Transcranial direct current stimulation (tDCS) has shown the potential to improve symptoms in patients with Parkinson's disease, however its effects have not been consistent in randomized studies to date, limiting widespread adoption of this technology. A critical gap in our knowledge is a detailed understanding of how tDCS affects motor areas in the brain. We propose using tDCS while recording directly from motor cortex using subdural electrocorticography (sECoG) in Parkinson's patients undergoing deep brain stimulation surgery. We expect this novel approach to broaden our understanding of tDCS application in Parkinson's disease and possibly lead to therapeutic advances in this population.
After stroke, it is common for individuals to experience hand impairment. This deficit can severely restrict functional ability and independence. Recovery of hand function following stroke is highly variable. In this study, we will use brain imaging to predict individual response to treatment after only one therapy session. Survivors of stroke will receive upper extremity therapy with a novel intervention using a smart watch. The device applies imperceptible vibration to the wrist and has been shown to immediately improve chronic stroke survivors' touch sensation and hand dexterity in preliminary studies.
Post-stroke hand impairment is highly prevalent and severely restricts functional ability and independence. Yet, there is no assistive device to help hand function at home, every day, during activities of daily living. This study addresses this gap by providing an innovative technology. The "TheraBracelet" is a wristband applying imperceptible white-noise vibration to skin. TheraBracelet is efficacious, as it has been shown to immediately improve chronic stroke survivors' touch sensation and hand dexterity in preliminary studies. TheraBracelet is affordable by using only a low-cost vibrator. TheraBracelet is also translational, because a vibrator strategically placed at the wrist does not interfere with dexterous finger motions, and it is low-risk by involving only imperceptible vibration on skin. These practicalities assure easy adoption in home environment for large impact on sensorimotor impairment. This study is to determine the feasibility and safety of using this assistive device all day every day for a month during daily activity, and to determine if TheraBracelet's instant effects are sustained during prolonged use. This objective will be accomplished in a double-blinded, randomized, controlled, crossover design study. Feasibility (compliance of using the device everyday) and safety will be assessed for the treatment condition compared to the control condition (wearing the device without vibration) through weekly evaluations. In addition, TheraBracelet's instant benefits in improving hand function will be assessed weekly. Persistence of TheraBracelet's instant benefits across all weekly evaluations will support durability (i.e. desensitization to vibration does not occur during extended daily use over a one-month period). This project is expected to lead to an assistive wristband that increases hand function during activities of daily living, thus increasing independence and quality of life and reducing caregiver burden for a large number of stroke survivors with hand impairment.
Transcranial magnetic stimulation (TMS) is often used to assess the excitability of the brain and the connectivity between the brain and peripheral muscles. However, less work has been completed with the portion of the brain controlling leg muscles. In addition, there appears to be more error and less reliability in these measures in those with stroke. This project aims to assess a battery of TMS-derived outcome measures to determine the most effective for those after stroke. This information is of critical importance as we use this technology to assess changes after rehabilitation post stroke and to understand the motor control of walking after neurologic injury.
Rehabilitation interventions including resistance training, functional and task-specific therapy, and gait or locomotor training have been shown to be successful in improving motor function in individuals with neurologic disease or injury. Recent investigations conducted in our laboratory indicate that intense resistance training coupled with task-specific functional training lead to significant gains in functional motor recovery. Similarly, gait rehabilitation involving intense treadmill training and/or task-specific locomotor training has been shown to be effective in improving locomotor ability. However, the underlying neural adaptations associated with these therapeutic approaches are not well understood. Our primary goal is to understand the motor control underpinnings of neurologic rehabilitation in order to apply this knowledge to future generations of therapeutic interventions.
This study will be a chart review and FaCE questionnaire developed for patients who have undergone chemodenervation for unilateral facial paresis. Patients who come in to the PI's clinic and undergo chemodenervation clinically until 2016 will be included. We anticipate that this cohort will include approximately 50 patients ranging in age from 18 to 85. Information collected will include patient name, MRN, diagnosis, dates of therapy, comorbidities, gender, race questionnaire results-drinking from a cup, ability to make specific sounds, ability to keep food in mouth, eye tearing, difficulty brushing teeth, isolating themselves, calmness, irritability with others, social activities, tension/pain/spasms on affected side of face, ability to move face (pucker lips, smile raise eyebrows), treatment by others. The effects of chemodenervation gradually decrease over several months after administration, which requires a continuous readministration as needed. Questionnaire will be delivered prior to chemodenervation and after chemodenervation. Each patient will be asked to undergo the study process(pre- and post- survey) through one chemodenervation treatment randomly. The pre-treatment questionnaire will be filled out in writing prior to the procedure in clinic. Then, approximately 2-6 weeks post-injection, the patients will be called and asked to conduct the same questionnaire verbally over the phone as a post-treatment survey. The data will be collected, deidentified and stored in an Excel spreadsheet for analysis. Analysis will involve assessing if patients have improved functionality and quality of life for undergoing chemodenervation. Chemodenervation is a standard treatment these patients routinely undergo. Study is only adding a survey to assess the outcomes from the patients perspective.