Stroke Recovery & Rehabilitation
Our research is aimed at developing effective and efficient, individualized rehabilitation for people with neurological injury, particularly those with stroke.
Our studies are focused on characterizing neurobehavioral changes over the course of stroke recovery, developing new and optimizing current motor interventions, and improving clinical practice. The research tools used include: computerized analyses of human movement (kinematics, kinetics, electromyography) to quantify behavior during ecologically-valid laboratory tasks; standardized clinical assessments to quantify the capacity to produce skilled movement; biosensors (accelerometers) that quantify types and amount of movements outside the laboratory; and standardized questionnaires that quantify self-perception of function, behavior, and participation in everyday life. Ongoing partnerships with others add additional approaches (fMRI, TMS, serum marker analyses) to the available tool set. The interdisciplinary, interactive laboratory environment promotes collaborations within and outside the lab with scientists and clinicians, resulting in a productive, successful research program.
Allyson Getty, DPT student
Gina Malito, DPT Student
Anna Mattlage, Postdoctoral Fellow
Alice McGee, DPT student
Swati Surkar, Postdoctoral Fellow
Allison Tsuai, DPT Student
Kimberly Waddell, PhD Student
Shelby Wilson, DPT Student
Current Research Studies
Translation of in-clinic gains to gains in daily life
Funding source: NIH R01HD068290
A key purpose of providing rehabilitation services post stroke is to improve performance in daily life. It has long been assumed that improvements in capacity, where capacity is defined as what a person is capable of doing in the structured environment of the clinic or laboratory, result in improvements in real-world performance, where performance is defined as what a person actually does in daily life, outside of the clinic or laboratory. Data from the previous award cycle show a striking difference after intervention between capacity and performance. While many people improved their capacity for upper limb function after an intensive intervention, not a single person improved their performance in daily life, as measured by wearable sensors. In this award cycle, we are examining the discrepancy between capacity and performance, with the long-term goal of using the knowledge gained to develop new or modify current rehabilitation interventions that will improve performance in daily life. We are studying two prospective, longitudinal cohorts to address three aims. Aim 1 seeks to understand the scope of the problem within the field of neurorehabilitation. We are studying a cohort of people receiving outpatient services to determine whether the discrepancy between capacity and performance is unique to upper limb interventions and/or stroke rehabilitation. Aim 2 is designed to learn when, how much, and in whom, upper limb capacity gains translate to performance gains. We are studying another cohort of persons with first time stroke to map the natural trajectory of performance and its relationships to capacity and other factors over the time course of stroke recovery (within 2 weeks out to 6 months). Aim 3 takes the viewpoint that upper limb performance is a health behavior, or habit, which may be amenable to change. We are capitalizing on the same cohort as Aim 2 and exploring the time course of stroke survivor attitudes and barriers to performance.
Ischemic conditioning as a neurorecovery agent for stroke
Funding Source: NIH R01HD085930 and HealthSouth Corporation
Ischemic conditioning is an endogenous phenomenon in which exposing a target organ or another, remote tissue to brief episodes of sub-lethal ischemia results in protection of the target organ against ischemia. A clinically-feasible method is remote limb ischemic conditioning (RLIC), where episodes of ischemia and reperfusion are induced with a blood pressure cuff. In humans, the cardioprotective effects of RLIC have been demonstrated repeatedly, while neuroprotective effects are just beginning to be evaluated. Here, we propose that the multifactorial, epigenetic mechanisms of RLIC might extend beyond cardio- and neuroprotection and into plasticity, learning, and recovery. The current project is a series of Phase I experiments designed to gather the critical information needed to move down the translational pathway, with the eventual goal of harnessing RLIC as a neurorecovery agent to enhance stroke rehabilitation and outcomes.
Collaborative Research Studies
Spinal control during functional activities to improve low back pain outcomes
NIH R01HD047709 (PI: Van Dillen)
Enhanced Medical Rehabilitation of older adults
NIH R01MH099011 (PI: Lenze)
Harnessing neuroplasticity to enhance functional recovery in allogenic hand transplant and heterotopic hand replant recipients
DoD W81XWH-15-2-0037 (PI: Frey)
Past Research Studies
A Brain Recovery Core for measuring the effectiveness of stroke care (Barnes Jewish Hospital Foundation, Washington University McDonnell Center for Systems Neuroscience)
Effects of movement context on hemiparetic grasping after stroke (NIH R01HD055964)
Mechanisms underlying loss of hand function after stroke (NIH K01HD047669)