Neurorehabilitation Research Laboratory

Neurorehabilitation Research Laboratory

PI: Catherine Lang, PT, PhD – langc@wustl.edu

Research Coordinator: Maggie Bland DPT, MSCI

Lab Members: Sydney Schaefer, PhD Dustin Hardwick DPT Rebecca Birkenmier MS OTR/L Stacey DeJong PT, MS, PCS Eliza Prager OTS Hillary Smith SPT Kendra Cherry, SPT Monica Ratner, SPT Former Lab Members: Justin Beebe PT, PhD Joanne Wagner, PT, PhD, ATC Christopher Gnip, DPT Jillian MacDonald DPT Sara Francois DPT Sage Tarter DPT

	Laboratory Description: We are interested in better understanding how the central nervous system learns and controls skilled, voluntary movements, how movement recovers after nervous system damage, and how the mechanics of the body interact with the nervous system to produce movement. The lab is equipped to study sensorimotor control in the upper extremity in healthy people and in people with central nervous system pathology. Our lab is located in the building adjacent to the Rehabilitation Institute of St. Louis. This convenient location enables us to study inpatients during their acute rehabilitation stay as well as people with more chronic movement disorders. .
Justin collecting data

Projects:

Mechanisms underlying loss of hand function after stroke
The hand is the tool with which we interact with our environment. In order to use the hand for functional activities, we need the ability to locate it in the correct position in space, orient it with respect to objects in the environment, and then manipulate our fingers to interact with that object. The purpose of this project is to investigate how movement control at each segment of the upper extremity and how loss of various somatosensory modalities contributes to the loss of hand function after stroke (see pictures below). Subjects with acute stroke are followed longitudinally to determine how movement control at each segment recovers and how relationships between movement control, somatosensation, and hand function may change over time.

Amount of practice during therapy for post-stroke hemiparesis
Little is known about the amount of task practice that occurs during treatment for people with hemiparesis after stroke. In contrast, animal models of stroke engage in hundreds of repetitions of task practice during their daily “rehabilitation”. Although our clinical intuition says the numbers of movement repetitions is likely small, there is little data to substantiate or refute this claim. The purpose of this multi-site study is to gather descriptive data about the number of tasks and the numbers of repetitions per task that people with hemiparesis typically engage in during physical and occupational therapy. An additional purpose is to determine if the number of tasks and repetitions are affected by variables such as clinical setting (inpatient vs. outpatient), stroke chronicity, or stroke severity. We hope this knowledge will give us better insight into current care, assist in developing future rehabilitation treatments, and aid in the design of future clinical trials for rehabilitation.

300 or more repetition doses to improve motor function after stroke
Arm weakness happens frequently following a stroke. Animal models of stroke investigating the adaptive capacity (plasticity) of the nervous system have the animals perform hundreds of daily repetitions of functional movements during their “rehabilitation”. In contrast, our work has shown that people with stroke do far fewer (10 – 40) repetitions of functional arm movements. We hypothesize that increasing the number of repetitions to hundreds of times within a session may improve arm use during everyday activities. We are currently running a pilot developmental trial to determine if it is feasible to participate in a high (300 – 400) repetition dose

Mechanisms of hemiparetic shoulder pain
Shoulder pain is a common complaint and a cause of disability in people with post-stroke hemiparesis. Few effective treatments are available to relieve hemiparetic shoulder pain and little is known about its underlying musculoskeletal and neuromuscular origins. The purpose of this project is to investigate scapulo-thoracic and glenohumeral movement problems in the painful shoulders of people with hemiparesis using kinematic and electromyographic techniques. We hypothesize that an important mechanism underlying hemiparetic shoulder pain is the inability to move the scapula, and that techniques to maximize and/or normalize its movement during arm elevation will be useful in alleviating the painful symptoms.

Effects of movement context on hemiparetic grasping early after stroke

While the hand can do many things, most of the time it is used for grasping. In healthy people, control of grasping is affected by the context in which the grasping movement occurs. For example, hand shaping and finger force production are modified, depending on what action will be performed with an object once it is grasped. We are investigating these phenomena in people with hemiparesis early after stroke, to determine the effects of combining grasping with reaching, lifting, and/or bilateral movement. If the control of grasping is improved in specific movement contexts, then it may be possible to enhance recovery of hand function during rehabilitation by incorporating those contexts.

Optimizing Rehabilitation to Improve Outcomes after Stoke

Rehabilitation after stroke has the potential to save many people from disability. While organized stroke care often exists within institutions that provide care at different stages of the rehabilitation process, it does not exist across institutions, as patients move from one institution to another and then to home.
Furthermore, use of consistent, standardized outcome measures to track patient improvement and predict future services are not part of stroke rehabilitation today. The goal of this project is to develop and evaluate a model system of organized stroke rehabilitation across the continuum of care, from the acute stroke service to return to home and community life. We believe that implementation of this model system will improve continuity of care as well as establish a much needed database allowing both clinicians and investigators to examine patient characteristics as predictors for recovery and patient outcomes to assist with discharge planning and follow-up care. Once established our care model can then serve as the foundation for implementing evidence-based rehabilitation interventions and for evaluating future changes to rehabilitation service delivery.

Publications:
Link to articles by CE Lang on pubmed.

CONTACT INFORMATION
Catherine E. Lang, PT, PhD
Washington University in St. Louis - School of Medicine
Program in Physical Therapy
Campus Box 8502
4444 Forest Park Blvd.
St Louis, MO 63108-2212
PH: 314-286-1945
FAX: 314-286-1410
Email address: langc@wustl.edu