Novel Brain Signal Feedback Paradigm to Enhance Motor Learning After Stroke Problem. Stroke damages brain neural structures that control coordinated upper limb movement, causing dysfunction and compromised quality of life. Existing and emerging treatment methods, which are only peripherally-targeted to limbs or directed only at the brain, show limited efficacy in upper extremity (UE) functional recovery in many survivors. Thus, there is a critical need for an innovative, transformative strategy to restore normal coordinated UE movement and functional task performance. Purpose. We will engage the remaining neuronal tissue and pathways in stroke survivors through a precise brain neural feedback system. First, real time functional magnetic resonance imaging (rtfMRI) will provide feedback regarding the specific brain region(s) that the stroke survivor should up-regulate. Second, in sequence, we will then employ real time functional near-infrared spectroscopy (rtfNIRS) to provide the more repetitive practice of an array of movements (not possible in the MR scanner) required to induce the brain plasticity that can drive recovery of more normal UE coordination. Third, to engage Hebbian principles of learning, we will use our fNIRS-triggered functional electrical stimulation (FES), producing affective signals from joint and muscle sensory receptors to the brain motor control system. Fourth, we will subsequently provide a series of motor learning sessions (without brain neural feedback) in order to provide the means for the learner to consolidate and generalize the coordination training to more normal functional task performance.
Aim I. Test the innovative coordination training protocol of combination rtfMRI/rtfNIRS brain neural feedback and peripherally-directed, neurally-triggered FES-assisted coordination practice within a framework of motor learning principles.
The aim focuses on re-training of wrist extension coordination because it is impaired, but essential for grasp preparation and stable maintenance of the hand for functional use. Hypothesis 1. Chronic stroke survivors will show significant improvement in upper limb function in response to the combined rtfMRI/rtfNIRS brain neural feedback and peripherally-directed, neurally-triggered FES-assisted coordination practice within a framework of motor learning principles. (Primary measure: Arm Motor Abilities Test; AMAT; secondary measures include: AMAT Wrist/Hand subscale; Fugl-Meyer upper limb coordination; and quality of life (Craig Handicap Assessment Rating Tool)). Secondary Aim II. Measure changes in brain activation patterns in response to proposed treatment. We will measure baseline and treatment response according to brain activation volume, intensity, centroid location, and white matter integrity. Objective. During wrist extension, we will measure baseline and treatment response according to brain activation volume, intensity, centroid location, and white matter integrity. Significance. The proposed intervention is a new direction for the PI's laboratory and may be paradigm- shifting in its concept and potential restoration of motor function after stroke.
of Proposed Work to the VA Patient Care Mission: The VA's central mission is to improve Veteran's health. Stroke is a devastating burden for the Veteran and US healthcare system, preventing normal function and preventing good quality of life. Standard care, and even emerging new treatments, do not restore arm and hand function to normal for those with chronic, persistent impairment and dysfunction after stroke. This creative and innovative study will provide brain neural feedback to stroke survivors so that they can actually see with their own eyes how their brain is functioning and, importantly, how to modulate their brain signals so as to recover more normal brain control of upper limb movements. The treatment protocol also includes the use of a practice-assist device, comfortable functional electrical stimulation (FES), which is triggered during practice, by the stroke survivor's own intentional brain signal. If successful, the study results will ultimately create a paradigm shift in treatment methods to restore functional recovery after stroke.
