Functional Magnetic Resonance Imaging (fMRI) and Robot-Assisted Practice of Activities of Daily Living
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 30 - 85 |
| Updated: | 3/1/2014 |
| Start Date: | November 2008 |
| End Date: | June 2013 |
| Contact: | Michelle J Johnson, PhD |
| Email: | mjjohnso@mcw.edu |
| Phone: | 414 384-2000 |
fMRI and Robot-Assisted Practice of Activities of Daily Living
The investigators will study motor recovery after robot-assisted therapy after stroke. A
small clinical trial will be conducted to quantify the central nervous system changes
associated with robotic or standard training, and identify trends across high and low
responders in terms of patterns of change in cortical activity and type of white matter
connectivity.The investigators hypothesize that robot training will lead to larger
improvements as compared to standard occupational therapy. The investigators hypothesize
that high responders to the robot training will have reduced compensatory activation in the
bilateral area and will connectivity in the motor tracts.
small clinical trial will be conducted to quantify the central nervous system changes
associated with robotic or standard training, and identify trends across high and low
responders in terms of patterns of change in cortical activity and type of white matter
connectivity.The investigators hypothesize that robot training will lead to larger
improvements as compared to standard occupational therapy. The investigators hypothesize
that high responders to the robot training will have reduced compensatory activation in the
bilateral area and will connectivity in the motor tracts.
Robot-assisted therapy is on the cutting edge of stroke rehabilitation and is a therapy
method that promises to improve the lives of persons with disabilities due to stroke.
Preliminary studies using these tools provide mixed evidence for their effectiveness and
reveal limitations. For example, inconsistent carryover of motor gains to real life
activities of daily living (ADLs) is seen. Therefore, it is still not clear what treatment
strategies maximize functional outcomes on ADLs. There is a need to study the stroke
recovery process and to understand how to optimize robot-assisted therapies in order to
enhance patient rehabilitation and improve functional outcomes. Imaging techniques such as
functional Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) can assist
us in understanding the stroke recovery process, in determining who may benefit from
robot-assisted training, and in defining how training induced functional cortical changes
occur after robot training. We propose to conduct an interventional study plus control to
assess the effectiveness of four weeks of robot-assisted practice of tasks with skilled
functional tasks that involve reaching and grasping activities similar to real activities.
We will examine the process of recovery for low-to-moderate functioning stroke survivors
with chronic disability. We will assess the ability of active-assisted reaching and
grasping training to effect immediate gains and long-term functional improvements. Further,
using fMRI and DTI, we plan to associate changes seen in motor impairment levels and
functional task performance levels with white matter injuries and connectivity and changes
in oxygen utilization in the motor cortex as well as other areas of the brain. Our
short-term aims are to, i) assess short-term functional gains after practice of skilled
reaching and grasping tasks; ii) assess maintenance of these improvements; iii) quantify the
neuronal changes associated with short-term gains, and iv) identify trends across high and
low responders in terms of patterns of change in cortical activity and type of white matter
connectivity. In the long-term, we hope to improve understanding of the process of ADL
functional recovery after stroke and optimize robot-training strategies leading to cerebral
plasticity. We also hope to determine how lesion characteristics affect changes seen in
function, white matter connectivity, and cortical activity. By, accomplishing these aims,
we hope to improve upper extremity function after stroke and reduce disability.
method that promises to improve the lives of persons with disabilities due to stroke.
Preliminary studies using these tools provide mixed evidence for their effectiveness and
reveal limitations. For example, inconsistent carryover of motor gains to real life
activities of daily living (ADLs) is seen. Therefore, it is still not clear what treatment
strategies maximize functional outcomes on ADLs. There is a need to study the stroke
recovery process and to understand how to optimize robot-assisted therapies in order to
enhance patient rehabilitation and improve functional outcomes. Imaging techniques such as
functional Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) can assist
us in understanding the stroke recovery process, in determining who may benefit from
robot-assisted training, and in defining how training induced functional cortical changes
occur after robot training. We propose to conduct an interventional study plus control to
assess the effectiveness of four weeks of robot-assisted practice of tasks with skilled
functional tasks that involve reaching and grasping activities similar to real activities.
We will examine the process of recovery for low-to-moderate functioning stroke survivors
with chronic disability. We will assess the ability of active-assisted reaching and
grasping training to effect immediate gains and long-term functional improvements. Further,
using fMRI and DTI, we plan to associate changes seen in motor impairment levels and
functional task performance levels with white matter injuries and connectivity and changes
in oxygen utilization in the motor cortex as well as other areas of the brain. Our
short-term aims are to, i) assess short-term functional gains after practice of skilled
reaching and grasping tasks; ii) assess maintenance of these improvements; iii) quantify the
neuronal changes associated with short-term gains, and iv) identify trends across high and
low responders in terms of patterns of change in cortical activity and type of white matter
connectivity. In the long-term, we hope to improve understanding of the process of ADL
functional recovery after stroke and optimize robot-training strategies leading to cerebral
plasticity. We also hope to determine how lesion characteristics affect changes seen in
function, white matter connectivity, and cortical activity. By, accomplishing these aims,
we hope to improve upper extremity function after stroke and reduce disability.
Inclusion Criteria:
Stroke:
- 30 to 85 years
- Right-handed (evaluated with handedness survey)
- suffered a unilateral ischemic stroke in the motor control area, which resulted in
hemiparesis of the arm (confirmed by medical data),
- at least 6-months post-stroke
- residual movement at least (a) 15 degree shoulder flexion or adduction, (b) 15 degree
active elbow flexion and extension
- not claustrophobic
- not depressed (as measured depression survey)
- able to use the scanner, i.e., passes the fMRI screening survey
- able to understand the instructions and complete the tracking tasks Control
- older than 20 years
- Right-handed (evaluated with survey)
- not claustrophobic
- able to use the scanner, i.e., passes the fMRI screening survey
- able to understand the instructions and complete the tracking tasks
- no history of neurological disorders --not depressed (as measured depression survey)
Exclusion Criteria:
Stroke:
- brain stem, stroke
- pre-existing neurological or psychiatric disorders
- Spasticity >3 at elbow or fingers on Ashworth
- demonstrated visuospatial, language or attention deficits of a severity that prevents
understanding the task
- shoulder pain or joint pain during movements
- synkinetic movements or mirror movements
- decline to participate
- will not comply with full protocol
- pregnant
- allergic to goretex and conductivity gel
Control
- decline to participate
- will not comply with full protocol
- pregnant
- allergic to goretex and conductivity gel
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