Post-stroke, functional visual problems are frequently cerebral rather than ocular. However, brain systems are not the basis of current rehabilitation. Even marginally better outcomes in estimated 230,000 US acute stroke survivors with spatial neglect could result in annual savings >$200 million. The Candidate proposed that better spatial neglect rehabilitation outcomes may result from appropriate subject stratification: performance supported by dopaminergic """"""""aiming"""""""" systems, as well as established perceptual """"""""where"""""""" brain networks, determined recovery in classical animal studies. With outstanding mentoring and training, under a K08 award she developed and validated a spatial neglect assessment method quantifying these recovery components. Novel K02 studies further demonstrated that """"""""aiming"""""""" and """"""""where"""""""" functional stratification correlated with recovery and response to clinical treatment. Continuous NIH funding since 1999 allowed her to apply the translational stratification hypothesis to neurorehabilitation research, attracting numerous clinician-researcher trainees for hands-on training. Recently, R01 funding allows her to expand her research goals, investigating translational stratification of recovery trajectory in larger groups of stroke survivors with spatial neglect. A physician cognitive neuroscientist applying psychological theory to stroke rehabilitation, she is a unique role model for medical trainees at three distinct levels. Medical students compete for research laboratory rotations, and are mentored individually in clinical research. Physiatric resident physicians are mentored in clinical research, and physiatric residents and post-doctoral fellows perform program-required research in her laboratory, resulting in trainee-authored manuscripts and presentations (5 in 2008). The K24 mechanism provides critical protected time for the Candidate to expand the theoretical basis of her clinical research, and commit appropriately to mentoring activities. The proposal activities also build her collaboration with Anne Foundas, MD. Their developing translational neuro- anatomic model, to potentially predict recovery and response to spatial neglect treatment after stroke, is expected to generate novel hypotheses for further trainee-mentor collaboration and grant applications.

Public Health Relevance

This application supports ongoing involvement of the next generation of physician investigators in the Candidate's studies, which apply laboratory neuroscience principles to treating hidden functional vision disabilities after stroke. The project research aims to improve rehabilitation outcomes, and bring the Candidate to the next level of participation in international translational rehabilitation. The Candidate's novel ideas have also catalyzed bedside brain science, however, and this work may launch a new set of much more effective methods for restoring adaptive movement and daily visual function to millions of stroke survivors.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Special Emphasis Panel (ZHD1-DSR-Z (BA))
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Michel, Mary E
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Kessler Foundation, Inc.
West Orange
United States
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Houston, Kevin E; Pachalis, Eleftherios I; Angueira, Danielle C et al. (2016) Restoration of Vision After Brain Injury Using Magnet Glasses. Am J Phys Med Rehabil :
Wagner, Daymond; Eslinger, Paul J; Barrett, A M (2016) Decreased leftward 'aiming' motor-intentional spatial cuing in traumatic brain injury. Neuropsychology 30:731-41
Hreha, Kimberly; Mulry, Claire; Gross, Melissa et al. (2016) Assessing chronic stroke survivors with aphasia sheds light on prevalence of spatial neglect. Top Stroke Rehabil :1-8
Chen, Peii; Chen, Christine C; Hreha, Kimberly et al. (2015) Kessler Foundation Neglect Assessment Process uniquely measures spatial neglect during activities of daily living. Arch Phys Med Rehabil 96:869-876.e1
Sacchetti, Daniela L; Goedert, Kelly M; Foundas, Anne L et al. (2015) Ipsilesional neglect: behavioral and anatomical correlates. Neuropsychology 29:183-90
Chen, Peii; Hreha, Kimberly; Kong, Yekyung et al. (2015) Impact of spatial neglect on stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility. Arch Phys Med Rehabil 96:1458-66
Shigaki, Cheryl L; Frey, Scott H; Barrett, A M (2014) Rehabilitation of poststroke cognition. Semin Neurol 34:496-503
Barrett, A M; Galletta, Elizabeth E; Zhang, Jun et al. (2014) Stroke survivors over-estimate their medication self-administration (MSA) ability, predicting memory loss. Brain Inj 28:1328-33
Galletta, Elizabeth E; Campanelli, Luca; Maul, Kristen K et al. (2014) Assessment of neglect dyslexia with functional reading materials. Top Stroke Rehabil 21:75-86
Oh-Park, Mooyeon; Hung, Cynthia; Chen, Peii et al. (2014) Severity of spatial neglect during acute inpatient rehabilitation predicts community mobility after stroke. PM R 6:716-22

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