Stroke is a leading cause of disability in the U.S. and many Veteran stroke survivors live with severe disability. Despite recent advances in rehabilitation treatments many stroke survivors have persistent physical and mental difficulties such as reduced arm and leg function, difficulty thinking, and depression.
Developing treatments that address these problems is necessary to improve long-term recovery for stroke survivors. Aerobic exercise (AEx) can improve physical and mental function, and reduce depression. Additionally, AEx may enhance physical rehabilitation by making the brain more receptive to, and consequently improving the response to a rehabilitation treatment. Therefore, combining AEx with physical rehabilitation has the potential to improve multiple parts of stroke recovery. This study will examine the effect of combining AEx with physical rehabilitation on physical and mental function in stroke survivors. By gaining a better understanding of the effects of this combined intervention we aim to advance the rehabilitative care of Veteran stroke survivors.

The purpose of this research project is to evaluate the effectiveness of a mobile health (mHealth) application in improving adherence to hydroxyurea therapy in patients with Sickle Cell Disease (SCD). Participants will be asked to install an application on their phone that will remind them to take their medication regularly. It notifies the participants when it is time to request a refill, it tracks their hydroxyurea use, and it gives them information on their medication. It also has resources that could be helpful for the ongoing care of their sickle cell disease. This is a 24-week project with 3 study visits. The first study visit will be at the beginning of the study period (enrollment or baseline visit), the second will be at approximately 12 weeks, and the third is at the end of the 24 weeks. At each visit, participants will complete a survey, share with us their experience with the application, and share with us where they refilled their medications. Some participants will also be asked to complete an interview at the end of their final study visit. Patient participants will receive a $25 Walmart Gift card at each of visits (including an additional $25 gift card for the optional interview) for their participation.

The study team is recruiting 20 adults with spasticity due to chronic stroke and 20 adults with no neurological injuries for a 2 day study. In people with chronic stroke, one of the most common and disabling problems is spasticity (increased muscle tone or muscle stiffness). The purpose of this research study is to examine effects of dry needling on the nervous system (pathways between the muscle, spinal cord, and brain) in people with spasticity due to chronic stroke. Dry needling is a procedure in which a thin, stainless steel needle is inserted into your skin to produce a muscle twitch response. It is intended to release a knot in your muscle and relieve pain.

The total study duration is 2 days. The first visit will take about 3 hours, during which dry needling will take place, and the second visit will take about 1 hour. During both visits you will be asked to participate in examinations of reflexes (muscle responses to non-invasive nerve stimulation) and arm/leg function.

After a stroke, many people experience a language impairment called aphasia. One of the most debilitating types of aphasia is non-fluent aphasia. Non-fluent aphasia is defined by significantly reduced speech production, with the speaker producing only a few words or even less. Speech entrainment therapy (SET) is a treatment that has been shown to increase fluency in people with non-fluent aphasia. Our study looks to define the best dose of SET that leads to sustained improvements in spontaneous speech production.
Participants who are eligible will undergo baseline language testing, an MRI, and will be randomized into one of 4 treatment groups: SET for 3 weeks, SET for 4.5 weeks, SET for 6 weeks, and no treatment (control group).

MultiStem is regenerative medicine derived from donated human cells to treat acute ischemic stroke within 36 hours after symptom onset. Stroke leads to brain cell injury and many stroke patients suffer functional deficits as results. The purpose of this study is to evaluate safety and effectiveness of MultiStem on functional outcome in subjects with ischemic stroke.

Transcranial direct current stimulation (tDCS) has shown the potential to improve symptoms in patients with movement deficits, such as Parkinson's disease and chronic stroke. However, the effects of tDCS have so far not been proven on a wider scale due to lack of knowledge regarding exactly how tDCS works. This has limited the adoption of this potentially useful therapy for patients with Parkinson's disease, chronic stroke and other conditions affecting movement. We think that by studying the effect of tDCS on brain signals while subjects perform a virtual reality task that requires integration of visual and motor information we can separate out exactly what occurs in the brain when tDCS is turned on. We expect this approach to broaden our understanding of tDCS application in conditions affecting movement and possibly lead to therapeutic advances in this population.

Hand disability after stroke has a profound negative impact on functional ability and independence. Hand therapy may be augmented with sensory stimulation for better outcomes. We have developed a novel sensory stimulation - unfelt vibration applied via a wristwatch. In this study, we will determine if combining this stimulation with hand task practice is superior to hand task practice alone.

Fatigue is a common and disabling symptom post-stroke.

Causes of post-stroke fatigue are not well known.

This study will investigate how changes in the way the brain communicates may be associated with post-stroke fatigue.

To do this the investigators will use transcranial magnetic stimulation, TMS, to measure how the brain communicates.

TMS uses a magnet that turns on parts of the brain, and researchers can measure the response by placing sensors on specific muscles in the legs.

The researchers will also measure how you walk by placing sensors on your body and having you walk on a treadmill.

The purpose of this study is to determine if 3-dimensional finger force training is an effective tool in restoring hand function post stroke. Persons who survived a stroke 3 to 9 months ago and have a hand impairment will be eligible to participate in this study. Participants will be asked to come to the laboratory to practice controlling the finger force generation 3 times a week for 6 weeks. Participants will see their performance on a computer screen. Participants will also come to the laboratory for additional 4-7 visits for assessments of their upper extremity function. The total duration of the study will be 2.5 months.

This research is being done to figure out whether treatment for sleep apnea, in people who have had a stroke or TIA, improves recovery from stroke, and helps prevent future stroke, heart problems, and death.

The intervention being tested is called continuous positive airway pressure (CPAP). The U.S. Food and Drug Administration (FDA) has approved CPAP for the treatment of obstructive sleep apnea.

A total of 15,010 patients are expected to enroll in this study and be screened for sleep apnea across about 110 sites in the United States. About 3,000 are expected to participate in the second part of the study, in which sleep apnea treatment is tested. Participation in this study is approximately 6 months.