Investigational Technologies in Stroke Recovery Laboratory
The Investigational Technologies in Stroke Recovery Laboratory employs quantitative technologies such as robotics, electromyography and ultrasound imaging to systematically investigate mechanism of motor recovery in individuals with stroke. Efforts culminate in the development of novel therapeutic interventions designed to more effectively target specific upper extremity movement impairments.
Produced by and published with permission of Jonathan Moeller.
- Joseph V. Kopke, BScEng, DPT, PhD(cand.)
- Grace C. Bellinger, MS (Dr. John N. Nicholson Fellow)
New NIH-funded Clinical Trial
Progressive Abduction Loading Therapy in Acute/Subacute Stroke Recovery
We have begun work on a phase IIb randomized clinical trial. The stroke recovery trial is supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number R01HD096071. The study extends prior intervention work from the lab to clinical practice as an augmentative therapy and will be conducted at Shirley Ryan AbilityLab in collaboration with Dr. Richard Harvey, MD, Director of the Brain Innovation Center.
Constitutive Elements Predicting Reaching Dysfunction in Chronic Severe Stroke
This cross-sectional study quantitatively evaluates multiple impairments that may contribute to reaching dysfunction, including isometric strength, loss of independent joint control (flexion synergy), flexor spasticity and passive range of motion. A multiple regression model will determine the relative contribution of each impairment to reaching function using standardized coefficients. It is hypothesized that flexion synergy expression is the overwhelming contributor to reaching dysfunction.
Constitutive Elements Predicting Reaching Dysfunction in Acute/Subacute Severe Stroke
We will be implementing the same model described above at four timepoints during acute to subacute recovery. It is currently unclear how various impairments such as weakness, abnormal synergy, reflex hyperexcitability, and muscle shortening manifest in early stroke recovery and how they impact reaching function. This work will be conducted at Shirley Ryan AbilityLab with patients undergoing in-patient stroke rehabilitation.
Flexion Synergy Overshadows Flexor Spasticity During Reaching in Chronic Moderate to Severe Hemiparetic Stroke
We have recently completed an study integrating movement kinematics and kinetics with EMG of elbow flexors and extensors to tease apart the contributions of synergy-related and spasticity-related flexor activation to reaching function. Results indicate an overwhelming impact of flexion synergy overshadowing flexor spasticity on reaching function.
Read the study publication in Clinical Neurophysiology.
Progressive Abduction Loading Therapy with Horizontal-Plane Viscous Resistance Targeting Weakness of Flexion Synergy to Treat Upper Limb Function in Chronic Hemiparetic Stroke: A Randomized Clinical Trial
We have recently completed a single-site double-blinded RCT funded by the National Institute of Disability and Rehabilitation Research (H133G110245). The RCT utilized the ACT3D, a robotic device, to administer a dynamic arm strengthening intervention for adults with chronic moderate to severe stroke. Detailed information can be found at ClinicalTrials.gov.
Read the study publication in Frontiers of Neurology - Stroke.
Graduate Student Research
Doctor of Physical Therapy Research (Synthesis Project)
This laboratory participates in the didactic education of doctor of physical therapy (DPT) students in the content area of clinical research.
Class of 2019
"A pilot study investigating the predictive capacity of strength, synergy, spasticity and passive range of motion on reaching function in chronic moderate to severe hemiparetic stroke."
DPT students (class of 2019) conducted quantitative measurements of flexion synergy, spasticity, weakness and passive range of motion to evaluate the predictive capacity of each underlying stroke impairment to reaching function. This is part of a larger study being conducted by Grace Bellinger, MS, as part of her Neuroscience PhD dissertation and also will be continued in the DPT class of 2020 synthesis project.
DPT Class of 2018: Keyra Ogden, DPT, Ake Paramadilok, DPT, Nicole Stortini, DPT, Jenna Urbaniak, DPT, and Nick Newman, DPT (pictured below right), presenting at Combined Sessions Meeting of the APTA, New Orleans, 2018. This work was conducted in collaboration with Netta Gurari, PhD, and Sabrina Lee, PhD.
Class of 2018
"Inter-Rater Reliability of Shear Wave Ultrasound Elastography on the Biceps Brachii Muscle in Individuals with Chronic Stroke"
DPT students (class of 2018) measured shear wave velocity in the paretic biceps muscle of individuals with stroke. A five-rater design was employed to evaluate inter-rater reliability in trained novice users. With the validity and reliability supported, this metric will serve as a new tool for clinicians to evaluate muscle architectural changes that occur following stroke.
DPT Class of 2018: Keyra Ogden, DPT, Ake Paramadilok, DPT, Nicole Stortini, DPT, Jenna Urbaniak, DPT, and Nick Newman, DPT.
Presenting at Combined Sessions Meeting of the APTA, New Orleans, 2018. This work was conducted in collaboration with Netta Gurari, PhD, and Sabrina Lee, PhD.
Classes of 2017 & 2016
"Maximum Reaching Abduction Load: Evidence for the Concurrent Validity of a Rapid Robotic Assessment of Reaching Function Following Stroke"
DPT 2017 graduate Stefani Cleaver, PT, DPT, presented at APTA National Conference (CSM 2017) on behalf of students in the classes of 2017 and 2016. They presented results of a development project dedicated to the production of a clinically viable robotic evaluation method to quantify the impact of abnormal flexion synergy on reaching function in individuals with stroke.
Photo: DPT 2016 graduates Kim Sipple, PT, DPT, and Crystal Liang, PT, DPT, presented their work in Anaheim, California, at the Combined Sections Meeting of the APTA in 2016.
Classes of 2014 & 2015
"Assessing a Robotic Measure of Loss of Independent Joint Control in Chronic Stroke."
DPT graduates (class of 2014 featured below) presented their work in Indianapolis in 2015 at the Combined Sections Meeting of the APTA. They presented results from an investigation of the minimal detectable change (MDC) of two robotic/kinematic metrics of reaching performance in individuals with moderate to severe stroke. The MDC is the smallest possible change in repeated measurements that cannot be attributed to error. Determination of the MDC will guide clinical evaluation of response to interventions such as occurring in the RCT described above.