Use of Sensory Substitution to Improve Arm Control After Stroke
Study Details
Study Description
Brief Summary
Supplementing or augmenting sensory information to those who have lost proprioception after stroke could help improve functional control of the arm. Twenty-eight subjects will be recruited to a single site to evaluate the ability of various forms of vibrotactile stimulation to improve motor function, and to determine which locations of stimulation may optimize function. Participants will be tested in performing reaching movements and stabilization movements as well as more functional tasks such as simulated drinking from a glass
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
This study has two distinct aims. In aim 1, data will be collected across four days:
Day 1: Participants complete baseline screening including a test of cognition (Montreal Cognitive Assessment), clinical tests of sensory and motor function (Fugl-Meyer Assessment, two-point discrimination, vibration sensation) and a robotic test of proprioception (Arm Movement Detection Test).
Day 2: Participants will have their more affected hand wrapped around a robot handle. They will either perform reaching-type movements or hold the handle still if it attempts to make small movements. During these tasks, participants will receive vibrotactile feedback on the other arm which will provide information about hand position and/or hand speed to guide the movements.
Day 3: Participants will perform the holding-still task from the previous day while also performing a grip task. They will be cued to lightly squeeze and then relax their grip in the more affected hand while they are holding the handle as still as possible. During this time, they will be provided vibrotactile feedback to help them maintain hand position.
Day 4: Participants will perform the same task as the previous day. In this experiment, the vibrotactile feedback will be provided to the opposite arm, opposite thigh or on the same (grasping) arm.
In aim 2, data will be collected across ten days:
Day 1: Participants complete baseline screening including a test of cognition (Montreal Cognitive Assessment), clinical tests of sensory and motor function (Fugl-Meyer, two-point discrimination, vibration sensation) and a robotic test of proprioception (Arm Movement Detection Test).
Days 2-10: Participants will use the more affected arm to reach to specific 'unseen' targets in three-dimensional space, using vibrotactile feedback to guide the movement of the arm. Once participants reach the location, they will be asked to squeeze and release the fingers. View of a computer monitor will also be used during part of the experiment to help the participants guide the hand. Participants will also be asked to perform a simulated feeding task at the beginning or end of practice on each day.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Stroke Cohort - Optimize Delivery Aim 1 intervention: Vibrotactile stimulation. An optimal location and style of vibrotactile feedback for reach and stabilization behaviors will be determined. |
Behavioral: Vibrotactile stimulation
Non-invasive, computer-controlled miniature tendon vibrators, similar to those used in FitBit activity monitors.
|
| Experimental: Stroke Cohort - Extended Training Aim2 intervention: Vibrotactile stimulation. Progressive training from simple to more complex reaching and stabilizing tasks using vibrotactile feedback to guide performance |
Behavioral: Vibrotactile stimulation
Non-invasive, computer-controlled miniature tendon vibrators, similar to those used in FitBit activity monitors.
|
Outcome Measures
Primary Outcome Measures
- Root Mean Square Kinematic Error [across experimental sessions spanning a typical time frame of 1 to 3 weeks]
orthogonal distance between target and hand position during reaching and stabilizing
Eligibility Criteria
Criteria
Inclusion Criteria:
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stroke survivors who can perform our stabilization and grip modulation tasks and who
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had a single ischemic or hemorrhagic stroke of the middle cerebral artery (MCA) in the chronic state of recovery (> 6 months post-stroke).
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ability to give informed consent and be able to follow two-stage instructions.
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mild-to-moderate motor impairment as assessed using the upper extremity (UE) portion of the Fugl-Meyer Motor Assessment (FM); i.e., UE-FM score between 28 and 50 (inclusive) out of a possible 66.
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proprioceptive deficit at the elbow in the more involved (contralesional) arm.
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preserved tactile sensation in either the ipsilesional arm and/or thigh.
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a minimal active wrist extension of 5°.
Exclusion Criteria:
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Inability of subjects to give informed consent or follow two-stage instructions.
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subjects with a bleeding disorder.
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subjects with fixed contractures or a history of tendon transfer in the involved limb.
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subjects with a diagnosis of myasthenia gravis, amyotrophic lateral sclerosis or any disease that might interfere with neuromuscular function.
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subjects who are currently using or under the influence of aminoglycoside antibiotics, curare-like agents, or other agents that may interfere with neuromuscular function.
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subjects with a history of epilepsy.
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history of other psychiatric co-morbidities (e.g. schizophrenia).
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malignant or benign intra-axial neoplasms.
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concurrent illness limiting the capacity to conform to study requirements.
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Cardiac pacemaker, cardiac arrhythmia or history of significant cardiovascular or respiratory compromise.
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subjects with profound atrophy or excessive weakness of muscles in the target area(s) of testing.
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subjects with a systemic infection.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Marquette University | Milwaukee | Wisconsin | United States | 53233 |
Sponsors and Collaborators
- Marquette University
- Medical College of Wisconsin
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Investigators
- Principal Investigator: Leigh A Mrotek, PhD, Marquette University
Study Documents (Full-Text)
None provided.More Information
Publications
- Carey LM, Matyas TA. Frequency of discriminative sensory loss in the hand after stroke in a rehabilitation setting. J Rehabil Med. 2011 Feb;43(3):257-63. doi: 10.2340/16501977-0662.
- Conrad MO, Gadhoke B, Scheidt RA, Schmit BD. Effect of Tendon Vibration on Hemiparetic Arm Stability in Unstable Workspaces. PLoS One. 2015 Dec 3;10(12):e0144377. doi: 10.1371/journal.pone.0144377. eCollection 2015.
- Conrad MO, Scheidt RA, Schmit BD. Effects of wrist tendon vibration on arm tracking in people poststroke. J Neurophysiol. 2011 Sep;106(3):1480-8. doi: 10.1152/jn.00404.2010. Epub 2011 Jun 22.
- Conrad MO, Scheidt RA, Schmit BD. Effects of wrist tendon vibration on targeted upper-arm movements in poststroke hemiparesis. Neurorehabil Neural Repair. 2011 Jan;25(1):61-70. doi: 10.1177/1545968310378507. Epub 2010 Oct 4.
- Scheidt RA, Stoeckmann T. Reach adaptation and final position control amid environmental uncertainty after stroke. J Neurophysiol. 2007 Apr;97(4):2824-36. Epub 2007 Jan 31.
- HR-3303
- 1R15HD093086