Ankle Tracking Training in Stroke

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DESCRIPTION (provided by applicant): The broad objective is to improve ambulation in subjects with stroke through telerehabilitation training in the subject's own home. Stroke can destroy walking ability. Usually, rehabilitation is offered intensively in the acute stage following stroke and then is curtailed or eliminated entirely. But the acute stage of stroke may not be the optimum time for intensive training. An alternative after initial training in the clinic is to train subjects in their own home using telerehabilitation technology. Also, traditional rehabilitation emphasizes much repetition of simple movements but studies now suggest that simple movement may not be the best stimulus to promote the neural changes leading to recovery. Instead, movements that require skillful learning with cognitive processing produce richer neural changes. So, the PIs' aim is to use the advantage of telerehabilitation in comparing the effectiveness of two different training strategies: tracking training, emphasizing accurate movements, versus movement training, involving simple movements. A total of 20 subjects with stroke will be randomly assigned to either the Track group or Move group. Both groups will be issued ankle electrogoniometers, a computer, web camera, and cell phone to be used at home. Both groups will be directed by the computer to perform 30 blocks of 3 trials of ankle training each day for 20 days (4 weeks). For the Track group, the computer screen will show target waveforms for the subject to track as accurately as possible with a displayed cursor that responds to ankle dorsiflexion/plantarflexion movements. For the Move group, no target or response line will be shown; subjects will merely produce simple ankle movements that will be recorded by the computer but not seen on the screen so that there is no cognitive processing. Visual and audio teleconferencing between subjects and a therapist will occur every other day to keep the subjects motivated. Pretests and posttests will measure 1) ankle range of motion, 2) ankle tracking during fMRI, 3) knee tracking (not during fMRI), 4) Berg Balance performance, and 5) gait parameters with infrared cameras. The PIs hypothesize that the Track group will show greater improvements in behavioral measures and greater changes in brain reorganization on fMRI than the Move group. The relevance of this work is that it may demonstrate an innovative training method that not only carries cost and convenience advantages but also the scientific advantage of intensifying treatment at a more optimal time.