Almost 30 % of stroke survivors with initial severe arm impairment fail to achieve sufficient recovery of arm function to enable them to independently perform activities of daily living. Functional deficits can be improved by combining rehabilitation with promising new technologies. Myoelectrically controlled devices utilize the weak electrical signals generated by the affected muscles and amplify them to activate a motor in the device. The movement of the motor augments their own volitional movement in the joint associated with that motor. Hence, the device provides the user the support needed to move their paretic arm. a-Myopro is an adjustable myoelectrically controlled orthosis that facilitates movement of the paretic hand and elbow by providing assistance through four modes of movements. The a-Myopro user can train with a single mode, or multiple modes can be combined to allow for more complex training of individual or multi-joint movements. Thus, a- Myopro provides stroke subjects who have limited arm function a unique movement training paradigm that allows them to volitionally practice isolated arm movements that they otherwise cannot practice on their own. During the first weeks after the onset of stroke, the injured brain undergoes several neural mechanisms, a process known as neuroplasticity, that intend to reorganize the neural connectivity and repair the damaged tissue around the injury region. Several studies have revealed that rehabilitation during this acute period would enhance the functional outcome of the paretic arm presumably by modulating the heightened neuroplastic mechanism. Specifically, it has been suggested that novel interventions that enhance neuroplastic mechanisms of recovery are particularly needed for stroke survivors who are severely impaired. The rationale of this CDA1 proposal is to explore if the myoelectrically controlled device a-Myopro can be added to the acute rehabilitation of stroke subjects with severe arm deficits. The study will also investigate if application of a-Myopro would lead greater enhancement of clinical outcomes compared to standard care. Because neuroplasticity is heightened in the acute phase, the study aims to correlate the neurophysiological changes with the enhancement gained as a result of practicing with a-Myopro in this population. Thus, this study will test the premise that adding practice with a-Myopro to the acute rehabilitation of subjects with severe arm impairment acts as a novel rehabilitative tool that promotes the neuroplastic mechanisms of recovery to enhance clinical outcomes for these subjects. Preliminary data on chronic stroke subjects provides support for the central premise of this study. We have found that individuals with chronic stroke who receive 18 sessions of individualized practice using Myopro exhibit improvements in the clinical outcomes of the paretic arm. In this proposed study, to test my premise in the acute rehabilitation phase, ten subjects with acute ischemic stroke (2 ? 14 days post stroke) will receive 18 sessions of individualized practice using a-Myopro. The improvements in upper extremity impairment and function measured by clinical measures will be compared to previously reported standard care results. Neurophysiological and neuroimaging tools will be used to collect information on the neuroplastic changes during the study period. This CDA-1 will inform whether implementation of a- Myopro in acute rehabilitation is feasible and leads to improvement in arm function in the study population. This project is ideal for me during my transition into clinical neurorehabilitation field. Specifically, with the help of my primary mentor and comprehensive mentoring team, I will begin to be trained in (1) clinical outcome measures for stroke subjects, (2) neurophysiological and neuroimaging tool in neurorehabilitation research, (3) clinical best practices in stroke and preparation for clinical trial management and (4) aspects to become an independent clinical researcher. My project is highly integrated with my career goal of becoming a leading investigator in clinical neurorehabilitation within the VA medical center.
Stroke is a significant problem for the aging Veteran population that leads to arm paralysis. Many stroke survivors are left with severe functional arm deficits despite receiving rehabilitation. Early therapy has the best outcomes, however, practice of movement is challenging for those with severe arm weakness. Novel rehabilitative tools are needed for rehabilitation of severely impaired individuals. This CDA-1 proposal aims to obtain preliminary data for utilizing a myoelectrically controlled arm orthosis as a therapy tool in acute rehabilitation for stroke survivors with severe motor deficit. This study will test clinical outcomes and evaluate functional brain changes. This study will provide the basis for evaluation of this technology for acute rehabilitation in stroke in future studies. Furthermore, this training grant is supported by an experienced and committed mentoring team and will provide the principal investigator with skills and knowledge neede to become an independent VA clinical scientist.
