Deficit Fields for Stroke Recovery

Shirley Ryan AbilityLab

Status: Completed

Conditions: Stroke

Treatments: Behavioral: Deficit-fields to expand range of motion; Behavioral: Deficit-fields to improve function; Behavioral: Deficit-fields to reduce error

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02570256

RehabilitationIC

2R01NS053606-05A1 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

This study investigates the potential of customized robotic and visual feedback interaction to improve recovery of movements in stroke survivors. While therapists widely recognize that customization is critical to recovery, little is understood about how take advantage of statistical analysis tools to aid in the process of designing individualized training. Our approach first creates a model of a person's own unique movement deficits, and then creates a practice environment to correct these problems. Experiments will determine how the deficit-field approach can improve (1) reaching accuracy, (2) range of motion, and (3) activities of daily living. The findings will not only shed light on how to improve therapy for stroke survivors, it will test hypotheses about fundamental processes of practice and learning. This study will help us move closer to our long-term goal of clinically effective treatments using interactive devices.

Enrollment: 45 patients

Sex: All

Ages: 18 to 100 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

STROKE SURVIVORS:

• adult (age >18)
• Chronic stage stroke recovery (8+ months post)
• available medical records and radiographic information about lesion locations
• strokes caused by an ischemic infarct in the middle cerebral artery
• primary motor cortex involvement
• a Fugl-Meyer score (between 15-50) to evaluate arm motor impairment level

HEALTHY CONTROL PARTICIPANTS:

• adult (age >18)
• healthy individuals with no history of stroke or neural injury

Exclusion criteria

• bilateral paresis;
• severe sensory deficits in the limb
• severe spasticity (Modified Ashworth of 4) preventing movement
• aphasia, cognitive impairment or affective dysfunction that would influence the ability to perform the experiment
• inability to provide an informed consent
• severe current medical problems
• diffuse/multiple lesion sites or multiple stroke events
• hemispatial neglect or visual field cut that would prevent subjects from seeing the targets.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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45 participants in 3 patient groups

Deficit-fields to reduce error

Experimental group

Description:

We hypothesize that a deficit-field design, using the statistics of a patient's errors to customize training, will provide optimal augmentation that varies during motion as needed. We will compare the training effects of error deficit-fields with previous methods of error augmentation to improve reaching ability.

Treatment:

Behavioral: Deficit-fields to reduce error

Deficit-fields to expand range of motion

Experimental group

Description:

Amplifying augmentation can expand motor exploration and improve skill retention in patients. Using motor exploration patterns from each patient, we will form customized deficit-fields to recover normal joint workspace. We will compare augmentation training that either amplifies or diminishes the observed deficits (Expt-1). We also compare deficit-fields with our prior augmentation methods to determine the added value of increased customization (Expt-2).

Treatment:

Behavioral: Deficit-fields to expand range of motion

Deficit-fields to improve function

Experimental group

Description:

Here we present visual distortion of whole body movement during manual tasks during standing, including reaching, grasping, and object manipulation. We compare the training effects of feedback based on deficit-fields versus practice with normal vision.

Treatment:

Behavioral: Deficit-fields to improve function