Northwestern University Feinberg School of Medicine

Physical Therapy & Human Movement Sciences

Investigational Technologies in Stroke Recovery Laboratory

Robots example

Laboratory Description

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

Future Direction

Translating Progressive Abduction Loading Therapy to Acute Recovery

We plan to bring Progressive Abduction Loading Therapy (see recent study below) to in-patient and day-rehabilitaiton through a Phase IIb clincal trial in the near future. Stay tuned!

Current Project

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. Preliminary results are being presented in late 2018 at Scientific Sessions of American Heart Association and the annual conferences of American Society of Neurorehabilitation and Society for Neuroscience.

Recent Projects

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 here: 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 here: Frontiers of Neurology - StrokeResults

Graduate Student Research

Joseph V. Kopke, DPT, PhD (cand.): Upper-extremity Powered Orthosis Feasibility and Requirements for Application to Stroke Survivors

Dr. Kopke is part of the combined DPT/PhD (biomedical engineering) program at NUPTHMS. The overall goal of his thesis is to develop a controller and determine the mechanical requirements for a powered orthosis that enables stroke survivors to control each paretic joint independently and access more of their work volume to enable ADLs. Dr. Kopke is co-advised with Levi J. Hargrove, PhD, Director of the Neural Engineering for Prosthetics and Orthotics Laboratory, at Shirley Ryan AbilityLab. 

Joe


Grace C. Bellinger, MS (Dr. John N. Nicholson Fellow)

Grace is a PhD student in the Northwestern University Interdepartmental Neuroscience (NUIN) program. Her previous work on interlimb coordination and interest in neuroanatomy has facilitated her transition into rehabilitation robotics research. Grace plans to investigate motor recovery in stroke and methods for implementing investigative technologies in acute clinical settings. She was awarded the prestigious Nicholson Fellowship for the 2018-19 academic year from the The Graduate School at Northwestern University.

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Ninette Gerritsen, MS: A Passive-State Comparison of Ultrasound Elastography of the Biceps Brachii With Robotic Measurement of Elbow Extension Impedance in Chronic Stroke

Muscle properties are known to change following stroke. An increase in connective tissue composition likely contributes to impaired reaching function. We utilized a single-DOF robotic device to measure passive elbow joint stiffness and ultrasound-based shear wave elastography to measure shear wave velocity (surrogate for muscle stiffness) in the biceps muscle. This work was part of the Masters Thesis of Ninette Gerritsen (pictured below) and is also in collaboration with Sabrina Lee, PhD and Netta Gurari, PhD.

Ninette

 

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.

group presentation

NU DPT Class of 2019 presentation at the annual NUPTHMS Research Day shown top left to right; Grace Bellinger, MS, Arek Solawa, SPT, Qianyun "Ella" Meng, SPT, Michael D. Ellis, PT, DPT, and bottom left to right; Amanda Tay, SPT, and Rebecca Dugan, SPT.


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.

2018 Presentation at CSM in New Orleans

NU 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, LA, 2018. This work was conducted in collaboration with Dr. Netta Gurari, PhD and Dr. Sabrina Lee, PhD

Class of 2018 pic

Annual Department of Physical Therapy and Human Movement Sciences Research Day Presentation


Class of 2017 & 2016

- "Maximum Reaching Abduction Load: Evidence for the Concurrent Validity of a Rapid Robotic Assessment of Reaching Function Following Stroke"

NU 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. 

Cleaver

Students presenting at CSM

NU DPT 2016 Graduates, Kim Sipple, PT, DPT and Crystal Liang, PT, DPT presented their work in Anaheim, CA at the Combined Sections Meeting of the APTA, 2016.


Class of 2014 & 2015

- "Assessing a Robotic Measure of Loss of Independent Joint Control in Chronic Stroke"

NU DPT Graduates (class of 2014 featured below)  presented their work in Indianapolis, IN 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.

doh!

Principal Investigator

Graduate Students

Collaborating Staff

Collaborating Faculty