Jay L. Alberts, Ph.D. - US grants

Fast and accurate assessment of motor control has lacked methods to quickly assess force control in movement coordination patterns in everyday tasks. Recent advances in technology and motor research allow us to measure and analyze forces with great reliability. In this proposal we will build a prototype of a user-friendly force measurement and analysis system that provides a fast, objective and quantitative description of movement patterns associated with grip and load forces involved in prehension tasks. The proposed system will be based upon recent findings in motor control and signal processing. It will be one of the first systems providing a comprehensive assessment of the forces used to control and manipulate objects. No movement analysis system is known to allow evaluation of the control of forces produced during the manipulation of objects in everyday tasks. The potential market is large because neurological and psychological clinics, motor control research laboratories, government laboratories, educational testing services, rehabilitation centers, health insurance companies, and environmental testing laboratories are in need of such an assessment device. The novelty of our system is that it combines portability, flexibility, and accurate analysis methods based on recent findings in motor research. PROPOSED COMMERCIAL APPLICATIONS: The proposed movement analysis system quantifies force control and regulation. The assessment of movement impairments can be made more objective by evaluating how a given individual controls and regulates force during prehension movements when grip and load forces form a stable coordination pattern. No similar movement analysis system is on the market. The potential market consists of neurological and psychological clinics, motor control research laboratories, educational testing services, rehabilitation centers, and health insurance companies.

DESCRIPTION (provided by applicant): The proposed project addresses the issues of motor function and quality of life in patients with stroke as described in NIH PA-02-111. Many patients who have sustained strokes are unable to effectively use their hemiparetic upper extremity. Limited mobility in the performance of daily activities, such as eating or dressing, adversely affects their quality of life and compromises independence. Rehabilitation techniques engaging the hemiparetic limb in repetitive task practice (RTP) may improve upper extremity function and quality of life in patients with stroke, but costs limit the number of patients that can utilize this type of therapy. Advances in microprocessor design and function make the use of an assistive device as an adjunct to RTP plausible. An innovative assistive repetitive motion (ARM) device using an "air muscle" has been developed specifically for the rehabilitation of the hemiparetic upper extremity. The primary aim of the proposed study is to collect pilot data to estimate the clinical effectiveness of using the ARM device in conjunction with RTP to improve upper extremity motor function and the quality of life of patients with stroke. Twenty sub-acute (3 to 9 mos. post-stoke) patients will be randomized to one of three groups: ARM only, RTP only or RTP + ARM group. The ARM group will use the ARM for four hours per day for 15 days. The RTP group will receive 15 days (4 hours per day) of intensive one-on-one RTP therapy. The ARM + RTP group will use the ARM device for 2 hours per day and receive 2 hours of intensive RTP per day for 15 days. Clinical motor function and quality of life measures will be taken before and after the interventions and two months later. We hypothesize that the ARM + RTP group will exhibit greater improvements in motor function and quality of life measures than the ARM or RTP only groups. Gathering quantitative motor (kinematic and kinetic) and imaging (fMRI) data from a subset of patients in each group to examine potential mechanisms contributing to improved motor function constitute unique addenda to this study. The results from this project will provide valuable data as a pre-requisite for submission of a multi-year R01 randomized clinical trial to determine the efficacy of using an assistive device, such as the ARM, as an adjunct to RTP. This project has the potential to increase the availability of effective rehabilitation techniques to patients with stroke.

DESCRIPTION (provided by applicant): This proposal demonstrates a novel healthcare delivery system that has the potential to significantly advance stroke rehabilitation monitoring and therapy. The broad, long-term objective is to provide accessible, affordable stroke care for people in rural and underserved areas. A major public health issue is the variability in the quality and quantity of treatment that stroke survivors receive based on their proximity to major metropolitan medical centers. This proposal evaluates a system of stroke patient monitoring and delivery of state-of-the-art stroke therapy for that is accessible for rural residents. This comprehensive rehabilitation delivery system utilizes Web-based platforms for storage and retrieval of patient information in conjunction with easy-to-use robot therapy devices that can be remotely monitored. Collected data are automatically entered into the system and sent to a data center (transparent to the user), where the information is monitored by a clinician through a secure website. To demonstrate the functionality of the system, an existing user-friendly home-compatible stroke therapy robotic device is utilized. A randomized, controlled, multisite clinical trial is designed to evaluate this combination of controlled rehabilitation therapy for stroke survivors with telehealth components. The model can be generalized in the future with the use of other home-based therapy and monitoring devices as needed for a specific patient. Fostering effective home treatments through the use of these devices will help determine the difference between functional independence and nursing home placement. The clinical trial will enroll 96 stroke patients and treat them at home for three months. These important considerations combine contemporary technology for service delivery and the potential for cost-savings. In a relatively short time, these advances will have a major beneficial impact on the delivery of stroke therapy to millions of rural stroke survivors. Kinetic Muscles, Inc. is an emerging company developing state-of-the-art therapy devices to fundamentally improve rehabilitation for people with neurologic injury such as stroke or traumatic brain injury (TBI). As an early stage medical device company, we regularly seek private funding to support growth objectives. Funding of this proposal would not only allow KMI to retain and add four full-time research and development personnel but would also facilitate additional funding from the private investment community to accelerate market deployment of innovative telerehabilitation therapy. This strategy has the realistic capability to provide a new level of accessible, affordable rehabilitative care for stroke patients. It is estimated that this current proposal will also create or retain four jobs between the Cleveland Clinic and Emory University. PUBLIC HEALTH RELEVANCE: The purpose of this research is to evaluate a therapy delivery system for stroke patients that provide accessible, affordable stroke care. User-friendly home therapy robots and a telerehabilitation system are combined to monitor and provide therapy that is accessible for patients in rural and underserved locations.