Principal Investigators: Peter S. Lum, PhD and E Taub, PhD (Birmingham VAMC) Project Staff: V Mark, MD (Birmingham VAMC); Douglas F. Schwandt, MS; and James H. Anderson, JEM Project Category: Stroke - 2001 Objective: Constraint-Induced (CI) therapy is one of the few techniques that has been proven with controlled, randomized studies to substantially reduce the incapacitating motor deficit of the more affected upper limb of patients with mild to moderately severe chronic strokes. The therapy involves promoting use of the more affected upper limb for 90% of waking hours by constraining the less affected limb for two or three consecutive weeks with a device which prevents movement of the hand and wrist for activities of daily living. The patients receive a type of training termed "shaping" for 7 hours/day for all weekdays during this period (massed practice). We propose to develop and evaluate a workstation that significantly enhances the application of CI therapy by automating and instrumenting several of the tasks currently used. The motivation for development of such a device is as follows: 1) Patients could receive CI therapy at home without the need for constant supervision from a therapist. A home-based device would expand the pool of veterans who could receive CI therapy. 2) For subjects who were able to receive CI therapy in the clinic, this device would facilitate an effective post-treatment home-practice program. 3) Currently, patients are treated on a one-on-one basis in the clinic. This device could allow one therapist to treat 3 or 4 patients at one time, thereby substantially reducing the cost of the therapy. 4) This workstation would provide clear and comprehensive quantification of the progress of the treatment, and would enable effective modifications of the treatment plan while treatment was in progress. Research Plan: The hypothesis to be tested is that the positive outcomes of CI therapy can be achieved with the use of a workstation that guides, motivates and records exercise of the more affected limb. In the first 18 months, we will design and build a workstation that automates the application of CI therapy. Eight of the tasks currently used in the shaping training will be automated. In the second 18 months, we will perform a controlled, randomized, clinical trial to compare the effectiveness of automated CI therapy programs with standard CI therapy. The standard CI therapy group would receive shaping training in a clinical setting, one-on-one with a therapist. The automated CI therapy group would perform the shaping training in the workstation, in a clinical setting and with minimal supervision. Outcome measures will include the Wolf Motor Function Test, the Motor Activity Log, the Fugl-Meyer motor impairment scale, and the Functional Independence Measure. Work Accomplished: The eight tasks to be automated have been identified and a design for each has been developed. Prototypes of these eight devices are under construction. The challenge of the design is to develop a workstation which can be operated entirely with a moderately impaired limb. To this end, the tasks will be dispersed on four different work surfaces and a mechanism has been designed to bring alternate work surfaces to the lap of the subject. The data acquisition and user interface software is under development and a preliminary “shaping” algorithm for automatically adjusting task difficulty has been identified. The timetable for delivery of the first prototype has been accelerated and testing with patients is expected to begin ahead of schedule. Funding Source: VA RR&D Merit Review Funding Status: Approved |
