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Project

Error-enhancement as basis for novel upper limb rehabilitation in the chronic phase after stroke

The doctoral research consists of a four-year project. The overall aim of this project is to gain knowledge into the potential of error-enhancement robot training in patients with upper limb impairments in the chronic phase after stroke. Error-enhancement is characterized as unexpected external perturbation forces acting upon the upper limb during a reaching movement, causing the upper limb to deflect from the reaching pathway, and this results in errors. If one allows for repetitive reaching performance with the same systematic perturbation forces, then we expect a decrease in errors and improvement in movement performance. The robot used for the training, the DeXtreme, is a CE marked rehabilitation device that offers this error-enhancement approach during three-dimensional movements and which is located in the BrainsHub facility.

First, a pilot study will be conducted. The pilot study has a pre-post intervention design, recruiting 20 patients in the chronic phase after stroke. Error-enhancement treatment will be provided one hour per day for 5 consecutive days and will consist of facilitation of accuracy, range of movement, stability, and smoothness with the DeXtreme device. Two times 20 min. of deXtreme training will be alternated with 15 min. conventional therapy. The content of the conventional therapy only will involve active relaxation, focusing on stretching and (auto-) mobilisation. Algorithms provide progression in terms of accuracy, range of movement, stability and smoothness, depending upon the performance of the patient. Advancements in upper limb motor function and activity will be evaluated through a triad of measurements including clinical and patient-reported outcomes, error-enhancement variables, and objective quantification of uni- and bimanual sensorimotor function by making use of the KINARM robotic manipulandum, also present in the BrainsHub facility. This study will serve as a pilot trial for a subsequent randomized controlled trial conducted within this four-year project.

For the randomized controlled trial, 60 chronic patients with upper limb impairments will be randomly allocated (1:1) to a low dose (± 1000 repetitions) or a high dose (± 2000) deXtreme training program. The content of the therapy is similar as in the pilot study and the same for both groups. The difference between the groups lies in the dose of therapy, the number of repetitions: the low dose group practices once a week and the high dose practices twice, for five weeks.  Both the low and high dose groups will be assessed by a blinded assessor, at two time points: before the intervention  and after a 5-week deXtreme training program. The same demographic parameters will be collected and outcome measures will be used as in the pilot study.

Date:14 Oct 2021 →  31 Dec 2022
Keywords:Stroke, chronic phase, neurorehabilitation, Upper limb rehabilitation, error enhancement
Disciplines:Rehabilitation
Project type:PhD project