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Northwestern University Feinberg School of Medicine
Physical Therapy & Human Movement Sciences

Investigational Technologies in Stroke Recovery Laboratory

The Investigational Technologies in Stroke Recovery Laboratory employs quantitative technologies such as mechantronic devices, electromyography and ultrasound imaging to systematically investigate mechanisms of motor recovery in individuals with stroke. Efforts culminate in the development of novel therapeutic interventions designed to more effectively target specific upper extremity movement impairments.

Our Team

Principal Investigator

Collaborating Faculty

Collaborating Staff

  • Ahalya Mandana, MS - Northwestern University
  • Jane Gyarmaty, PT, DPT - Northwestern University
  • Gina Clark, PT, DPT - Shirley Ryan AbilityLab
  • Lexie Cirrincione, OTR/L - Streeterville Day Rehabiliation Center
  • Kimberly Ramirez, PT, DPT - Northwestern Medicine
  • Daniella R. Cannone, PT, DPT - Northwestern Medicine

Graduate Students

  • Angelica F. Smith, BSeng
  • Reem Ibrahim, BAeng

PRALINE Trial

Progressive Abduction Loading Therapy in Acute/Subacute Stroke Recovery

We have begun work on a phase IIb randomized clinical trial. The stroke recovery trial is supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number R01HD096071. The study extends prior intervention work from the lab to clinical practice as an augmentative therapy and will be conducted at Shirley Ryan AbilityLab in collaboration with Dr. Richard Harvey, MD, Director of the Brain Innovation Center.

Inpatient Rehab Lab

Stroke Recovery at Shirley Ryan AbilityLab

Day Rehab Lab

Streeterville DayRehabCenter®

Outpatient Lab

Department of Physical Therapy and Human Movement Sciences Research

Selected Key Work

Flexion Synergy Overshadows Flexor Spasticity During Reaching in Chronic Moderate to Severe Hemiparetic Stroke

We have recently completed an study integrating movement kinematics and kinetics with EMG of elbow flexors and extensors to tease apart the contributions of synergy-related and spasticity-related flexor activation to reaching function. Results indicate an overwhelming impact of flexion synergy overshadowing flexor spasticity on reaching function. 

Read the study publication in Clinical Neurophysiology.

Progressive Abduction Loading Therapy with Horizontal-Plane Viscous Resistance Targeting Weakness of Flexion Synergy to Treat Upper Limb Function in Chronic Hemiparetic Stroke: A Randomized Clinical Trial

We have recently completed a single-site double-blinded RCT funded by the National Institute of Disability and Rehabilitation Research (H133G110245). The RCT utilized the ACT3D, a robotic device, to administer a dynamic arm strengthening intervention for adults with chronic moderate to severe stroke. Detailed information can be found at ClinicalTrials.gov.

Read the study publication in Frontiers of Neurology - Stroke.

Graduate Alumni

Grace C. Bellinger, MS, MPH ('23), PhD ('23)

Grace C. Bellinger

Dissertation

Contributing Factors to Reaching Dysfunction in Individuals with Stroke

The overall goal of this thesis was to identify the degree to which each impairment contributes to reaching dysfunction throughout subacute stroke recovery and into the chronic phase. Identification of the relative contributions of the various impairments positioned this dissertation to benefit the field of neurorehabilitation by identifying critical therapeutic targets. The knowledge gained through this dissertation was therefore intended to ultimately guide future clinical trial design and improve outcomes in stroke rehabilitation, leading to enhanced health, function, and quality of life in individuals with stroke.

Joseph V. Kopke, PT, DPT ('17), PhD ('21)

Joseph V. Kopke

Dissertation

Understanding Control of the Shoulder after Stroke: Towards Myoelectric Control of Verical Support to Improve Reach

This dissertation explores the possibility of using pattern recognition, a type of machine learning, to control vertical support at the shoulder after stroke thus reducing the effort required and consequently reducing the severity of presentation of the abnormal synergy. It is hoped that this work will contribute towards the realization of a control paradigm that will aid in the rehabilitation and assistance of those surviving stroke.

Dr. Kopke was also co-advised by Levi J. Hargrove, PhD, director of the Neural Engineering for Prosthetics and Orthotics Laboratory, at Shirley Ryan AbilityLab.

Ninette Gerritsen, MS

Ninette Gerritsen

Master's Thesis

A Passive-State Comparison of Ultrasound Elastography of the Biceps Brachii with Robotic Measurement of Elbow Extension Impedance in Chronic Stroke

Muscle properties are known to change following stroke. An increase in connective tissue composition likely contributes to impaired reaching function. We utilized a single-DOF robotic device to measure passive elbow joint stiffness and ultrasound-based shear wave elastography to measure shear wave velocity (surrogate for muscle stiffness) in the biceps muscle.

Ms Gerritsen was co-advised by Sabrina Lee, PhD, and Netta Gurari, PhD.

Doctor of Physical Therapy Research (Synthesis Project)

This laboratory participates in the didactic education of doctor of physical therapy (DPT) students in the content area of clinical research.

Class of 2024

"Psychometric Properties of High-Resolution Outcomes of Stroke-Related Impairments and Reaching Performance Measured with a Mechatronic Device."

High-resolution measurements of upper extremity impairment and activity limitation can be safely conducted on a mechatronic system in individuals who have had a stroke. Previous mechatronic protocols were thorough but time-consuming which limits clinical feasibility. In the present study, test-retest reliability and responsiveness to change were evaluated for the outcomes of abduction and elbow extension strength, shoulder/elbow flexion synergy expression, and reaching performance in a repetition-limited protocol suitable for efficient clinical application. Precise measurements are critical for clinical trials seeking to target and ameliorate specific impairments with novel interventions that may have small but meaningful effects.

Ellis synthesis CO2024From Left to Right: Jane Gyarmaty, PT, DPT, NCS, Michael D. Ellis, PT, DPT, Emily Linne, SPT, Sanjana Matta, SPT, Maya Sankaran, SPT, and Reem Ibrahim, BAeng.

 

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