Robot Assisted Virtual Rehabilitation for the Hand Post Stroke (RAVR)
| Status: | Recruiting |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 30 - 80 |
| Updated: | 8/31/2018 |
| Start Date: | August 24, 2018 |
| End Date: | March 1, 2023 |
| Contact: | Sergei V Adamovich, PhD |
| Email: | sergei.adamovich@njit.edu |
| Phone: | 973-596-3413 |
Optimizing Hand Rehabilitation Post Stroke Using Interactive Virtual Environments
This study investigates the effects of intensive, high dosage task and impairment based
training of the hemiparetic hand, using haptic robots integrated with complex gaming and
virtual reality simulations. There is a time-limited period of post-ischemic heightened
neuronal plasticity during which intensive training may optimally affect the recovery of
motor skills, indicating that the timing of rehabilitation is as important as the dosing.
However, recent literature indicates a controversy regarding both the value of intensive,
high dosage as well as the optimal timing for therapy in the first two months after stroke.
This study is designed to empirically investigate this controversy. It is evident that
providing additional, intensive therapy during the acute rehabilitation stay is more
complicated to implement and difficult for patients to tolerate, than initiating it in the
outpatient setting, immediately after discharge. The robotic/VR system is specifically
designed to deliver hand and arm training when motion and strength are limited, using
adaptive algorithms to drive individual finger movement, gain adaptation and workspace
modification to increase finger and arm range of motion, and haptic and visual feedback from
mirrored movements to reinforce motor networks in the lesioned hemisphere.
training of the hemiparetic hand, using haptic robots integrated with complex gaming and
virtual reality simulations. There is a time-limited period of post-ischemic heightened
neuronal plasticity during which intensive training may optimally affect the recovery of
motor skills, indicating that the timing of rehabilitation is as important as the dosing.
However, recent literature indicates a controversy regarding both the value of intensive,
high dosage as well as the optimal timing for therapy in the first two months after stroke.
This study is designed to empirically investigate this controversy. It is evident that
providing additional, intensive therapy during the acute rehabilitation stay is more
complicated to implement and difficult for patients to tolerate, than initiating it in the
outpatient setting, immediately after discharge. The robotic/VR system is specifically
designed to deliver hand and arm training when motion and strength are limited, using
adaptive algorithms to drive individual finger movement, gain adaptation and workspace
modification to increase finger and arm range of motion, and haptic and visual feedback from
mirrored movements to reinforce motor networks in the lesioned hemisphere.
This study investigates the effects of high dosage task and impairment based training of the
hemiparetic hand, using haptic robots integrated with complex gaming and virtual reality
simulations on recovery and function of the hand, when the training is initiated within early
period of heightened plasticity. The intervention uses two training systems. NJIT-RAVR
consists of a data glove combined with the Haptic Master robot that provides tracking of
movements in a 3D workspace and enables programmable haptic effects, such as variable
anti-gravity support, springs and dampers, and various haptic objects. The NJIT-TrackGlove
consists of a robotic hand exoskeleton to provide haptic effects or assistance and an
instrumented glove for finger angle tracking, and an arm tracking system to track hand and
arm position and orientation. Using programmable software and custom bracing we enable use of
this system for patients with a broad set of impairments and functional abilities. A library
of custom-designed impairment and task-based simulations that train arm transport and hand
manipulation, together or separately will be used. Pilot data show that it is possible to
integrate intensive, high-dosage, targeted hand therapy into the routine of an acute
rehabilitation setting. The study integrates the behavioral, the kinematic/kinetic and
neurophysiological aspects of recovery to determine: 1) whether early intensive training
focusing on the hand will result in a more functional hemiparetic arm; (2) whether it is
necessary to initiate intensive hand therapy during the very early inpatient rehabilitation
phase or will comparable outcomes be achieved if the therapy is initiated right after
discharge, in the outpatient period; and 3) whether the effect of the early intervention
observed at 6 months post stroke can be predicted by the cortical reorganization evaluated
immediately prior to the therapy. This study will fill critical gaps in the literature and
make a significant advancement in the investigation of putative interventions for recovery of
hand function in patients post-stroke.
hemiparetic hand, using haptic robots integrated with complex gaming and virtual reality
simulations on recovery and function of the hand, when the training is initiated within early
period of heightened plasticity. The intervention uses two training systems. NJIT-RAVR
consists of a data glove combined with the Haptic Master robot that provides tracking of
movements in a 3D workspace and enables programmable haptic effects, such as variable
anti-gravity support, springs and dampers, and various haptic objects. The NJIT-TrackGlove
consists of a robotic hand exoskeleton to provide haptic effects or assistance and an
instrumented glove for finger angle tracking, and an arm tracking system to track hand and
arm position and orientation. Using programmable software and custom bracing we enable use of
this system for patients with a broad set of impairments and functional abilities. A library
of custom-designed impairment and task-based simulations that train arm transport and hand
manipulation, together or separately will be used. Pilot data show that it is possible to
integrate intensive, high-dosage, targeted hand therapy into the routine of an acute
rehabilitation setting. The study integrates the behavioral, the kinematic/kinetic and
neurophysiological aspects of recovery to determine: 1) whether early intensive training
focusing on the hand will result in a more functional hemiparetic arm; (2) whether it is
necessary to initiate intensive hand therapy during the very early inpatient rehabilitation
phase or will comparable outcomes be achieved if the therapy is initiated right after
discharge, in the outpatient period; and 3) whether the effect of the early intervention
observed at 6 months post stroke can be predicted by the cortical reorganization evaluated
immediately prior to the therapy. This study will fill critical gaps in the literature and
make a significant advancement in the investigation of putative interventions for recovery of
hand function in patients post-stroke.
Inclusion Criteria:
- unilateral right or left sided stroke within 7 to 30 days of starting study
- sufficient cognitive function to follow instructions
- Fugl-Meyer (FM) of ≤ 49/66
- intact cutaneous sensation (e.g. ability to detect <4.17 N stimulation using Semmes-
Weinstein nylon filaments
Exclusion Criteria:
- prior stroke with persistent motor impairment or other disabling neurologic condition
- non-independent before stroke
- receptive aphasia
- hemispatial neglect or severe proprioceptive loss
- significant illnesses
- severe arthritis that limits arm and hand movements
- a score of ≥1 on the NIHSS limb ataxia item
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