Functional Magnetic Resonance Imaging (fMRI) and Robot-Assisted Practice of Activities of Daily Living
Condition: Hemiparesis; Ischemic Stroke; Chronic
MeSH terms: Ischemic Stroke; Paresis
Study type: Interventional
Phase: Phase 1

Summary: 
      The investigators will study motor recovery after robot-assisted therapy after stroke. A
      small clinical trial will be conducted to quantify the central nervous system changes
      associated with robotic or standard training, and identify trends across high and low
      responders in terms of patterns of change in cortical activity and type of white matter
      connectivity.The investigators hypothesize that robot training will lead to larger
      improvements as compared to standard occupational therapy. The investigators hypothesize that
      high responders to the robot training will have reduced compensatory activation in the
      bilateral area and will connectivity in the motor tracts.
    

Detailed description: 
      Robot-assisted therapy is on the cutting edge of stroke rehabilitation and is a therapy
      method that promises to improve the lives of persons with disabilities due to stroke.
      Preliminary studies using these tools provide mixed evidence for their effectiveness and
      reveal limitations. For example, inconsistent carryover of motor gains to real life
      activities of daily living (ADLs) is seen. Therefore, it is still not clear what treatment
      strategies maximize functional outcomes on ADLs. There is a need to study the stroke recovery
      process and to understand how to optimize robot-assisted therapies in order to enhance
      patient rehabilitation and improve functional outcomes. Imaging techniques such as functional
      Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) can assist us in
      understanding the stroke recovery process, in determining who may benefit from robot-assisted
      training, and in defining how training induced functional cortical changes occur after robot
      training. We propose to conduct an interventional study plus control to assess the
      effectiveness of four weeks of robot-assisted practice of tasks with skilled functional tasks
      that involve reaching and grasping activities similar to real activities. We will examine the
      process of recovery for low-to-moderate functioning stroke survivors with chronic disability.
      We will assess the ability of active-assisted reaching and grasping training to effect
      immediate gains and long-term functional improvements. Further, using fMRI and DTI, we plan
      to associate changes seen in motor impairment levels and functional task performance levels
      with white matter injuries and connectivity and changes in oxygen utilization in the motor
      cortex as well as other areas of the brain. Our short-term aims are to, i) assess short-term
      functional gains after practice of skilled reaching and grasping tasks; ii) assess
      maintenance of these improvements; iii) quantify the neuronal changes associated with
      short-term gains, and iv) identify trends across high and low responders in terms of patterns
      of change in cortical activity and type of white matter connectivity. In the long-term, we
      hope to improve understanding of the process of ADL functional recovery after stroke and
      optimize robot-training strategies leading to cerebral plasticity. We also hope to determine
      how lesion characteristics affect changes seen in function, white matter connectivity, and
      cortical activity. By, accomplishing these aims, we hope to improve upper extremity function
      after stroke and reduce disability.
    

Intervention name(s): Robot Therapy Device; Occupational Therapy
Intervention type(s): Device; Behavioral
Intervention description(s): 3x a week for 4 weeks; 3x a week for 4 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Robot Therapy; Upper Limb; Stroke; Rehabilitation; fMRI; DTI