Rehabilitation Robotics, Cognitive Skills Training and Function

Research has shown that robot-assisted therapy can help people regain control of simple
reaching or grasping movements, but these improvements don't generalize well to use of the
weaker limb during everyday tasks.

This study aims to refine and test a protocol named the Active Learning Program for Stroke
(ALPS), which teaches people to use active problem solving strategies and a home program to
improve function. Therapist-delivered ALPS instruction may incorporate use of strategies
(e.g. STOP, THINK, DO, CHECK) modeled after the Cognitive Orientation for daily Occupational
Performance (CO-OP) approach to improve real-world use of the paretic upper limb. We will
evaluate whether the combination of robot-assisted therapy and ALPS training leads to better
satisfaction and functional use of the weaker arm in persons with motor impairments more than
6 months after stroke, as compared to robot-assisted therapy alone.

Inclusion Criteria:

- Diagnosed with unilateral stroke more than 6 months prior to study enrollment.

- Stroke type will include both ischemic and hemorrhagic stroke.

- Moderate UE hemiparesis (characterized by initial scores on upper limb subtest of the
Fugl-Meyer Assessment (FMA) between 19-47/60)

- Intact cognitive function to understand and actively engage in the ALPS robotic
therapy procedures (Montreal Cognitive Assessment Score >/=26/30)during the initial
evaluation visit

Exclusion Criteria:

- No more than moderate impairments in paretic UE sensation, passive range of motion,
and pain that would limit ability to engage in therapy, as indicated by subtests of
the Fugl-Meyer Assessment (FMA) [13]

- Increased muscle tone as indicated by score of >/= 3 on the Modified Ashworth Scale
[15];

- Hemispatial neglect or visual field loss measured by the symbol cancellation subtest
on the Cognitive Linguistic Quick Test [16]

- Aphasia sufficient to limit comprehension and completion of the treatment protocol

- Currently enrolled or has plans to enroll in other upper limb therapy/research during
the study period

- Treatment with Botox injections for the affected arm within the previous 4 months or
planned Botox injections before the end of the study

- Contraindications for robot-assisted therapy including recent fracture or skin lesion
of paretic UE