Novel spatial-motor approaches targeting post-stroke spatial neglect and gait deficits

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PROJECT SUMMARY/ABSTRACT Aiming spatial neglect (SN) is a sub-type of SN that is a dysfunction in initiation/execution of motor–intentional behavior. SN components such as directional hypokinesia, turning behavior, weight-bearing asymmetry, and veering with straight-walking path adversely affect walking. However, there is a paucity of treatments targeting gait dysfunction caused by SN. Dr. Barrett (sponsor) is a leading rehabilitation researcher who has characterized Aiming SN and has established prism adaptation therapy (PAT) as an effective treatment to reduce pathological Aiming SN and improve upper extremity function post-stroke. However, while traditional PAT remains effective for targeting the upper extremity, its generalization to walking has only been studied in able-bodied people. In parallel, other studies have shown that electrical stimulation applied to the affected side improves SN deficits in stroke survivors, but the additive effects of electrical stimulation and PAT are largely unknown. Dr. Kesar (co- sponsor) has expertise in post-stroke gait biomechanics and gait rehabilitation treatments incorporating electrical stimulation. Dr. Kesar has shown that adding electrical stimulation during gait training enhances motor learning, augments force production, restores gait deficits, and improves walking function. Importantly, the feasibility and effects of adding electrical stimulation to augment the effects of PAT and gait training in stroke survivors with SN are not well-studied. Thus, this F31 research proposal seeks to generate data supporting novel motor spatial retraining approaches that can enhance the rehabilitation of SN and gait performance in individuals post-stroke. I will evaluate novel combinations of PAT, electrical stimulation, and gait training, which are effective rehabilitation paradigms previously studied in isolation, as well as their effects on Aiming SN and gait post-stroke. Specifically, this F31 proposal will evaluate the effects of combining PAT and electrical stimulation (Aim 1), as well as PAT and gait training (Aim 2), on Aiming SN and gait performance in post-stroke Aiming SN. I hypothesize that adding stimulation to the neglected upper limb during PAT will induce larger improvements in Aiming SN versus PAT without electrical stimulation and that PAT with electrical stimulation will induce greater generalization to gait performance. In addition, I hypothesize that gait training with stimulation to the left lower limb preceded by PAT will induce larger improvements in gait performance than gait training with stimulation alone. This F31 proposal will capitalize on the PI’s clinical training and mentoring team’s expertise in post-stroke Aiming SN (sponsor Barrett) and gait (co-sponsor Kesar) rehabilitation to address SN and gait deficits in individuals with SN post-stroke. This work will generate novel information that will inform future design of new and targeted treatment protocols for evidence-based rehabilitation of spatial neglect and gait dysfunctions post- stroke, to improve gait function and quality of life in stroke survivors.