Optimizing Hand Rehabilitation Post-Stroke Using Interactive Virtual Environments

New Jersey Institute of Technology (NJIT)

Status and phase: Completed; Phase 1

Conditions: Cerebrovascular Accident; Hemiparesis; Hemiplegia

Treatments: Behavioral: Bimanual Training; Behavioral: HAT training; Behavioral: HAS Training

Study type: Interventional

Funder types: Other

Identifiers

NCT01072461

5R01HD058301-02

Details and patient eligibility

About

The complexity of sensorimotor control required for hand function as well as the wide range of recovery of manipulative abilities makes rehabilitation of the hand most challenging. The investigators past work has shown that training in a virtual environment (VE) using repetitive, adaptive algorithms has the potential to be an effective rehabilitation medium to facilitate motor recovery of hand function. These findings are in accordance with current neuroscience literature in animals and motor control literature in humans. The investigators are now in a position to refine and optimize elements of the training paradigms to enhance neuroplasticity. The investigators first aim tests if and how competition among body parts for neural representations stifles functional gains from different types of training regimens. The second aim tests the functional benefits of unilateral versus bilateral training regimens.The third aim tests whether functional improvements gained from training in a virtual environment transfer to other (untrained) skills in the real world.

Full description

The complexity of sensorimotor control required for hand function as well as the wide range of recovery of manipulative abilities makes rehabilitation of the hand most challenging. The investigators past work has shown that training in a virtual environment (VE) using repetitive, adaptive algorithms has the potential to be an effective rehabilitation medium to facilitate motor recovery of hand function. These findings are in accordance with current neuroscience literature in animals and motor control literature in humans. The investigators are now in a position to refine and optimize elements of the training paradigms to enhance neuroplasticity. The investigators first aim tests if and how competition among body parts for neural representations stifles functional gains from different types of training regimens. The second aim tests the functional benefits of unilateral versus bilateral training regimens.The third aim tests whether functional improvements gained from training in a virtual environment transfer to other (untrained) skills in the real world.

Enrollment: 55 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Six months post cerebrovascular accident
• Residual upper extremity impairment that affects participation
• At least ten degrees of active finger extension
• Tolerate passive shoulder flexion to chest level

Exclusion criteria

• Severe neglect
• Severe aphasia

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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55 participants in 3 patient groups

Train Paretic Hand and Arm Separate

Active Comparator group

Description:

Eight three hour training sessions of robotically facilitated hand and arm training in complex virtual environments, using activities that train the fingers in isolation and other activities that train the arm in isolation.

Treatment:

Behavioral: HAS Training

Train Paretic Hand and Arm Together

Experimental group

Treatment:

Behavioral: HAT training

Train Both Hands Together in VE

Experimental group

Treatment:

Behavioral: Bimanual Training