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R3. Rehabilitation of Upper Limb Function Following Stroke Using Computer-Assisted Task-Specific Isokinetic Strength Training
Disturbances in movement coordination are the least well understood but often the most debilitating with respect to functional recovery following stroke. These deficits in coordination are expressed in the form of abnormal muscle synergies and result in limited and stereotypic movement patterns, that are functionally disabling. Current neurotherapeutic approaches to the amelioration of these abnormal synergies have produced, at best, limited functional recovery. This study investigates the use of a novel computer-assisted isokinetic training regime to overcome abnormal movement synergies following hemiparetic stroke. The major objective, therefore, is the evaluation and demonstration of the usefulness and effectiveness of this novel isokinetic training regime for enhancement of quality of life of consumers with stroke.
The effect of two training regimes on functional arm movements is investigated in 40 hemiparetic stroke subjects. The first training regime, which serves as the control, uses a conventional isokinetic strengthening protocol at the elbow using the Biodex multi-joint system. The second, and novel, training regime uses a dual task protocol starting with shoulder torque combinations that allow for the isokinetic exertion of elbow extension torque and then progresses to torque combinations (e.g., elbow extension in combination with shoulder abduction) that require the subject to progressively deviate from the limited torque combinations available in the impaired arm. Assessment of the effectiveness of the two training regimes is based on quantitative comparisons of voluntary upper limb movements performed pre- and post-training. It is expected that this study will provide direct quantitative evidence for the superiority of the torque-combination training regime.
Publications:Dewald, J.P.A. & Beer, R.F. (2001). Evidence for abnormal joint torque patterns in the paretic upper limb of subjects with hemiparesis. Muscle & Nerve, 24 (2), 273-283.
Dewald, J.P.A., Sheshadri, V., Dawson, M.L., Beer, R.F. (2001). Upper limb discoordination in hemiparetic stroke: Implications for neurorehabilitation. Topics in Stroke Rehabilitation, 8(1), 1-12.
Beer, R.F., Dewald, J.P.A. & Rymer, W.Z. (2000). Deficits in the coordination of multijoint arm movements in hemiparetic movements in hemiparetic subjects. Evidence for disturbed control of limb dynamics. Experimental Brain Research, 131 (3), 305-319.
Beer, R.F., Given, J.D., Dewald, J.P.A. (1999). Task-Dependent weakness at the elbow in patients with hemiparesis. Archives of Physical Medicine and Rehabilitation. 80(7), 766-72.
http://www.northwestern.edu/bme/faculty/dewald.html