Current research projects:
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Characterizing Hemisphere-Specific Deficits in Bimanual Motor Control after Stroke
This project is the Dissertation project of Ph.D. candidate, Rini Varghese and is funded by an NIH F31 Ruth L. Kirschstein National Research Service Award. It has just recently been completed and is in the analysis and publication phase. Understanding the specific roles of the cerebral hemispheres for the control of bilateral movement is an important goal of motor control research with implications for rehabilitation of neurological injury, especially stroke. This proposal seeks to examine hemisphere-specific deficits in interlimb coordination during bimanual tasks by investigating an empirical phenomenon known as interlimb coupling (IC). We hypothesize that interlimb coupling during bimanual tasks is influenced by hemispheric specialization. Studying fundamental neurobehavioral mechanisms and the identification of hemisphere-specific deficits of bimanual movements after stroke is a necessary first step toward the development of interventions to remediate these deficits. Successful accomplishment of these aims will advance our understanding of hemisphere-specific mechanisms, and by doing so, lays the groundwork for the development of targeted training programs for stroke survivors with left- or right-hemisphere damage.
Aim 1: Characterize interlimb coupling during discrete bimanual aiming tasks.
Aim 2: Determine the influence of the side of stroke lesion on interlimb coupling.
Aim 3: Investigate the relationship between corpus callosum microstructure and interlimb coupling.
HSC IRB # HS-18-01024
This project has been completed as of July 2021.
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Predicting Ipsilesional Motor Deficits in Stroke with Dynamic Dominance (IPSI Study)
This is an NIH Phase I/II clinical trial that is in its 3rd year of recruitment and in collaboration with colleagues at Penn State (Robert Sainburg, Carolee Winstein, Co-PIs). This study is designed as an intervention to remediate the hemisphere-specific deficits in the non-paretic arm, using a virtual-reality platform, and then follow this training with manipulation training of a variety of real objects, designed to facilitate generalization and transfer to functional behaviors encountered in the natural environment. This intervention protocol is grounded in the premise that targeted remediation of fundamental control deficits exhibited by the non-paretic arm will generalize and transfer beyond practiced tasks to performance of activities of daily living (ADL). The impact of the proposed research is that we address persistent functional performance deficits in chronic stroke patients with severe paresis, whose non-paretic arm impairments are generally ignored in most current rehabilitation protocols. Amelia Cain, DPT and Clinical Instructor from USC has joined the team as our interventionist. Brianna Chang is the project coordinator, and Lauri Bishop is the blinded assessor.
Aim 1: Addresses the overall effectiveness of this intervention, relative to our control group: To determine whether non-paretic arm VRMT in chronic stroke survivors with severe paresis will produce durable improvements in non-paretic arm motor performance that will generalize to improve functional activities and functional independence to a greater extent than conventional therapy focused on the paretic arm.
Aim 2: Focuses on the mechanistic basis of potential training-related improvements in motor performance: To determine whether intervention-induced improvements in non-paretic arm performance are associated with improvements in hemisphere-specific reaching kinematics.
Aim 3: Monitors for potential negative effects of our experimental intervention on paretic arm impairment.
Clinical Trials # NCT03634397
HSC IRB # HS-18-00802
NIH Grant # 2R01HD059783-06A1
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RESTORE Project (weaRablEs for Stroke funcTiOn in the natuRal Environment)
This is a collaboration with a small business, Flint Rehabilitation that makes the MiGo sensor, the Small Business Technology Transfer (STTR) grant title, MiGo: wearable sensors that combine actionable data with a behavioral intervention to improve function after stroke. Lauri Bishop and Marika Demers, Co-Investigators, Daniel Zondervan and Justin Rowe, Flint Rehab, our industry partners. For more details about this study or to participate visit our website.
Aims: This study aims to better understand what influences motor recovery of stroke survivors (arm and hand behavior, and mobility), such as confidence in using the arm or positive social interactions. To do this, we use a system of activity monitors to track functional movement behavior in the home environment. This study comprises 2 phases:
Phase 1: To maximize the accuracy of MiGo’s movement detection algorithms across a range of motor impairments (i.e., mild, moderate, severe) while minimizing the number of sensors required and the total utility cost to the user.
Phase 2: To establish short-term feasibility and usability of MiGo in chronic stroke survivors in the natural environment, and to determine user satisfaction of MiGo feedback and obtain user-perceived meaningfulness of feedback type and preferred feedback delivery schedule that will drive behavior change.
HSC IRB # HS-20-00015 and HS-19-00984
STTR Grant # 1 R41 HD104296-01A1
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Mindfulness after Stroke
This is a pragmatic randomized control trial (RCT) done in collaboration with a team of colleagues from Harvard University, Deborah Philips and Francesco Pagnini, and Alison McKenzie from Chapman University. This RCT aims to determine the effectiveness of a 3-week non-meditative mindfulness program compared to a waitlist control on quality of life and well-being in individuals with stroke and their caregivers. The program includes a set of Mindfulness exercises patterned after the Langarian (Ellen Langer) approach. The mindfulness exercises are specifically designed for stroke survivors and caregivers, and they cover the following topics: attention to variability, positive and negative events, unpredictability, sense-making and novelty-seeking, and novelty producing. The 3-week program is done entirely online using the Division’s Desire2Learn platform. Marika Demers is leading this effort and is the contact for information on this project. For more details about this study or to participate, visit our website and view this informational flyer.
Aims: This study aims to assess the impact of a mindfulness program compared to a waitlist control on quality of life and wellbeing in people with stroke and caregivers or loved ones. The program is specifically designed to increase mindfulness for stroke survivors and their caregivers or loved ones.
Clinical Trials # NCT05029193
IRB # UP-20-00568-P2
CTSI Voucher # GR1055369