# A biomarker for personalized care in post-stroke spatial neglect

> **NIH VA I21** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

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.

## Key facts

- **NIH application ID:** 10447653
- **Project number:** 5I21RX003760-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** A. M. Barrett
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-08-01 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10447653

## Citation

> US National Institutes of Health, RePORTER application 10447653, A biomarker for personalized care in post-stroke spatial neglect (5I21RX003760-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10447653. Licensed CC0.

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