Coordination of Hemiparetic Movement after Post-stroke Rehabilitation

Investigators: Steven A. Kautz, PhD and Pam W. Duncan, PhD, PT

Project Staff: Richard R. Neptune, PhD

Project Category: Stroke - 2000

Stroke is a major cause of chronic disability and one of the leading conditions requiring rehabilitation services in older veterans. Stroke continues to be a major cause of morbidity and mortality for the general US population and for the veteran population. Most survivors have some residual physical or psychological impairments that frequently are disabling and long lasting. Emerging evidence suggests that intensive remedial therapy may be beneficial for stroke survivors. Evaluation of changes in muscle activity patterns during locomotor activity may elucidate central nervous system (CNS) mechanisms of recovery due to intensive remedial therapy.

The short term objectives of this study are 1) to evaluate the effectiveness of a post-stroke therapeutic exercise program designed to improve balance, strength, and cardiovascular endurance, and 2) to determine whether improved performance after treatment results from improved coordination in a post-stroke population. The long term objective of this study is to develop a more rational basis for the design of stroke rehabilitation programs which target individuals most likely to recover and which are based on physiological principles.

The primary research question is:

• Does the ability of the hemiparetic subject to produce an appropriate locomotor pattern during a pedaling task improve after the intervention as assessed by:

  1. kinetic characteristics as measured by pedal reaction forces?
  2. muscle activity pattern characteristics as measured by EMG analyses?
  3. muscle force characteristics as calculated by computer simulation analyses?

Secondary research objectives: In secondary analyses, we will merge data from an ongoing NIH study to evaluate relationships between changes in functional performance with changes in muscle coordination. In particular, we will evaluate the ability of the intervention to improve key impairments and functional performance in individuals post-stroke through assessment of the following skills: 1) strength, 2) motor recovery (Fugl-Meyer), 3) gait, and we will relate these improvements to changes in coordination during the pedaling task.

Funding Source: VA RR&D Merit Review