The Effect of Proximal and Distal Training on Stroke Recovery: Stroke is the leading cause of impairment and disability. Although treatment of post stroke recovery in dedicated rehabilitation units positively influences outcome, no one treatment strategy has demonstrated superiority. We have been delivering targeted sensorimotor training for the shoulder and elbow with a planar robotic device, MIT-Manus. In randomized controlled trials, for both inpatients and persons with chronic impairment after stroke, persons treated with the robotic protocol demonstrated reduction in impairment in the exercised limb. Our results are in agreement with a prominent theme of current research into recovery from brain injury which posits that activity-dependent plasticity underlies neuro-recovery. If that is true, it suggests that significant recovery of motor function may be facilitated by """"""""properly targeted"""""""" sensory-motor activity. By """"""""properly targeted,"""""""" we mean that with the under-emphasis or absence of sensory and motor stimulation of the central nervous system related either to a particular group of muscles and joints, or to particular tasks, the associated neural systems would be expected to (1) exhibit little plastic change, or (2) be pre-empted to subserve other functions. We have recently introduced to the clinic a complement to MIT-MANUS (shoulder-and-elbow robot): a wrist robot, which motivated the specific aims of this project:
Specific Aim 1. Test whether task specific wrist robotic training improves motor performance among inpatients and persons with chronic impairment after stroke.
Specific Aim 2. Test whether the order in which robot therapy is delivered influences outcomes (shoulder-and-elbow before wrist vs. wrist before shoulder-and-elbow).
Specific Aim 3. Test whether there is generalization across different joints (shoulder & elbow vs wrist).
Specific Aim 4. Test whether simultaneous targeted sensorimotor training of the shoulder, elbow, and wrist (integrated system) leads to better outcomes than isolated movement component training. Briefly we will invite persons with chronic impairment due to stroke to participate in a study that will train them first on wrist and then on the shoulder-and-elbow or vice-versa. A third group will be trained on the shoulder, elbow, and wrist simultaneously. Outcomes will be measured using standard instruments as well as robot-based measures.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD045343-04
Application #
7241605
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Quatrano, Louis A
Project Start
2004-07-01
Project End
2009-04-30
Budget Start
2007-07-01
Budget End
2008-06-30
Support Year
4
Fiscal Year
2007
Total Cost
$346,548
Indirect Cost
Name
Massachusetts Institute of Technology
Department
Engineering (All Types)
Type
Schools of Engineering
DUNS #
001425594
City
Cambridge
State
MA
Country
United States
Zip Code
02139
Krebs, Hermano Igo; Volpe, Bruce T (2015) Robotics: A Rehabilitation Modality. Curr Phys Med Rehabil Rep 3:243-147
Dipietro, Laura; Poizner, Howard; Krebs, Hermano I (2014) Spatiotemporal dynamics of online motor correction processing revealed by high-density electroencephalography. J Cogn Neurosci 26:1966-80
Edwards, Dylan J; Dipietro, Laura; Demirtas-Tatlidede, Asli et al. (2014) Movement-generated afference paired with transcranial magnetic stimulation: an associative stimulation paradigm. J Neuroeng Rehabil 11:31
Krebs, H I; Volpe, B T (2013) Rehabilitation robotics. Handb Clin Neurol 110:283-94
Dohle, Carolin I; Rykman, Avrielle; Chang, Johanna et al. (2013) Pilot study of a robotic protocol to treat shoulder subluxation in patients with chronic stroke. J Neuroeng Rehabil 10:88
Vaisman, Lev; Dipietro, Laura; Krebs, Hermano Igo (2013) A comparative analysis of speed profile models for wrist pointing movements. IEEE Trans Neural Syst Rehabil Eng 21:756-66
Krebs, Herman Igo; Hogan, Neville (2012) Robotic therapy: the tipping point. Am J Phys Med Rehabil 91:S290-7
Dipietro, L; Krebs, H I; Volpe, B T et al. (2012) Learning, not adaptation, characterizes stroke motor recovery: evidence from kinematic changes induced by robot-assisted therapy in trained and untrained task in the same workspace. IEEE Trans Neural Syst Rehabil Eng 20:48-57
Kim, Seung-Jae; Krebs, Hermano Igo (2012) Effects of implicit visual feedback distortion on human gait. Exp Brain Res 218:495-502
Krebs, Hermano I; Fasoli, Susan E; Dipietro, Laura et al. (2012) Motor learning characterizes habilitation of children with hemiplegic cerebral palsy. Neurorehabil Neural Repair 26:855-60

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