Principal Investigator: Peter S. Lum, PhD and Edward Taub, PhD (Birmingham VAMC) Project Category: Stroke 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 that 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. This would allow patients to receive CI-therapy at home without the need for constant supervision from a therapist, and also allow one therapist to treat 3 or 4 patients at one time in the clinic, thereby substantially reducing the cost of the therapy. 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 first iteration of the workstation, which we have named AutoCITE, has been built and delivered to the Birmingham VAMC for testing. The workstation incorporates eight tasks and can be operated entirely with a moderately impaired limb. The tasks are dispersed over four different work surfaces and a mechanism brings alternate work surfaces to the lap of the subject. A working version of the data acquisition and user interface software has been incorporated into this first iteration. Nine subjects have undergone testing with the device for three hours a day for two weeks. Results from clinical evaluations of these subjects suggest use of AutoCITE is as effective as equal intensities of standard CI-therapy. Expected Outcome: Many of the tasks currently used in CI-therapy can be automated with low-cost, off-the-shelf components. Furthermore, the results suggest that the effectiveness of the treatment is not diminished when using a subset of the tasks used in standard CI-therapy. This bodes well for future versions of the device that will be designed for in-home use. The ability to use simple, low-cost, off-the-shelf components in the AutoCITE workstation will greatly improve its feasibility as a home-based tele-rehab device. Funding Source: NIH Funding Status: Funded |
