Stroke rehabilitation research has produced a number of efficacious and emerging interventions for improving mobility, balance, and upper limb function. Trial outcomes are measured at the functional capacity level, where capacity is defined as what a person is capable of doing in the structured environment of the clinic or laboratory. It has long been assumed that improvements in capacity result in improvements in real-world performance, where performance is defined as what a person actually does in daily life, outside of the clinic or laboratory. Our data from the previous award cycle show a striking difference after intervention between capacity and performance measured with wearable sensors, i.e. accelerometers. Group averages indicated some improvement in capacity and in self-reported performance, but no improvement in actual performance. At the individual level, no one showed improvements in performance, even those individuals who made substantial changes in capacity. Given that a key purpose of providing rehabilitation services post stroke is to improve performance in daily life, we have uncovered a major problem that merits investigation. This project will examine the discrepancy between capacity and performance, with the long-term goal of using the knowledge gained to develop new or modify current rehabilitation interventions that will improve performance in daily life. We will study two prospective longitudinal cohorts to address three aims.
Aim 1 will seek to understand the scope of the problem within the field of neurorehabilitation. We will study a cohort of people receiving outpatient services to determine whether the discrepancy between capacity and performance is unique to upper limb interventions and/or stroke rehabilitation.
Aim 2 is designed to learn when, how much, and in whom, upper limb capacity gains translate to performance gains. We will study another cohort of persons with first time stroke to map the natural trajectory of performance and its relationships to capacity and other factors over the time course of stroke recovery (within 2 weeks out to 6 months).
Aim 3 takes the viewpoint that upper limb performance is a health behavior, or habit, which may be amenable to change. We will capitalize on the same cohort as Aim 2 and explore the time course of stroke survivor attitudes and barriers to performance. Data from these cohorts will transform current practice with knowledge of when and with whom motor rehabilitation interventions can improve performance in daily life. Rehabilitation research will be advanced by knowledge about capacity vs. performance, and when and how capacity improvements can translate to performance improvements. Our data will inform future research design and serve as a basis for developing and testing of performance-level interventions to improve stroke outcomes in the real world, not just in the clinic or laboratory.

Public Health Relevance

Stroke rehabilitation may improve what people are capable of doing, i.e. functional capacity, but may not improve what they actually do, i.e. performance in daily life. Because a key purpose of providing rehabilitation services post stroke is to improve performance in daily life, this project will investigate the discrepancy between functional capacity and daily performance, with the long-term goal of using the knowledge gained to develop new or modify current rehabilitation interventions that will improve outcomes in the real world, not just in the clinic or laboratory.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
2R01HD068290-05
Application #
9302890
Study Section
Special Emphasis Panel (ZRG1-MOSS-K (90)M)
Program Officer
Marden, Susan F
Project Start
2012-02-01
Project End
2022-01-31
Budget Start
2017-04-01
Budget End
2018-01-31
Support Year
5
Fiscal Year
2017
Total Cost
$456,659
Indirect Cost
$126,436
Name
Washington University
Department
Other Health Professions
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Hayward, Kathryn S; Lohse, Keith R; Bernhardt, Julie et al. (2018) Characterising Arm Recovery in People with Severe Stroke (CARPSS): protocol for a 12-month observational study of clinical, neuroimaging and neurophysiological biomarkers. BMJ Open 8:e026435
Waddell, Kimberly J; Lang, Catherine E (2018) Comparison of Self-Report Versus Sensor-Based Methods for Measuring the Amount of Upper Limb Activity Outside the Clinic. Arch Phys Med Rehabil 99:1913-1916
Lang, Catherine E; Waddell, Kimberly J; Klaesner, Joseph W et al. (2017) A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers. J Vis Exp :
Basso, D Michele; Lang, Catherine E (2017) Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury. J Neurol Phys Ther 41 Suppl 3:S24-S31
Waddell, Kimberly J; Strube, Michael J; Bailey, Ryan R et al. (2017) Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke? Neurorehabil Neural Repair 31:290-300
Lang, Catherine E; Strube, Michael J; Bland, Marghuretta D et al. (2016) Dose response of task-specific upper limb training in people at least 6 months poststroke: A phase II, single-blind, randomized, controlled trial. Ann Neurol 80:342-54
Reinkensmeyer, David J; Burdet, Etienne; Casadio, Maura et al. (2016) Computational neurorehabilitation: modeling plasticity and learning to predict recovery. J Neuroeng Rehabil 13:42
Doman, Caitlin A; Waddell, Kimberly J; Bailey, Ryan R et al. (2016) Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke. Am J Occup Ther 70:7003290040p1-7003290040p11
Grattan, Emily S; Lang, Catherine E; Birkenmeier, Rebecca et al. (2016) Examining the Feasibility, Tolerability, and Preliminary Efficacy of Repetitive Task-Specific Practice for People With Unilateral Spatial Neglect. Am J Occup Ther 70:7004290020p1-8
Lohse, Keith R; Schaefer, Sydney Y; Raikes, Adam C et al. (2016) Asking New Questions with Old Data: The Centralized Open-Access Rehabilitation Database for Stroke. Front Neurol 7:153

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