Elizabeth R. Skidmore, Ph.D. - US grants

DESCRIPTION (provided by applicant): Anywhere from 30 to 50% of individuals who sustain stroke experience cognitive impairments. Individuals with cognitive impairments after stroke are less likely to regain independence with activities of daily living than individuals without cognitie impairments after stroke. Loss of independence is associated with significant costs, as individuals with persistent disabilities require more rehabilitation services, and more resources to support their living, whether in institutional or community settings. Interventions ideally suitd for training individuals with cognitive impairments have the potential to promote independence, and reduce health care expenditures after stroke. The best time to initiate training to promote independence with daily activities is during acute rehabilitation. However, the best method for training remains unclear. Directed training maximizes the expertise of the rehabilitation practitioner, who identifies and prioritizes problematic activities, identifies barriers to performng these activities, generates strategies to address these barriers and instructs patients in these strategies, and repeats the process with a variety of problematic activities identified during the rehabilitation program. Guided training maximizes the expertise of the patient, by teaching the patient how to apply the same 4-step process themselves. Thus, the patients identify and prioritize activities, identify barriers to performing activities, generate their own strategies fo addressing these barriers, and learn this process through iterative practice. In doing so, guided training equips patients with practical skills that have the potential to generalize beyond activities addressed during the intervention program to novel problematic activities that arise after the intervention program, thereby promoting long-term independence. While evidence suggests that both training methods are feasible and beneficial for individuals with cognitive impairments, it is unclear which method may be superior in promoting independence after acute stroke. The aim of the proposed pilot study is to examine the effects of directed training and guided training on independence with daily activities. The PIs predict that individuals with cognitive impairments in both groups will demonstrate significant improvement in independence with daily activities in the first 6 months after rehabilitation admission, but that individuals wh receive guided training will demonstrate significantly more improvement than individuals who receive directed training. At the end of this pilot study, the PIs will be able to identify optimal training methods for promoting independence, particularly among individuals with cognitive impairments engaged in acute rehabilitation. In addition, they will gather pilot data that will allw them to examine potential explanatory factors influencing treatment response, as well as begin to examine characteristics of individuals who benefit from these training methods. The PIs will use findings from the present study to refine their protocols before conducting future large scale clinical trials examining the efficacy of training methods in individuals with cognitive impairment after acute stroke. PUBLIC HEALTH RELEVANCE: Individuals with cognitive impairments after stroke sustain significant disability in their daily tasks. The proposed study examines training methods to identify the best rehabilitation approach to help individuals with cognitive impairment gain more benefit from rehabilitation and potentially reduce their long-term disability.

Unilateral spatial neglect is a perceptual disorder that is one of the most common consequences of right-side brain damage after stroke, occurring in 29% of the 15 million people who sustain stroke worldwide. Patients with neglect demonstrate inattention to objects or events on the side that is opposite to the damaged part of the brain. They often miss food on one side of the plate, missing words on one side of the page, bumping into the left door jamb, getting confused by moving objects, and being fearful of walking in crowded places. The current gold standard for detecting and rehabilitating neglect lacks generalizability to dynamic tasks and contexts encountered during activities of daily living (ADL). The investigators in this project will develop a brain-computer interface (BCI) system that will be implemented in augmented reality (AR) environment for detection, assessment and rehabilitation of unilateral neglect during ADL. More specifically, the system will in real-time monitor the brain activity recorded through electroencephalography (EEG) for the detection and assessment of visually neglected extra-personal space. Moreover, the system will also include haptic, auditory and visual stimulation while the users are engaged in real-world tasks conducted during rehabilitation for reducing neglect-related disabilities. It is also anticipated that the novel scientific discoveries and engineering enhancements of this project will have effects on the current practice on BCIs: (i) enabling design and implementation of such systems in more naturalistic environments providing more immersive experiences; and (ii) expansion of the use of BCIs in the design of intervention and rehabilitation techniques for other neurological disorders. This project will promote STEM education and provide rigorous training and variety of hands-on experiences to researchers from K-12 to graduate level.

The research objective of this project is to introduce a prototype for stroke-induced neglect detection, assessment, and rehabilitation system, featuring: (i) seamless integration of EEG and AR in the design of visually evoked EEG-based BCIs to operate during activities of daily living; (ii) accurate and continuous EEG event related potential detection for neglect assessment and mapping through Bayesian inference models; (iii) information theoretic optimum design of neglect intervention focusing on activities of daily living; and (iv) multimodal real-time feedback for rehabilitation of neglect related disabilities during intervention. Unlike the common computerized neglect assessment methods, EEG will not require any physical responses from the patient. Also, the use of EEG permits automation, making it an ideal method to guide a personalized and automated neglect intervention. It is known that one common element among the existing interventions that have shown promise for reducing neglect is multimodal stimulation to the neglected side of the body or environment. Timely feedback to the user when neglect is detected during the continuous EEG monitoring will enable this stimulation. Finally, used in conjunction with AR headset and skill-based training during acute inpatient rehabilitation, the planned system will provide the opportunity to deliver high-intensity repetitive stimulation with progression during meaningful everyday activities. The outcomes of this project will be disseminated to the scientific community through technical reports, journal publications and conference presentations. All software developed through this project will be publicly available through archival repositories.

This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.