Research

High-Intensity Intervention

The research seeks to determine whether an intervention conducted at high intensity and dosage, while focusing on movement quality, is feasible during the early subacute stage after stroke.

We aim to assess the feasibility of a 4-week upper-extremity training program assessing quality of movement practiced at high intensity and dosage applied during the early subacute phase after stroke.

Specific Objectives:

Assess the acceptability and suitability of the intervention (i.e., adherence rates to study procedures, intervention attendance, and engagement; time spent on task, capacity, and comprehension of the procedures and intervention; participant satisfaction; and risks).
Evaluate the resources and abilities needed to manage and implement the study and intervention (i.e., administrative capacity, equipment and technological requirements, and training requirements).
Conduct a preliminary evaluation of participant responses to intervention (i.e., quantitative and qualitative analyses of participant responses to the intervention, as well as evaluation of potential effectiveness).

This research is a collaboration with Prof. John W. Krakauer, JHU, and Mindmaze Healthcare uk ltd

Natural History

The research focuses on the "natural history" of recovery after stroke.

We have been measuring the functional ability, quality of movement, capacity for motor learning, and overall physical activity of stroke survivors, using internationally accepted definitions and tools. Patients are examined several times from the start of rehabilitation up until one year after stroke.

Tools

Tools for taking cognitive measures: LOTCA (Loewenstein Occupational Therapy Cognitive Assessment), MoCa (The Montreal Cognitive Assessment), MMSE (Mini mental state examination), and LOTCA-G (Geriatric version of Loewenstein Occupational Therapy Cognitive Assessment).

Tools for measuring upper-limbfunction: ARAT (Action Research Arm Test), 9HPT (9 Hole Peg Test), FDT (Functional Dexterity Test), and The Fugel-Mayer Assessment of sensorimotor recovery after stroke.

Tools for measuring lower-limb function: Semmes Weinstein monofilament examination, The Fugel-Mayer Assessment of sensorimotor recovery after stroke, BBS (The Berg Balance Scale), TUG (Time Up and Go), 10 Meters Walk test, and LEMOCOT (Lower Extremity Motor Coordinating Test).

Tools for measuring daily function: NIHSS (National Institutes Health Stroke Scale), FIM (Functional Independence Measure), and SSEQ (The Stroke Self-Efficacy Questionnaire).

Investigation of the association among cognitive impairments, motor learning, and motor recovery after stroke

Stroke has become a worldwide epidemic. Recovery from stroke is almost never complete. We hypothesize that the cognitive and motor deficits after stroke interact in the process of motor recovery. Therefore, our study concerns the association among cognitive capacities, such as executive functions, working memory, and motor learning and recovery. At the center of our research lie three questions:
1) What are the associations between cognitive capacities and motor learning in chronic-stroke patients and in age-matched controls?
2) What are the associations between cognitive capacities and upper-extremity motor recovery in the subacute phase of stroke?
3) What is the natural history of cognitive recovery after stroke?

The mechanisms that drive balance control and gait recovery after stroke

The research focuses on the mechanisms that drive balance control and gait recovery after stroke. We use an instrumented treadmill (Zebris Medical GmbH, Germany) to measure balance and gait parameters (e.g. left-right symmetry in spatiotemporal parameters of gait and center-of-pressure characteristics in standing and walking), as well as error measures (i.e., absolute error, constant error, and variable error), during the performance of a clinical test that assesses lower extremity coordination. These laboratory-based assessments are conducted from the early subacute to chronic stages after stroke.

Walking is a complex human behavior

Although most stroke survivors will regain the ability to walk, they exhibit a rigid, unstable walking pattern that may lead to falls, injury, or even death. Over the years, professionals have failed to implement a rehabilitation strategy that yields consistent and meaningful results. The main interest is the control mechanism underlying gait and the way in which stroke impacts this mechanism—specifically, the importance of sensory deficits to gait disorders.

UL 3-D kinematics study

The development of an accurate, reliable, and sensitive assessment of impairment post-stroke is essential for the examination of the natural history of recovery post-stroke and was therefore the focus of the second Stroke Recovery and Rehabilitation Roundtable. Furthermore, such an assessment is imperative to current clinical treatments and to the development of new interventions during rehabilitation. To this end, we have been using a novel method for quantifying full-body 3-D kinematic data in order to assess motor impairment in sub-acute and chronic patients recovering from stroke. Carefully monitory hand kinematics, we aim to use this method to examine motor control in different post-stroke stages.

This research is a collaboration with with Dr. Ahmet Arac from UCLA and Prof. John W. Krakauer from JHU.