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.
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.
The aim of this study is to gather information about veterans at the Ralph H. Johnson Veterans Medical Center (RHJ-VAMC) who've experienced a stroke and are interested in participating in rehabilitation research.
VA principal investigators at the Center for Rehabilitation Research in Neurologic Conditions (CRRNC) conduct stroke rehabilitation research for individuals. CRRNC include laboratories that investigate and assess upper extremity motor function, neuro-stimulation, communication and swallowing, locomotor energetics, locomotor and rehabilitation, and motor performance functions.
Participants will be asked to come to the CRRNC located at the Medical University of South Carolina (77 President Street, Charleston, South Carolina) and fill out a simple screening form with study personnel. Participants may be contacted in the future for qualifying studies.
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.
Individuals with chronic stroke (greater than 6 months post-stroke) will be evaluated to assess the effects of repetitive transcranial magnetic stimulation (rTMS) on walking function. Contributors to walking such as lesion size and location, brain activation, strength, force production during walking, and biomechanical variables will also be assessed. Each individual will be examined with excitatory, inhibitory and sham stimulation to assess the effects on the above variables. In addition, each type of stimulation will be combined with a walking rehabilitation program to determine the affect of adding rehabilitation. Each participant will be requested to undergo 8 sessions.
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 project will evaluate two different methods of normalizing the center of mass acceleration (COMa) in individuals post-stroke, specifically focusing on rates and pattern of recovery to analyze walking-specific adaptations as precursors to motor learning. In addition, the proposed project seeks to establish the optimal configuration of electrodes to activate neural circuits involved in post-stroke locomotion. Once the better method of training COMa and optimal parameters of electrode placement for tDCS are identified, we will evaluate the effects of tDCS on locomotor adaptations during single sessions and over a five-day training period.