Stroke is the leading cause of disability, as many of those affected demonstrate difficulty with movement and
walking. Rehabilitation post-stroke can be challenging and often ineffective because no two stroke survivors
present with the same mobility impairments, yet the same physical therapy interventions are utilized. Thus, a need exists to personalize rehabilitation techniques to improve function and mobility post-stroke. The proposed innovative research will test a framework created to identify the most effective intervention based on a participant's specific motor control problems. We plan to study how self-selected walking speed is impacted by a four-week walking program that incorporates either walking on an inclined or declined treadmill compared to walking on a flat treadmill. We will determine the best intervention for each problem and identify predictors of response. Selecting the correct intervention for personalized motor control problems, as opposed to applying a one-size-fits-all strategy for rehabilitation, is likely to improve walking function in Veterans after stroke.
This research studies the effects of brain stimulation (transcranial magnetic stimulation, or "TMS") on balance in progressive supranuclear palsy (PSP). The purpose of this research is to look for improvements in balance when subjects are on a tilting platform after stimulating the brain with a magnetic wand held over the scalp over an area at the back of the brain called the cerebellum. Participants will receive both active and inactive stimulation during the course of the study. There is no surgery involved. There are also optional portions of the study that include functional magnetic resonance imaging (fMRIs) and speaking samples.
The goal of this study is to improve FES-cycling which is a common therapy. We will test a new method of adjusting the FES intensity to maintain a constant pedaling speed. We are looking for participants 18-75 years old who experienced a stroke more than 3 months ago. The study will last a single session.
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.
After stroke, it is common for individuals to have difficulty attending to the affected side of their body or to the affected side of space (neglect). Rehabilitation therapists use many different clinical assessments to measure this inattention. However, it is unclear whether items from some of the most commonly used assessments are able to effectively and comprehensively measure inattention. Rehabilitation therapists use clinical assessments to inform treatment and document patient progress. Therefore, it is important that we examine these existing assessments.
Individuals with neglect frequently experience weakness in their arm/hand. This study also examines the effects of non-invasive brain stimulation (transcranial direct current stimulation) and arm/hand rehabilitation training (repetitive task-specific practice) on excitability in the brain, attention, and arm movement ability.
The study will use a new method for non-invasively examining the brain called Transcranial Magnetic Stimulation (TMS). TMS involves placing a coil of wire above the scalp and intermittently passing a very powerful current through it. This current produces energy in the form of a magnetic field that passes through the scalp. The magnetic field, in turn, induces a much weaker electrical current in the brain, causing the neurons directly under the coil to activate for a brief period of time. The U.S. Federal Drug Administration has approved TMS as a method for treating depression since 2008. By using TMS, we can evaluate how well your brain is controlling one of your hand or leg muscles. One way to measure this is by recording activity via electrodes on the hand opposite the side of the brain being stimulated. For example we will be stimulating on the left side of the brain and recording from electrodes on your right hand. In this study we are determining the effects of different types of repetitive Transcranial Magnetic Stimulation (rTMS) protocols on hand movement. rTMS means that the magnetic pulses are applied consecutively, and at a specified pace- the frequency. The specific type of rTMS you will receive is called "theta-burst stimulation" (TBS). TBS is characterized by a specific frequency of stimulation.
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.
We have designed a comprehensive, evidence-based approach to physical therapy rehabilitation after stroke that focuses on the intensity of cardiovascular, strength, and gait training, standardizing the dosage and progression of each type of training. Implementation of this standardization of intensity protocol will be guided via an internet-based (REDCap) interactive program available to each treating therapist. This program will cue the therapist to complete two sessions of cardiovascular, strength, and gait training each week at the appropriate intensity while not being prescriptive about specific activities to meet the stated goals. Eighty individuals with stroke (20 each from Charleston, SC; Anderson, SC; Rock Hill, SC; and York, PA ) who meet inclusion and exclusion criteria and will undergo a standardized evaluation at admission and discharge assessing gait speed, endurance, strength, balance, and overall functional independence and will be compared to 80 individuals with stroke receiving usual care. In addition, each enrollee will participate in a telephone screen at 90 days post-stroke to assess participation, quality of life, falls efficacy, falls history, and stroke-related secondary health conditions/readmissions.
Speech and language therapy for the management of aphasia (a language impairment that often occurs as a result of a stroke) is generally shown to be effective. However, the reasons that certain treatments may work for some individuals, and not others, and why some individuals do not respond to treatment is largely unknown. In this study, we plan to identify and model the relationship between many different factors (such as personal/biographical factors and an individual's baseline cognitive and language abilities) to help predict aphasia treatment outcome. Participants will be recruited for speech and language testing, brain imaging (MRI), and aphasia treatment (as warranted).
It is common for stroke survivors to have difficulty attending to the affected side of their body or to the affected side of space after stroke (unilateral neglect). Individuals with neglect frequently experience weakness in their arm/hand also. The purpose of this study is to test the effects of 3 different rehabilitation training sessions that combine non-invasive brain stimulation (transcranial direct current stimulation, tDCS) with arm/hand rehabilitation training (repetitive task-specific practice, RTP). This study is designed to determine the effects of tDCS + RTP on the excitability in the brain, attention to the affected side, and arm movement ability.