT 作为一项潜在障碍 脑卒中康复中多靶点治疗的可行性，缺乏证据评估 经常出现共病的左脑卒中患者的治疗方法和治疗程序 语言障碍（失语症）和记忆障碍。我们提出第一个 PAT 研究 患有失语症和记忆缺陷的亚急性左脑卒中患者 研究使用改编的 PAT 程序（目标 1）和改编的空间运动的可行性 感官评估（目标 2），这是进行全面临床试验的先决条件。 此外，之前的脑图研究表明，病变模式可用于 确定对 PAT 反应最佳的患者。因此，我们还寻求建立一个临床 对病变位置进行分类的可访问、可靠的方法（目标 3），这是广泛诊断的先决条件 实施有关 PAT 患者选择的临床指南。在拟议的研究中，我们 将收集和分析可行性的四个关键领域的数据，包括可接受性、 实施、适应和有限的功效。我们的长期目标是在这两个领域实施 PAT 左右脑中风康复可同时改善认知和运动功能， 和疼痛。通过证明适应评估和治疗程序的可行性 左脑卒中患者失语、记忆障碍的可行性及可靠性 临床上可用的病变分类方法，我们将为全面的病变分类方法开辟一条道路 PAT 作为多目标治疗中风康复的研究。该研究方向有 提高目前分散的护理流程的效率和有效性的潜力 并显着改善成千上万退伍军人的功能、独立性和生活质量 患有中风相关的残疾。