Grant: Project Grant

Treatment after stroke often involves rehabilitation. Rehabilitation involves learning to move and feel again through intensive practice. It may require tens of thousands of repetitions of a particular movement to relearn it after stroke. Robots can help increase intensity as many therapists cannot help someone do thousands of repetitions of a movement in today's healthcare system. We are specifically interested in when is the best time to start rehabilitation and how much do we need to best retrain someone to use their arm after stroke? Our first objective is to determine whether one hour per day or two hours per day of robotic rehabilitation is better. Our second objective is to determine if we should start having stroke survivors work on rehabilitating their arms a few days after their stroke or wait a few weeks to begin. We think that starting early and working harder will lead to the best possible outcomes. Our third objective involves using information from brain scans and electrical measures of brain function to determine who responds best to early rehabilitation. Stroke survivors will play robotic rehabilitation games to improve their strength, sensation, range of motion and overall function in the arm. We will randomize stroke survivors to one of five groups. The first will begin working with the robot 8 days after their stroke for 1 hour per day. The second will begin working with the robot 8 days after their stroke for 2 hours per day. The third will begin working with the robot 21 days after their stroke for 1 hour per day. The fourth will begin working with the robot 21 days after their stroke for 2 hours per day. A fifth will receive standard of care treatment. At different times during the study we will measure arm function with various scales as well as brain MRI's to determine which treatment is best. The study will also help us to decide when to begin rehabilitation and the amount of rehabilitation needed to get the best result.