Title: Novel strategies for stroke rehabilitation Cerebrovascular disease is the #1 cause of disability in western countries. The catastrophic burden of stroke and the scarcity of evidence-based rehabilitation interventions represent a major challenge to global health care. There is a gap between the massive impact of disability from stroke, studies in animals demonstrating """"""""rewiring"""""""" of neuronal circuits and availability of neurorehabilitative strategies to restore independent living in the clinical domain. Basic infrastructure to implement research in stroke rehabilitation has been developed at the Neurostimulation Laboratory at Hospital das Clmnicas/ Sao Paulo University, Brazil, in great part due to a previous NIH-funded grant. However there is a lack of skilled human resources to move the research forward. This grant proposal aims to plan a training program that will provide skills in neuroscience, stroke rehabilitation, neuromodulation and biomedical engineering that will nurture novel strategies to decrease disability from stroke. The P.I., Dr. Conforto, chief of the Neurostimulatation Laboratory, will collaborate with Dr. Leonardo Cohen, a senior researcher that leads the Human Cortical Physiology and Stroke Rehabilitation Section at Intramural NINDS, with Dr. P. Hunter Peckham, a distinguished researcher and pioneer on functional electrical stimulation, who is Professor of Biomedical Engineering at the Case Western Reserve University and with Dr. Andre Machado, Director of the Center for Neurological Restoration and Assistant Professor of Surgery in the Neurosurgery Department at the Cleveland Clinic, who leads rehabilitation protocols and who was mentored by Dr. Conforto at Sao Paulo in the past. In addition, Dr. Suely Marie, an eminent senior Brazilian researcher at Sao Paulo University with extensive experience in training research personnel and in participating in multicenter collaborations, will assist the P.I. in adapting the training program to local conditions. During the grant, researchers from the institution in the middle-income country (Brazil) and the high-income institutions in the United States will work together to identify creative, effective mechanisms to enhance research capability at the Neurostimulation Laboratory. We will design and test a preliminary, structured training program that includes theoretical and practical activities, and that until now has never been implemented in the middle-income institution. Adjustments will be made, and results of the program will be thoroughly and objectively evaluated to prepare a comprehensive training program for a future D-43 grant application proposal. The collaboration between Sao Paulo University, Intramural NINDS, Case Western Reserve University and Cleveland Clinic will set the stage for advancing education in non invasive cortical neuromodulation and biomedical engineering, needed to ripen strategies for stroke rehabilitation. Equipment and facilities are available at the middle-income country institution that will provide full support to this planning grant proposal.

Public Health Relevance

Cerebrovascular disease is the #1 cause of disability in western countries. The catastrophic burden of stroke and the scarcity of evidence-based rehabilitation interventions represent a major challenge to global health care. This planning grant will set the stage for advancing education in research in order to develop game-changer strategies for stroke rehabilitation.

National Institute of Health (NIH)
Fogarty International Center (FIC)
International Research Training Planning Grant (D71)
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Special Emphasis Panel (ZRG1-ICP2-N (51))
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Michels, Kathleen M
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Fundacao Faculdade de Medicina
Sao Paulo
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Menezes, Isabella S; Cohen, Leonardo G; Mello, Eduardo A et al. (2018) Combined Brain and Peripheral Nerve Stimulation in Chronic Stroke Patients With Moderate to Severe Motor Impairment. Neuromodulation 21:176-183
Conti, Juliana; Sterr, Annette; Brucki, Sônia Maria Dozzi et al. (2015) Diversity of approaches in assessment of executive functions in stroke: limited evidence? eNeurologicalSci 1:12-20
Anjos, Sarah M; Cohen, Leonardo G; Sterr, Annette et al. (2014) Translational neurorehabilitation research in the third world: what barriers to trial participation can teach us. Stroke 45:1495-7