Early Post-Stroke Biomarkers for Motor Rehabilitation Outcomes

Project Summary/Abstract
This proposal represents a five-year research career development program focusing on identifying early
predictors of chronic motor control impairments post-stroke. The outlined proposal builds on the candidate’s
prior research and experience, and will contribute to the candidate’s development as an independent
researcher by supporting her training in the application of neuroimaging, transcranial magnetic stimulation, and
advanced biostatistical analysis in post-stroke recovery research.
Stroke is the leading cause of adult disability in the US. Of those who receive rehabilitation therapy,
approximately 40% have chronically impaired motor function of the upper extremity, contributing to decreased
quality of life and increased societal burden of stroke. Currently, clinical rehabilitation focus on repetitive motor
exercises, but interventions are not adapted for individual stroke lesion location or predicted trajectory of
recovery. Prior studies have identified distinct impairments of motor control that contribute to poor function at
the chronic stage and likely depend on neuroanatomical structures damaged by the stroke, but the details of
what contributes to development of these impairments and timing of when they emerge remains unclear. In
order to create optimal rehabilitation strategies and maximize each individual patient’s rehabilitation potential,
we need better methods for predicting and treating these motor control impairments.
In this proposal, we aim to use an electromyographic computer interface (ECI) to study motor impairments in
the muscle groups that control wrist flexion and extension, and perform a longitudinal study to 1) establish the
natural history of distinct motor control impairments post-stroke and 2) identify early neuroimaging,
electrophysiologic, and clinical markers that predict specific motor impairments at the chronic stage. We then
3) evaluate the feasibility of using the ECI to provide early, intensive biofeedback therapy to target the
predicted impairments of the individual patients. These studies will establish the necessary foundation for
future development of precision-medicine therapies in neurorehabilitation. Furthermore, the mentored research
and career development plan will provide the applicant with the opportunity for further training in leading
longitudinal studies, advanced biostatistical analysis, and functional and structural neuroimaging. The results of
this research and career development award will foster the expansion of her clinical research program, which
is dedicated to developing novel therapies to treat early motor changes post-stroke.

Grant Number: 5K23NS121635-04
NIH Institute/Center: NIH
Principal Investigator: ANIA BUSZA