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Examining mobility restrictions through the lens of post-stroke apathy

Award Number: R01HD115526
ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 07/15/2025
PERIOD OF PERFORMANCE END DATE: 06/30/2030

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Examining mobility restrictions through the lens of post-stroke apathy - PROJECT SUMMARY Stroke is a leading cause of long-term disability worldwide, leaving many with restricted mobility that contributes to progressive functional decline, reduces quality of life, and increases the risk of recurrent stroke. Rehabilitation interventions are designed to enhance mobility post-stroke by reducing motor impairments and walking capacity limitations. However, post-stroke mobility is a multifactorial construct that is only partially explained by motor impairments, and motor-centered treatment approaches have a limited impact on walking performance in daily life. This suggests a more comprehensive understanding of the non-motor sequelae of stroke that influence mobility is necessary. Here, we posit that post-stroke apathy is an important factor to examine. Apathy, affecting over one-third of stroke survivors, is rarely studied in neurorehabilitation. Defined as a psychiatric syndrome characterized by a loss of motivation and reduced self-driven, goal-directed activity, apathy impacts effort-based decision-making, reducing willingness to exert effort for rewards due to altered sensitivity to rewards or effort. This provides a theoretical basis for a potential negative association between apathy and mobility, which remains untested. Additionally, the neural mechanism underlying post-stroke apathy is not well understood. Emerging research suggests that lower functional connectivity of brain areas involved in reward and salience processing are neural signatures of apathy in older adults. Yet, functional connectivity correlates of post-stroke apathy are poorly understood. The overall objective of this Katz Early-Stage Investigator Research Project Grant proposal is to determine the association between post-stroke apathy mobility and identify the functional connectivity signatures of post-stroke apathy. To accomplish this, we will conduct a cross-sectional observational study with three aims in a single cohort of 125 participants with chronic stroke. We will study two aspects of mobility post- stroke– habitual gait speed and community mobility. Aim 1 is designed to determine the relationship between post-stroke apathy and gait speed reserve, where gait speed reserve is the difference between one’s habitual gait speed and the speed that would minimize the total effort to move a given distance. Aim 2 will determine how post-stroke apathy is related to community mobility. Community mobility will be operationalized as a comprehensive combined metric of three commonly used measures – steps per day, GPS-derived activity space, and life-space mobility. Finally, Aim 3 will examine the association between post-stroke apathy and functional connectivity signatures of apathy using resting state-functional MRI. People with stroke who have a range of apathy severity will complete the procedures necessary for these aims over two sessions that take place one week apart. Successful completion of these aims will 1) lead to a more comprehensive understanding of post- stroke mobility determinants, catalyzing a paradigm shift in neurorehabilitation to consider neuropsychiatric symptoms as necessary treatment targets to improve mobility, and 2) delineate a potential neural mechanism of post-stroke apathy, essential for developing effective interventions to prevent or mitigate apathy after stroke.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $615,848 )
2026	2026	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST FL 3	LOS ANGELES	CA	90089	LOS ANGELES	USA	Child Health and Human Development Extramural Research	000	2	6/18/2026	NON-COMPETING CONTINUATION	$615,848
														Subtotal = $615,848

Issue Date FY: 2025 ( Subtotal = $647,043 )
2025	2025	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST FL 3	LOS ANGELES	CA	90033	LOS ANGELES	USA	Child Health and Human Development Extramural Research	000	1	7/8/2025	NEW	$647,043
														Subtotal = $647,043

Grand Total All Awards = $1,262,891

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Examining mobility restrictions through the lens of post-stroke apathy

Award Number: R01HD115526

ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 07/15/2025

PERIOD OF PERFORMANCE END DATE: 06/30/2030

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