Combined Aphasia and Robot-Assisted Arm Treatment for Chronic Stroke Survivors

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PROJECT SUMMARY/ABSTRACT Stroke is a leading cause of disability in the United States, frequently leading to both language and motor impairment that creates barriers to participation in professional, social, and family settings. The modal approach to rehabilitation separates treatment in language and motor domains, which contributes to the time and expense of stroke recovery. Co-treatment approaches are desirable to both enhance treatment efficiency and potentially lower costs, but the extent to which we can promote (and not dampen) recovery by combining treatment across domains has not been systematically explored. In this project, we integrate a computerized aphasia therapy targeting anomia into robot-assisted upper-extremity treatment while preserving the critical aspects of each treatment. This work will provide a foundational test of whether we can reduce impairment in both language and motor domains with a single combined treatment. Our long-term goal is to create effective and efficient approaches to aphasia recovery in chronic stroke survivors with both language and motor deficits by combining treatment across these traditionally-distinct rehabilitation domains. The central hypothesis of this proposal is that we can reduce impairment in each domain by combining treatments in a manner that retains the critical aspects of each. This central hypothesis will be tested by pursuing three specific aims: 1) determine the whether combining aphasia treatment with robot-assisted arm treatment can improve language outcomes in chronic stroke; 2) determine whether combining aphasia treatment with robot-assisted arm treatment supports motor recovery in chronic stroke; 3) explore whether combining aphasia treatment with robot- assisted arm treatment specifically enhances retrieval of lexical items associated with arm movement. Under the first two aims, we will directly test whether the combined treatment can reduce impairment in each domain, a critical step towards developing a larger Phase II clinical trial. The third exploratory aim tests whether the combining arm-based rehabilitation with aphasia treatment specifically enhances recall of arm-related words that activate motor cortex in unimpaired individuals. The proposed research represents an innovative approach to aphasia treatment within the larger context of stroke rehabilitation, combining therapeutic methods across language and motor domains to promote recovery in chronic stroke. The proposed research is significant because it tests the extent to which a combined language-motor treatment can enhance word retrieval and simultaneously whether it supports motor treatment. This combined treatment will form the basis of a Phase II trial as part of a future R01 powered to test the effectiveness of combined treatment compared to traditional approaches. This line of research based on combining treatment across domains has the potential to lead to a paradigm shift in stroke rehabilitation.