Optimizing Hand Rehabilitation Post-Stroke Using Interactive Virtual Environments

Completed

Phase 1 Results N/A

Trial Description

The complexity of sensorimotor control required for hand function as well as the wide range of recovery of manipulative abilities makes rehabilitation of the hand most challenging. The investigators past work has shown that training in a virtual environment (VE) using repetitive, adaptive algorithms has the potential to be an effective rehabilitation medium to facilitate motor recovery of hand function. These findings are in accordance with current neuroscience literature in animals and motor control literature in humans. The investigators are now in a position to refine and optimize elements of the training paradigms to enhance neuroplasticity. The investigators first aim tests if and how competition among body parts for neural representations stifles functional gains from different types of training regimens. The second aim tests the functional benefits of unilateral versus bilateral training regimens.The third aim tests whether functional improvements gained from training in a virtual environment transfer to other (untrained) skills in the real world.

Detailed Description

The complexity of sensorimotor control required for hand function as well as the wide range of recovery of manipulative abilities makes rehabilitation of the hand most challenging. The investigators past work has shown that training in a virtual environment (VE) using repetitive, adaptive algorithms has the potential to be an effective rehabilitation medium to facilitate motor recovery of hand function. These findings are in accordance with current neuroscience literature in animals and motor control literature in humans. The investigators are now in a position to refine and optimize elements of the training paradigms to enhance neuroplasticity. The investigators first aim tests if and how competition among body parts for neural representations stifles functional gains from different types of training regimens. The second aim tests the functional benefits of unilateral versus bilateral training regimens.The third aim tests whether functional improvements gained from training in a virtual environment transfer to other (untrained) skills in the real world.

Conditions

Interventions

  • HAS Training Behavioral
    Other Names: Isolated UE training
    Intervention Desc: Robotically measured and facilitated training of the hemiparetic hand and arm in isolation, in a three dimensional haptically rendered virtual environment.
    ARM 1: Kind: Experimental
    Label: Train Paretic Hand and Arm Separate
    Description: Eight three hour training sessions of robotically facilitated hand and arm training in complex virtual environments, using activities that train the fingers in isolation and other activities that train the arm in isolation.
  • HAT training Behavioral
    Other Names: Integrated UE training
    Intervention Desc: Robotically measured and facilitated training of the hemiparetic hand and arm as an integrated functional unit, in a three dimensional haptically rendered virtual environment
    ARM 1: Kind: Experimental
    Label: Train Paretic Hand and Arm Together
  • Bimanual Training Behavioral
    Other Names: Bilateral UE training
    Intervention Desc: Robotically measured and facilitated training of the hemiparetic hand and non-hemiparetic hand together, in a three dimensional haptically rendered virtual environment
    ARM 1: Kind: Experimental
    Label: Train Both Hands Together in VE

Trial Design

  • Allocation: Randomized
  • Masking: Double Blind (Subject, Outcomes Assessor)
  • Purpose: Treatment
  • Endpoint: Efficacy Study
  • Intervention: Parallel Assignment

Outcomes

Type Measure Time Frame Safety Issue
Primary Change in Jebsen Test of Hand Function Two Weeks Prior to Training, Immediately Prior to Training, Immediately After Training, 3 Months After Training No
Secondary Change in Wolf Motor Function Test Two Weeks Prior to Training, Immediately Prior to Training, Immediately After Training, 3 Months After Training No
Secondary Change in 9 Hole Peg Test Two Weeks Prior to Training, Immediately Prior to Training, Immediately After Training, 3 Months After Training No
Secondary Change in Box and Blocks Test Two Weeks Prior to Training, Immediately Prior to Training, Immediately After Training, 3 Months After Training No
Secondary Change in Robotically Collected Kinematics 1 day before training and 1 day after training No
Secondary Change in Reach to Grasp Test 1 day before training and 1 day after training No

Sponsors