Rehabilitation Institute Of Chicago

DEVELOPMENT OF A NEURAL INTERFACE FOR POWERED LOWER LIMB PROCEDURES

ENGINEERING FOR NEUROLOGIC REHABILITATION

CENTER FOR SMART USE OF TECHNOLOGY TO ASSESS REAL-WORLD OUTCOMES (C-STAR)

ERROR-ENHANCED LEARNING & RECOVERY IN 2 & 3 DIMENSIONS

ADAPTIVE RECALIBRATION OF A PROSTHETIC LEG NEURAL CONTROL SYSTEM

APPLICATION OF TARGETED REINNERVATION FOR PEOPLE WITH TRANSRADIAL AMPUTATION

REHABILITATION ENGINEERING RESEARCH CENTERS

TECHNOLOGIES TO EVALUATE AND ADVANCE MANIPULATION AND MOBILITY (TEAMM)- RERC

COLLABORATIVE MACHINES ENHANCING THERAPIES (COMET)

SENSOR TECHNOLOGY APPLIED TO REHABILITATION IN STROKE - STARS

A MULTI-CENTER CLINICAL TRIAL TO EVALUATE THE EFFECTIVENESS OF INTERMITTENT HYPOXIA THERAPY IN INDIVIDUALS WITH SPINAL CORD INJURY

HOME AND COMMUNITY BASED SERVICES PERSON CENTERED OUTCOMES AND MEASUREMENTS

REHABILITATION RESEARCH TRAINING CENTER (RRTC) ON EMPLOYMENT FOR PEOPLE WITH PHYSICAL DISABILITIES

ENHANCING COMMUNITY LIVING AND INCREASING PARTICIPATION THROUGH SELF EFFICACY (ECLIPSE)

RRTC ON DEVELOPING OPTIMAL STRATEGIES IN EXERCISE AND SURVIVAL SKILLS TO INCREASE HEALTH AND FUNCTION

REHABILITATION RESEARCH AND TRAINING CENTERS

CRITICAL TIME WINDOW FOR REHABILITATION AFTER INCOMPLETE SPINAL CORD INJURY: EARLY VS LATE LOCOMOTOR TRAINING

REHABILITATION RESEARCH AND TRAINING CENTERS

REHABILITATION ENGINEERING RESEARCH CENTERS: TIMING INVESTIGATION DOSAGE IMPLEMENTATION (TIDI)

REHABILITATION ENGINEERING RESEARCH CENTERS: TECHNOLOGIES TO EVALUATE AND ADVANCE MOBILITY AND MANIPULATION (TEAMM) RERC

CLINICAL TRIALS OF PATTERN RECOGNITION, ELECTRODE GRID, RIC ARM IN TMR

LOCOMOTOR FUNCTION FOLLOWING TRANSCUTANEOUS ELECTRICAL SPINAL CORD STIMULATION IN INDIVIDUALS WITH HEMIPLEGIC STROKE - PROJECT ABSTRACT APPROXIMATELY 70% OF THE MORE THAN 7.2 MILLION U.S. STROKE SURVIVORS EXPERIENCE PERSISTENT GAIT DEFICITS, INCLUDING REDUCED WALKING SPEED, ASYMMETRICAL WALKING PATTERNS, AND REDUCED LOWER LIMB COORDINATION, WHICH LIMIT THEIR CAPACITY FOR COMMUNITY AMBULATION. CURRENT REHABILITATION APPROACHES ARE BASED ON THE ASSUMPTION THAT STROKE IMPAIRS MOTOR CORTEX FUNCTION WHILE THE SPINAL CORD IS PRESERVED AND THUS FOCUS ON STIMULATING THE IPSILATERAL OR CONTRALATERAL MOTOR CORTEX DURING GAIT TRAINING TO ACTIVATE DORMANT OR NEW PATHWAYS. ALTHOUGH ANIMAL MODELS OF STROKE REVEAL SECONDARY DEGENERATION OF THE CERVICAL AND LUMBAR SPINAL CORD, SUGGESTING THAT DAMAGE TO THE SPINAL CORD MAY EFFECT FUNCTIONAL RECOVERY, LITTLE OR NO RESEARCH HAS BEEN DONE TO ELUCIDATE SPINAL CORD CHANGES IN HUMANS AFTER STROKE. OUR OBJECTIVE IS TO EVALUATE THE EFFECTS OF SPINAL STIMULATION COMBINED WITH GAIT TRAINING AFTER STROKE AND TO INVESTIGATE MECHANISMS UNDERLYING THESE EFFECTS. IN PRELIMINARY WORK, WE MEASURED SPINALLY EVOKED MOTOR POTENTIALS (SEMPS) GENERATED BY NON-INVASIVE, TRANSCUTANEOUS ELECTRICAL SPINAL STIMULATION IN 10 STROKE SURVIVORS, 10 AGE-MATCHED HEALTHY CONTROLS, AND 10 YOUNG HEALTHY SUBJECTS. STIMULATION THRESHOLDS WERE SIGNIFICANTLY HIGHER IN STROKE SURVIVORS THAN IN CONTROLS AND LATENCY WAS SIGNIFICANTLY DELAYED IN THE PARETIC SIDE COMPARED TO THE NON-PARETIC SIDE, INDICATING SECONDARY EFFECTS OF STROKE ON DOWNSTREAM SPINAL CIRCUITRY AND DESCENDING PATHWAYS. WE ALSO SHOWED THAT SPINAL STIMULATION + SYMMETRY-FOCUSED GAIT TRAINING (N=4) COMPARED TO GAIT TRAINING ALONE (N=4), SIGNIFICANTLY IMPROVED STEP-LENGTH SYMMETRY, WALKING SPEED (10-METER WALK TEST, 10MWT), AND WALKING ENDURANCE (6-MINUTE WALK TEST, 6MWT); THESE IMPROVEMENTS EXCEEDED THE MINIMAL CLINICALLY IMPORTANT DIFFERENCE FOR CHRONIC STROKE. THESE RESULTS SUPPORT OUR HYPOTHESIS THAT SPINAL STIMULATION MAY INCREASE GAIT TRAINING EFFICACY. IN AIM 1, WE WILL EVALUATE THE SHORT-TERM EFFECTS OF SPINAL STIMULATION AND SHAM STIMULATION, WITH OR WITHOUT SYMMETRY-FOCUSED GAIT TRAINING, ON GAIT FUNCTION (PRIMARY OUTCOME: STEP-LENGTH SYMMETRY) AND CORTICOSPINAL CIRCUITRY IN 25 STROKE SURVIVORS. IN AIM 2, WE WILL CONDUCT A RANDOMIZED CLINICAL TRIAL TO EVALUATE THE LONG-TERM EFFECTS OF SYMMETRY-FOCUSED GAIT TRAINING WITH STIM OR SHAM STIMULATION IN STROKE SURVIVORS (N=25 PER GROUP). THE PRIMARY OUTCOME WILL BE STEP-LENGTH SYMMETRY; SECONDARY OUTCOMES INCLUDE TEMPORAL GAIT SYMMETRY, SPEED (10MWT), MUSCLE ACTIVATION (ELECTROMYOGRAPHY), WALKING ENDURANCE (6MWT), ENERGY EXPENDITURE (COSMED K4B2), UPPER AND LOWER LIMB FUNCTION (FUGL-MEYER ASSESSMENT), HEALTH STATUS (STROKE IMPACT SCALE-16), AND COMMUNITY ACTIVITY (WEARABLE SENSORS, ACTIGRAPH LLC). WE WILL ALSO INVESTIGATE MECHANISMS UNDERLYING THE EFFECTS OF SPINAL STIMULATION BY EXAMINING SEMPS ELICITED IN LOWER LIMB MUSCLES BY CORTICAL/SUBCORTICAL STIMULATION OF CORTICOSPINAL AXONS AND INTRACORTICAL INHIBITION. THIS WORK WILL (I) IDENTIFY SHORT- AND LONG-TERM EFFECTS OF SPINAL STIMULATION, (II) VALIDATE SPINAL STIMULATION AS A NON-INVASIVE METHOD TO RESTORE GAIT IN CHRONIC STROKE, (III) IDENTIFY CLINICAL MEASURES THAT MAY DETERMINE RESPONSE TO SPINAL STIMULATION, AND (IV) IDENTIFY UNDERLYING NEUROMODULATORY MECHANISMS, WHICH MAY PROVIDE ADDITIONAL TREATMENT OPTIONS.

DEFINING TRAJECTORIES OF LINGUISTIC, COGNITIVE-COMMUNICATIVE AND QUALITY OF LIFE OUTCOMES IN APHASIA

CPS: LARGE: CYBERNETIC INTERFACES FOR THE RESTORATION OF HUMAN MOVEMENT THROUGH FUNCTIONAL ELECTRICAL STIMULATION

MODULATING STIMULUS INTENSITY TO IMPROVE CLINICAL OUTCOMES IN APHASIA TREATMENT

REHABILITATION ENGINEERING RESEARCH CENTERS: MACHINES ASSISTING RECOVERY FROM STROKE AND SPINAL CORD INJURY FOR REINTEGRATION INTO SOCIETY (MARS3)

REAL-TIME CONTROL OF A POWERED PROSTHETIC LEG USING INTRAMUSCULAR EMG SIGNALS. NEW AWARD.

APHASIA REHABILITATION: MODULATING CUES, FEEDBACK & PRACTICE

EFFECT OF A NOVEL INTERVENTION USING DAILY INTERMITTENT HYPOXIA AND HIGH-INTENSITY TRAINING ON UPPER-LIMB FUNCTION IN INDIVIDUALS WITH SPINAL CORD IN

THE FUNCTIONAL IMPORTANCE OF POWERED WRIST FLEXION/EXTENSION AND SIMULTANEOUS CONTROL FOR UPPER LIMB PROSTHESES

NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH - SPINAL CORD INJURY MODEL DEMONSTRATIONS

FROM NEURAL CONTROL OF MOVEMENT TO TREATMENTS FOR SPINAL CORD INJURY - PROJECT SUMMARY/ABSTRACT OVER THE LAST 15 YEARS, OUR NINDS-FUNDED RESEARCH HAS FOCUSED ON UNDERSTANDING TRANSMISSION IN DESCENDING MOTOR PATHWAYS AND SPINAL CORD NETWORKS DURING MOTOR BEHAVIORS IN HUMANS WITH AND WITHOUT SPINAL CORD INJURY (SCI), WITH THE LONG-TERM GOAL OF MAXIMIZING THE ACTIVITY OF SPARED PATHWAY CONNECTIONS TO ENHANCE RECOVERY POTENTIAL. OUR STUDIES REVEALED THAT IN PEOPLE WITH SCI, CORTICOSPINAL AND RETICULOSPINAL SYSTEMS CONTRIBUTE DIFFERENTIALLY TO MUSCLE WEAKNESS AND FUNCTIONALLY RELEVANT BEHAVIORS, SUCH AS FINE AND GROSS GRASPING MANIPULATIONS, COMPARED WITH CONTROL SUBJECTS. IMBALANCED CONTRIBUTIONS FROM THESE DESCENDING MOTOR SYSTEMS WERE FOUND WHEN SPASTICITY AND MUSCLE SPASMS WERE PRESENT, PROVIDING LIGHT FOR THE MECHANISMS OF HYPERREFLEXIA FOLLOWING SCI. MOTONEURON RESPONSIVENESS TO CORTICOSPINAL, RETICULOSPINAL, AND AFFERENT INPUT DECREASED IN A TASK- DEPENDENT MANNER. OUR RESEARCH GROUP PIONEERED THE USE OF SPIKE-TIMING DEPENDENT PLASTICITY IN THE CORTICOSPINAL PATHWAY, FROM BASIC PROOF-OF-PRINCIPLE STUDIES ON HEBBIAN PLASTICITY TO RANDOMIZED PLACEBO CONTROLLED CLINICAL TRIALS SHOWING THAT PLASTICITY AT CORTICOSPINAL-MOTONEURONAL SYNAPSES IMPROVES EXERCISE- MEDIATED RECOVERY AFTER CHRONIC INCOMPLETE SCI. IN THIS APPLICATION, WE REQUEST TO CONSOLIDATE TWO ONGOING NINDS-FUNDED PROPOSALS THAT FOCUS ON THE CONTROL OF VOLUNTARY MOVEMENT (R01NS090622) AND SPASTICITY AND MUSCLE SPASMS (R01NS100810). WE WILL LEVERAGE OUR EXISTING KNOWLEDGE TO PRODUCE NEW RESEARCH THAT CHALLENGES THE EXISTING PARADIGM BY INTEGRATING INFORMATION ACROSS RESIDUAL NETWORKS IN THE SUBACUTE AND CHRONIC PHASES OF SCI AND FOCUSES ON UNDERSTANDING: A) TRANSMISSION IN A WIDESPREAD SET OF SPARED DESCENDING MOTOR PATHWAYS AND SPINAL CIRCUITS, B) HYPERREFLEXIA IN THESE SPARED SYSTEMS, AND C) NEUROPLASTICITY-BASED THERAPIES. OUR RESEARCH PROTOCOL WILL BUILD ON OUR PAST SUCCESSES USING CUTTING-EDGE NEUROPHYSIOLOGICAL, NEUROIMAGING, AND BEHAVIORAL TOOLS. WE WILL EMPLOY MORE ADVANCED SPINAL CORD IMAGING METHODOLOGIES, HIGH-DENSITY SURFACE ELECTROMYOGRAPHY RECORDINGS, AND NEW PHYSIOLOGICAL EXAMINATIONS USING MULTIDIMENSIONAL BEHAVIORAL TOOLS TO ENHANCE OUR UNDERSTANDING OF RESIDUAL CONNECTIONS IN HUMANS WITH SUBACUTE AND CHRONIC SCI. SUCCESSFUL COMPLETION OF THIS RESEARCH WILL INCREASE OUR UNDERSTANDING OF THE NEURAL CONTROL OF MOVEMENT AND SYMPTOMS, INCLUDING SPASTICITY AND MUSCLE SPASMS, IN OTHER NEUROLOGICAL DISORDERS (I.E., STROKE, MULTIPLE SCLEROSIS, AND ALS). THIS RESEARCH ALSO MAY PROVIDE NEW AVENUES FOR TREATMENTS AND ASSESSMENT OF HUMANS WITH SCI AND OTHER NEUROLOGICAL DISORDERS.

NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH - REHABILITATION RESEARCH AND TRAINING CENTERS

UNDERSTANDING HOW POWERED COMPONENTRY IMPACTS K2-LEVEL TRANSFEMORAL AMPUTEE GAIT - PROJECT SUMMARY POWERED PROSTHETIC KNEE AND ANKLE JOINTS CAN ACTIVELY GENERATE TORQUE, POTENTIALLY ENABLING SAFE AND EFFICIENT PERFORMANCE OF MORE DEMANDING MOBILITY TASKS, SUCH AS ASCENDING RAMPS AND STAIRS OR PERFORMING SIT-TO-STAND TRANSITIONS, AND IMPROVING ENERGY EFFICIENCY. HOWEVER, AVAILABLE POWERED COMPONENTS HAVE BEEN ALMOST EXCLUSIVELY DEVELOPED FOR AND TESTED BY INDIVIDUALS AMBULATING AT MEDICARE FUNCTIONAL CLASSIFICATION LEVEL (MFCL) K3-OR K4. INDIVIDUALS DESIGNATED AS K2-LEVEL AMBULATORS (I.E., HAVE A MORE LIMITED AMBULATION CAPACITY) ARE TYPICALLY PRESCRIBED A PASSIVE PROSTHESIS, BUT THESE INDIVIDUALS HAVE BEEN SHOWN TO BENEFIT FROM MORE ADVANCED MICROPROCESSOR-CONTROLLED KNEES AND MAY GAIN ADDITIONAL BENEFIT FROM POWERED COMPONENTS. BECAUSE AVAILABLE POWERED COMPONENTS ARE HEAVY, WE DEVELOPED LIGHTWEIGHT, FULLY POWERED KNEE AND ANKLE COMPONENTS THAT CAN BE USED SEPARATELY OR TOGETHER AND ARE APPROPRIATE FOR K2-LEVEL AMBULATORS. THESE DEVICES WILL ALLOW US TO EVALUATE THE BENEFITS ASSOCIATED WITH PROVIDING POWER AT THE KNEE, ANKLE, OR KNEE AND ANKLE, AND THE TRADEOFFS ASSOCIATED WITH THE ADDITIONAL WEIGHT AND CONTROL COMPLEXITY OF ONE OR MORE POWERED COMPONENTS. OUR GOAL IS TO DETERMINE HOW POWERED PROSTHETIC COMPONENTS EFFECT FUNCTION—IN TERMS OF METABOLIC COST, GAIT BIOMECHANICS, AND FUNCTIONAL MOBILITY IN K2-LEVEL AMBULATORS WITH A UNILATERAL TRANSFEMORAL AMPUTATION, WHO USE A PRESCRIBED PASSIVE PROSTHESIS. WE WILL RECRUIT 20 INDIVIDUALS, WHO WILL PARTICIPATE IN THREE AIMS, WITH THE EXPECTATION THAT 15 WILL COMPLETE THE STUDY. FOR AIM 1, SUBJECTS WILL BE FIT FIRST WITH A FULLY PASSIVE DEVICE (OTTOBOCK C-LEG 4 MPK AND A TRITON 1C60 FOOT) AND THEN TO OUR FULLY POWERED DEVICE (KNEE-+ ANKLE PROSTHESIS). THEY WILL BE TRAINED TO USE EACH DEVICE BEFORE COMPLETING THE AMPUTEE MOBILITY PREDICTOR WITH PROSTHESIS (AMPPRO) (PRIMARY OUTCOME) AS WELL AS METABOLIC AND BIOMECHANICAL ASSESSMENTS, A SET OF STANDARD OUTCOME MEASURES, AND SELF-REPORT SURVEYS (SECONDARY OUTCOMES). FOR AIM 2, WE WILL EVALUATE COMBINATIONS OF POWERED KNEE + PASSIVE ANKLE AND PASSIVE KNEE + POWERED ANKLE, IN RANDOM ORDER. SUBJECTS WILL BE TRAINED TO USE EACH DEVICE, AND THE SAME PRIMARY AND SECONDARY OUTCOME MEASURES WILL BE PERFORMED TO ASSESS FUNCTIONAL BENEFITS AND THE EFFECTS OF ADDITIONAL WEIGHT AT THE KNEE OR ANKLE. IN AIM 3, WE WILL PROVIDE INTENSIVE TRAINING TO ENABLE SUBJECTS TO INDEPENDENTLY PERFORM TYPICAL ACTIVITIES OF DAILY LIVING AND ACHIEVE PERSONAL MOBILITY GOALS USING THE POWERED KNEE + ANKLE DEVICE, TO DETERMINE WHAT LEVEL OF IMPROVEMENT K2- LEVEL AMBULATORS CAN ATTAIN. SUBJECTS WILL AGAIN COMPLETE THE SAME PRIMARY AND SECONDARY OUTCOME MEASURES USING THE POWERED DEVICE AND WILL REPEAT THESE MEASURES USING THE PASSIVE DEVICE FROM AIM 1, TO ACCOMMODATE CARRYOVER OF TRAINING EFFECTS FROM PREVIOUS AIMS. THE ANTICIPATED OUTCOME IS AN UNDERSTANDING OF HOW POWER AND THE WEIGHT OF PROSTHETIC COMPONENTS AFFECT FUNCTION IN K2-LEVEL AMBULATORS, WHICH WILL ENABLE OPTIMAL SELECTION OF COMPONENTS TO IMPROVE FUNCTIONAL MOBILITY IN INDIVIDUALS WHO ARE DESIGNATED AS LIMITED COMMUNITY AMBULATORS AND CURRENTLY RESTRICTED TO PASSIVE DEVICES.

TARGETED REINNERVATION AND PATTERN-RECOGNITION CONTROL FOR TRANSRADIAL AMPUTEES

MIDWEST REGIONAL SPINAL CORD INJURY CARE SYSTEM

INTERNATIONAL EXPLORATION OF REHABILITATION LENGTH OF STAY FOLLOWING SPINAL CORD INJURY

PERSONALIZED MOBILITY INTERVENTIONS USING SMART SENSOR RESOURCES FOR LOWER-LIMB PROSTHESES USERS

THE MIDWEST REGIONAL SPINAL CORD INJURY MODEL SYSTEM

IMPROVING AGED NEUROMUSCULAR HEALTH AND FUNCTION - PROJECT SUMMARY LOSS OF NEUROMUSCULAR FUNCTION AND REGENERATIVE CAPACITY IS A HALLMARK OF AGING; HOWEVER, THE CAUSE OF THIS AGE- RELATED DECLINE AND THE MOLECULAR PATHWAYS UNDERLYING THIS PROCESS REMAIN UNKNOWN AND NO CLINICAL INTERVENTION SUCCESSFULLY ARRESTS AGE-RELATED NEUROMUSCULAR DYSFUNCTION. THE LONG-TERM OBJECTIVE OF THIS PROPOSAL IS TO DEVELOP AN EFFECTIVE STEM CELL-MEDIATED THERAPY TO AMELIORATE AGE-RELATED DETERIORATION OF NEUROMUSCULAR FUNCTION. OUR PREVIOUSLY PUBLISHED FINDINGS SHOW THAT TRANSPLANTATION OF OUR UNIQUE ADULT MULTIPOTENT MUSCLE-DERIVED STEM/PROGENITOR CELLS (MDSPCS) FROM YOUNG MICE PROMOTES FUNCTIONAL PERIPHERAL NERVE REGENERATION IN MICE WITH A SCIATIC NERVE DEFECT, DELAYS THE ONSET OF AGING-RELATED DISEASES, AND TRIPLES THE LIFESPAN IN MOUSE MODELS OF PROGERIA. IN ADDITION, INDUCED NEOVASCULARIZATION IN THE MUSCLES AND BRAIN—WHERE NO TRANSPLANTED CELLS WERE DETECTED—STRONGLY SUGGESTS A THERAPEUTIC PARACRINE/ENDOCRINE MECHANISM. MOST IMPORTANTLY, OUR RECENT PRELIMINARY RESULTS INDICATE THAT SYSTEMIC TRANSPLANTATION OF YOUNG MDSPCS INTO NATURALLY AGED MICE RESTORES PERIPHERAL NERVE HISTOLOGY AND MYELINATION, INCREASES SKELETAL MUSCLE WEIGHT AND FIBER CROSS-SECTIONAL AREA, DECREASES MUSCLE FIBROSIS, AND IMPROVES FUNCTIONAL MOBILITY AND GAIT. THESE NOVEL FINDINGS STRONGLY SUGGEST THAT YOUNG MDSPCS CAN MODULATE THE SYSTEMIC ENVIRONMENT OF AGED ANIMALS THROUGH SECRETED REJUVENATING FACTORS THAT ACTIVATE OR INHIBIT KEY MOLECULAR SIGNALING PATHWAYS CRITICAL FOR TISSUE REGENERATION. THUS, WE HYPOTHESIZE THAT YOUNG STEM CELLS—OR THE THERAPEUTIC FACTORS THEY SECRETE—CAN BE USED TO TREAT CHRONIC AGING-RELATED NEUROMUSCULAR IMPAIRMENTS. IN AIM 1, WE WILL DETERMINE TO WHAT EXTENT SYSTEMIC TREATMENT WITH YOUNG MDSPCS CAN REJUVENATE NEUROMUSCULAR TISSUE STRUCTURE AND MOTOR FUNCTION IN NATURALLY AGED MICE BY USING CLINICALLY RELEVANT TECHNIQUES SUCH AS REAL-TIME RESONANT REFLECTION SPECTROSCOPY (RRS), MUSCLE CONTRACTILE FORCE MEASUREMENT, NERVE CONDUCTION TESTING, AND LONGITUDINAL MOTOR FUNCTION TESTING OF MOBILITY, GAIT, AND MUSCLE FATIGUE. IN AIM 2, WE WILL IDENTIFY THE UNDERLYING MOLECULAR MECHANISM(S) OF NEUROMUSCULAR FUNCTIONAL IMPROVEMENTS RESULTING FROM TRANSPLANTATION OF YOUNG MDSPCS, USING MULTIPLEXING-TANDEM MASS SPECTROMETRY AND [PHOSPHOPROTEOMICS], AS WELL AS IDENTIFY PROTEINS CIRCULATING IN THE BLOOD SERUM INVOLVED IN THIS SYSTEMIC REJUVENATION. AIM 3 WILL UNCOVER KEY FACTORS SECRETED BY YOUNG MDSPCS THAT DRIVE NEUROMUSCULAR TISSUE REJUVENATION AND IMPROVE FUNCTION USING A QUANTITATIVE MULTIPLEX ANTIBODY ARRAY SYSTEM. TOGETHER, THESE AIMS WILL UNCOVER THE MECHANISMS OF YOUNG MDSPC-MEDIATED NEUROMUSCULAR TISSUE REJUVENATION AND FUNCTIONAL IMPROVEMENTS, IDENTIFY CIRCULATING BIOMARKERS THAT PREDICT NEUROMUSCULAR HEALTH IN AGED MAMMALS, AND FACILITATE THE DISCOVERY OF NOVEL STEM CELL–BASED THERAPEUTIC TARGETS FOR CLINICAL USE.

A NEUROMUSCULOSKELETAL INTERFACE FOR BIONIC ARMS: A RANDOMIZED CROSSOVER STUDY - LOSS OF AN ARM MAKES IT HARDER TO WORK, TO TAKE PART IN LEISURE ACTIVITIES, AND TO DO MANY OF THE TASKS NEEDED TO LEAD AN INDEPENDENT LIFE. USING AN ARTIFICIAL ARM (PROSTHESIS) CAN HELP WITH THESE ACTIVITIES, AND A LOT OF RESEARCH HAS GONE INTO DESIGNING ADVANCED PROSTHESES THAT CAN REPLACE THE MANY FUNCTIONS OF AN INTACT HAND AND ARM. HOWEVER, A PROSTHESIS IS TYPICALLY ATTACHED TO THE BODY USING A SOCKET, WHICH FITS OVER THE RESIDUAL LIMB. SOCKETS CAN CAUSE PROBLEMS WITH SKIN IRRITATION AND CAN BE UNCOMFORTABLE OR HOT TO WEAR FOR LONG PERIODS. ONE WAY AROUND THIS IS TO ATTACH THE PROSTHESIS DIRECTLY TO THE BONE OF THE RESIDUAL LIMB. THIS SOLVES THE PROBLEMS ASSOCIATED WITH WEARING A SOCKET, ALLOWS A WIDER RANGE OF MOVEMENT, AND THE MAKES THE PROSTHESIS FEEL MORE LIKE A PART OF THE USER’S BODY. THE PROSTHESIS IS ATTACHED TO A METAL ROD THAT IS INSERTED INTO THE ARM BONE DURING A TWO-STEP SURGERY. THE BONE THEN GROWS INTO THE METAL ROD, FORMING A STRONG PERMANENT ATTACHMENT. THIS PROCESS IS CALLED OSSEOINTEGRATION (OI). ANOTHER PROBLEM IS HOW TO CONTROL THE PROSTHESIS, I.E., HOW TO MAKE IT DO WHAT THE USER WANTS IT TO DO. SOME PROSTHESES ARE CONTROLLED USING SMALL ELECTRICAL SIGNALS (CALLED EMG SIGNALS) THAT ARE PRODUCED BY MUSCLES WHEN THEY CONTRACT. EMG SIGNALS ARE USUALLY RECORDED BY ELECTRODES PLACED ON THE SKIN OVER THE MUSCLE; THE SIGNALS ARE DECODED BY A COMPUTER ALGORITHM AND TURNED INTO CONTROL SIGNALS FOR THE PROSTHESIS. EMG SIGNALS RECORDED FROM THE SKIN SURFACE CAN BE UNRELIABLE, SO ANOTHER OPTION IS TO IMPLANT THE ELECTRODES ONTO THE MUSCLE. A SYSTEM CALLED OSSEOINTEGRATION OF PROSTHESES FOR THE REHABILITATION OF AMPUTEES (OPRA) USES OI TO ATTACH THE PROSTHESIS. A NEW VERSION OF THIS SYSTEM, E-OPRA, USES OI WITH IMPLANTED ELECTRODES. E-OPRA CAN ALSO BE USED TO STIMULATE PERIPHERAL NERVES SO THAT THE USER FEELS SOME SENSORY FEEDBACK FROM THE PROSTHESIS, WHICH ALSO MAY HELP WITH CONTROL OF THE DEVICE. OUR OBJECTIVE IS TO PERFORM TWO CLINICAL TRIALS TO FIRST TEST WHETHER E-OPRA PROVIDES BETTER FUNCTION AND COMFORT THAN OPRA, AND SECOND TO FIND OUT WHETHER E-OPRA IS BETTER WITH OR WITHOUT SENSORY FEEDBACK. OUR RATIONALE IS THAT DIRECTLY ATTACHING THE PROSTHESIS TO THE SKELETON HAS MANY ADVANTAGES OVER USE OF A SOCKET, THAT IMPLANTED ELECTRODES WILL PROVIDE CLEANER, MORE STABLE AND RELIABLE EMG SIGNALS THAN ELECTRODES AT THE SKIN SURFACE, AND THAT SENSORY FEEDBACK WILL HELP THE USER CONTROL THEIR DEVICE. WE THEREFORE EXPECT THAT THE E-OPRA SYSTEM WITH SENSORY FEEDBACK WILL PROVIDE IMPROVED PROSTHESIS CONTROL AND FUNCTION COMPARED TO CONVENTIONAL SOCKET-BASED SYSTEMS OR OI WITHOUT SENSORY FEEDBACK.

A MULTI-SCALE MODELING CONSTRUCT OF KNEE MECHANICS FOLLOWING ACL RECONSTRUCTION

IMPACT OF POWERED KNEE-ANKLE PROSTHESIS ON EVERYDAY COMMUNITY MOBILITY AND SOCIAL INTERACTION IN INDIVIDUALS WITH TRANSFEMORAL AMPUTATIONS

PREDICTIVE GAIT-BASED BIOMARKERS FOR FALL RISK IN LOWER-LIMB PROSTHESIS USERS - ABSTRACT FALLS ARE THE SECOND LEADING CAUSE OF UNINTENTIONAL DEATH WORLDWIDE AND LOWER LIMB PROSTHESIS USERS (LLPUS) CONSTITUTE AN EXCEPTIONALLY HIGH-RISK GROUP. OVER HALF OF LLPU FALL ANNUALLY WITH MANY FALLS RESULTING IN INJURIES.1 DESPITE THESE ALARMING STATISTICS, CLINICALLY ACCESSIBLE TOOLS FOR PREDICTING FALLS IN LLPU ARE CURRENTLY LACKING. A COMPREHENSIVE FALL PREVENTION RESEARCH PROGRAM SHOULD ADDRESS BARRIERS, SUCH AS POPULATION HETEROGENEITY AND SPECIFICITY OF MEASUREMENTS, AND IDENTIFY MODIFIABLE BIOMECHANICAL RISK FACTORS ACROSS LLPUS SUBGROUPS USING METHODS EASILY TRANSLATABLE INTO CLINICAL USE.4 GAIT ANALYSIS TO AS A SCREENING TOOL FOR FALLS HAS THE POTENTIAL TO SATISFY THESE REQUIREMENTS AND MARKERLESS MOTION CAPTURE MAKES IT POSSIBLE THAT ROUTINE GAIT ANALYSIS COULD BE FEASIBLY INTEGRATED INTO ROUTINE CLINICAL VISITS. THE OVERALL OBJECTIVE OF THIS PROPOSAL IS TO DEVELOP A SENSITIVE AND SPECIFIC FALL SCREENING PROTOCOL FOR LOWER LIMB PROSTHETIC USERS THAT UTILIZES GAIT AND KINEMATIC ANALYSIS FROM MARKERLESS MOTION CAPTURE AND IS APPLIES TO A REPRESENTATIVE POPULATION OF LOWER LIMB PROSTHETIC USERS. WE WILL WORK TOWARDS THIS OBJECTIVE BY EVALUATING FALL RISK PREDICTORS FROM GAIT ANALYSIS AND COMPARING THEIR ACCURACY TO TRADITIONAL PERFORMANCE-BASED CLINICAL ASSESSMENTS. TO DO THIS, WE WILL COLLECT IN CLINIC MARKERLESS MOTION CAPTURE GAIT AND KINEMATIC DATA AS WELL AS COMMON CLINICAL ASSESSMENTS FROM 150 LOWER LIMB PROSTHETIC USERS. WE WILL THEN COLLECT PROSPECTIVE FALL HISTORY FROM THESE INDIVIDUALS FOR 1 YEAR TO DETERMINE THE SUBSET OF GAIT PARAMETERS OR CLINICAL ASSESSMENTS THAT BEST PREDICT AN INDIVIDUAL’S FUTURE FALL RISK. FINALLY, DURING THIS ONE-YEAR COLLECTION PERIOD, WE WILL USE WEARABLE SENSORS TO OBTAIN FURTHER KINEMATIC DATA ON FALL TYPE, DIRECTIONALITY, AND CIRCUMSTANCES TO DEVELOP A MODEL FOR INCIDENT RISK BASED ON FALL TYPE. THE RESULTS FROM THIS STUDY WILL PROVIDE IMPORTANT FINDINGS TO PREDICT FALL RISK FOR A REPRESENTATIVE, HETEROGENEOUS POPULATION OF LOWER LIMB PROSTHETIC USERS. IT WILL DETERMINE WHETHER FALL RISK CAN BE ACCURATELY PREDICTED FROM 3D GAIT ANALYSIS USING MARKERLESS MOTION CAPTURE. IF SUCCESSFUL, OUR PROPOSED WORK WILL PRODUCE A TRANSLATABLE APPROACH FOR SCREENING AT-RISK LOWER LIMB PROSTHETIC USERS AND WILL IDENTIFY BIOMECHANICAL RISK-FACTORS FOR SPECIFIC FALL TYPES. ALL MODELS AND TOOLS FOR THIS STUDY WILL BE MADE OPEN SOURCE IN OUR CONTINUED COMMITMENT TO OPEN ACCESS. FURTHER, WE ANTICIPATE THAT OUR TECHNIQUES MAY GENERALIZE TO OTHER POPULATIONS AT-RISK FOR FALLS, SUCH AS OLDER ADULTS OR STROKE SURVIVORS. ULTIMATELY, WE ENVISION THESE TOOLS BEING INTEGRATED INTO ROUTINE CLINICAL ENCOUNTERS AND A SUBSEQUENT RESEARCH STUDY TESTING WHETHER FALL-PREVENTION INTERVENTIONS INITIATED FROM CLINICAL GAIT ANALYSIS CAN REDUCE THE FREQUENCY OF PREVENTABLE FALLS.

THERAPEUTIC ELECTRICAL STIMULATION USING WIRELESS, RESORBABLE IMPLANTS TO ACCELERATE DIAPHRAGM MUSCLE REINNERVATION AFTER PHRENIC NEUROPATHY - PROJECT ABSTRACT: PHRENIC NEUROPATHY, A CONDITION THAT IMPAIRS DIAPHRAGM MUSCLE FUNCTION, OFTEN LEADS TO SERIOUS RESPIRATORY PROBLEMS AND REQUIRES MECHANICAL VENTILATION. OUR RESEARCH PROPOSAL AIMS TO ENHANCE RECOVERY FROM THIS CONDITION THROUGH A NOVEL THERAPEUTIC ELECTRICAL STIMULATION PROTOCOL, IN CONJUNCTION WITH A CUSTOM-MADE, WIRELESS, BIORESORBABLE IMPLANT. INFORMED BY A RISING INCIDENCE OF PHRENIC NEUROPATHY DUE TO COMPLICATIONS FROM SEVERE COVID-19 AND GREATER DIAGNOSTIC CAPABILITIES AND OTHER FACTORS, THIS PROPOSAL IS THE RESULT OF COLLABORATION AMONG A MULTIDISCIPLINARY TEAM WITH SUBSTANTIAL EXPERTISE IN ALL ASPECTS OF THIS PROPOSED WORK. IN GENERAL, THERE IS A COMMON MISCONCEPTION THAT RECOVERY FROM PERIPHERAL AXON INJURY IS USUALLY GOOD, DUE TO THE FACT THERE IS SOME SPONTANEOUS AXON REGENERATION, BUT THIS DOES NOT MATCH THE REALITY THAT RECOVERY IS ACTUALLY SLOW AND INCOMPLETE FOR APPROXIMATELY 90% OF PATIENTS. THIS IS ALSO TRUE FOR PATIENTS WITH PHRENIC NEUROPATHY. OUR DATA AND OTHERS SHOW THAT 68-96% OF THESE PATIENTS HAVE INCOMPLETE OR NO FUNCTIONAL RECOVERY OF THE DIAPHRAGM MUSCLE. DESPITE VARYING CAUSES OF PHRENIC NEUROPATHY, ITS IMPACT ON RESPIRATORY FUNCTION AND INDIVIDUAL QUALITY OF LIFE IS SIGNIFICANT. AT ITS WORST, PEOPLE WITH PHRENIC NEUROPATHY MAY REQUIRE MECHANICAL VENTILATION, BUT MORE TYPICALLY THEY ARE SEVERELY LIMITED IN THEIR ABILITY TO ENGAGE IN ROUTINE EXERTION REQUIRED FOR ACTIVITIES OF DAILY LIFE. CURRENTLY, CLINICAL AND SURGICAL APPROACHES DO NOT SUFFICIENTLY ADDRESS THE ISSUE OF SLOW AXON REGROWTH. OUR PROJECT AIMS TO RECTIFY THIS BY DEVELOPING A THERAPEUTIC ELECTRICAL STIMULATION PROTOCOL THAT CAN RESTORE DIAPHRAGM MUSCLE INNERVATION AND FUNCTION FASTER AND MORE COMPLETELY THAN EVER BEFORE. BRIEFLY, OUR APPROACH IS FOCUSED ON THREE SPECIFIC AIMS: 1) DETERMINING IF REPEATED THERAPEUTIC ELECTRICAL STIMULATION SESSIONS ARE MORE EFFECTIVE THAN A SINGLE SESSION, 2) ASSESSING IF REPEATED SESSIONS ENHANCE BRAIN-DERIVED NEUROTROPHIC FACTOR-TRKB SIGNALING MORE THAN A SINGLE SESSION OR CONTROL, AND 3) ESTABLISHING HOW ESSENTIAL BRAIN-DERIVED NEUROTROPHIC FACTOR-TRKB SIGNALING IS TO THE EFFECTS OF THERAPEUTIC ELECTRICAL STIMULATION TREATMENT. WE AIM TO DELIVER A NEW THERAPEUTIC ELECTRICAL STIMULATION PARADIGM TO ACCELERATE DIAPHRAGM MUSCLE INNERVATION AND IMPROVE FUNCTIONAL OUTCOMES AFTER PHRENIC NEUROPATHY, PROVIDING NEW INSIGHTS INTO THE UNDERLYING MECHANISM OF HOW BRAIN-DERIVED NEUROTROPHIC FACTOR-TRKB SIGNALING CAN ENHANCE MUSCLE REINNERVATION. THE PRIOR SUCCESS OF CLINICAL TRANSLATION FROM RAT MODEL TO HUMAN CLINICAL TRIALS FOR THERAPEUTIC ELECTRICAL STIMULATION TO TREAT OTHER NERVE INJURIES IMPLIES A GREAT OPPORTUNITY TO MOVE QUICKLY TOWARDS CLINICAL TRANSLATION UPON THE SUCCESSFUL COMPLETION OF THESE AIMS.

STRETCH REFLEX CONTRIBUTIONS TO MULTIJOINT COORDINATION

CONSULTATIVE PHYSICAL THERAPY: A PHYSICAL ACTIVITY AND EXERCISE IMPLEMENTATION STRATEGY IN PARKINSON'S - PROJECT SUMMARY/ABSTRACT: EXERCISE IS A SUBSET OF PHYSICAL ACTIVITY THAT IS STRUCTURED AND PLANNED, WITH A GOAL TO INCREASE FITNESS. REGULAR EXERCISE IS ASSOCIATED WITH SLOWER DECLINES IN PARKINSON’S-RELATED MOBILITY OUTCOMES AND QUALITY OF LIFE. HOWEVER, FEWER THAN HALF OF PEOPLE WITH PARKINSON’S DISEASE (PWP) ACHIEVE RECOMMENDED LEVELS OF EXERCISE. EXERCISE BARRIERS INCLUDE LOWKNOWLEDGE AND EXPECTATIONS OF THE BENEFITS, MOBILITY CONCERNS, AND LACK OF TIME OR CONVENIENT EXERCISE OPTIONS. RESEARCH IS NEEDED TO DETERMINE HOW TO FACILITATE EXERCISE INITIATION, PROGRESSION, AND MAINTENANCE IN PWP AND THOSE WITH OTHER DISABILITIES OR CHRONIC CONDITIONS. PHYSICAL THERAPY (PT) IS A HEALTHCARE SERVICE THAT CAN HELP PWP AND OTHER CONDITIONS TO ADDRESS PERSONAL AND ENVIRONMENTAL BARRIERS TO EXERCISE. WE HAVE SUCCESSFULLY PILOTED A CONSULTATIVE PT PROGRAM TO HELP PWP TO INCREASE AND MAINTAIN THEIR EXERCISE AND PHYSICAL FUNCTION. WE DISTINGUISH CONSULTATIVE PT FROM TRADITIONAL PT BY USING FEWER, LESS FREQUENT VISITS. ADDITIONALLY, CONSULTATIVE PT FOCUSES ON EXERCISE PROMOTION IN THE PRESENCE OF MINIMAL OR STABLE FUNCTIONAL DEFICITS, RATHER THAN BRIEF BUT INTENSE EPISODES OF PT FOR FUNCTIONAL GAINS. HOWEVER, REFERRAL TO CONSULTATIVE PT CHALLENGES TRADITIONAL PERCEPTIONS OF PT AS A TREATMENT FOR MOBILITY PROBLEMS. THE PROPOSED EFFECTIVENESS-IMPLEMENTATION HYBRID TYPE II STUDY WILL SYSTEMATICALLY EVALUATE CONSULTATIVE PT IN TWO DISSIMILAR CONTEXTS TO INFORM EFFECTIVE SUSTAINMENT, EQUITABLE SPREAD TO OTHER PARKINSON’S PROGRAMS, AND FUTURE SCALING TO OTHER POPULATIONS THAT CAN BENEFIT FROM EXERCISE MONITORING AND MAINTENANCE. FIRST, WE WILL USE MIXED EFFECTS REGRESSION MODELS TO EVALUATE DIFFERENCES IN 12-MONTH PHYSICAL ACTIVITY TRAJECTORIES BETWEEN INDIVIDUALS ENROLLED DURING PERIODS OF (1) STANDARD CARE, (2) WRITTEN EXERCISE GUIDANCE FROM NEUROLOGISTS, AND (3) CONSULTATIVEPT (AIM1). WE WILL ENROLL 96 PWP PER GROUP. WE HYPOTHESIZE THAT CONSULTATIVE PT WILL HELP PWP IMPROVE AND MAINTAIN EXERCISE PARTICIPATION, CONTROLLING FOR DISEASE-SPECIFIC FACTORS AND SOCIAL DETERMINANTS OF HEALTH. SECOND, WE WILL CONTRAST CONSULTATIVE PT IMPLEMENTATION DETERMINANTS, STRATEGIES, OUTCOMES, AND SUSTAINMENT BETWEEN ORGANIZATIONS IN TWO DISSIMILAR COMMUNITIES (AIM 2). WE WILL STUDY DETERMINANTS AT THE INDIVIDUAL, INTERPERSONAL, ORGANIZATIONAL, AND COMMUNITY LEVELS. WE HYPOTHESIZE THAT FACILITATED IMPLEMENTATION WILL LEAD TO SIMILAR FIDELITY, ADOPTION, ACCEPTABILITY, AND APPROPRIATENESS BETWEEN ORGANIZATIONS, BUT THAT THE LOWER-RESOURCED COMMUNITY WILL EXPERIENCE CHALLENGES TO REACH AND SUSTAINMENT. THIS PROPOSAL IS RESPONSIVE TO THE NATIONAL INSTITUTES OF HEALTH NOTICE OF SPECIAL INTEREST ON DEVELOPING AND TESTING MULTILEVEL PHYSICAL ACTIVITY INTERVENTIONS (NOT-OD-21-087). ADDITIONALLY, THE PROPOSED PROJECT ADDRESSES THE EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE ON CHILD HEALTH AND HUMAN DEVELOPMENT’S RESEARCH THEME TO ADVANCE SAFE AND EFFECTIVE THERAPEUTIC INTERVENTIONS FOR PEOPLE WITH DISABILITIES. TARGETING TWO DISSIMILAR COMMUNITIES WILL FACILITATE THE EQUITY OF THE CURRENT AND FUTURE WORK TO HELP US OPTIMIZE ABILITIES FOR ALL.

ALTERING ACTIVATION PATTERNS IN THE DISTAL UPPER EXTREMITY AFTER STROKE

SAFETY AND EFFICACY OF AMPAKINES FOR IMPROVEMENT OF BLADDER FUNCTION IN INDIVIDUALS WITH SCI.

DISABILITY AND REHABILITATION RESEARCH PROJECTS

DEVELOPMENT OF ADVANCED PROSTHETICS SYSTEMS

DEVELOPMENT OF ADVANCED PROSTHETIC SYSTEMS

PROSTHESIS CONTROL BY FORWARD DYNAMIC SIMULATION OF THE INTACT BIOMEDICAL SYSTEM

NEUROMUSCULAR MECHANISMS OF SPECIFIC TRUNK INTERVENTIONS IN CHILDREN WITH CEREBRAL PALSY

COMPARISON OF UPPER LIMB VIRTUAL OUTCOME MEASURES AND CONTROL ACCURACY TO PHYSICAL OUTCOME MEASURES WITH A PROSTHETIC DEVICE

POWER FORWARD STUDY: A CROSS-SECTOR, MULTISITE CLINICAL TRIAL OF A POWERED KNEE-ANKLE-FOOT ORTHOSIS

CORTICOSPINAL FUNCTION AFTER SPINAL CORD INJURY

THE REPRESENTATION OF UNCERTAINTY IN THE SENSORIMOTOR SYSTEM

IMPROVE DYNAMIC LATERAL BALANCE OF HUMANS WITH SCI

NEUROMECHANICAL SUBSTRATES FOR POST STROKE ASYMMETRIC GAIT

ENHANCING QUALITY OF ORTHOTIC SERVICES WITH PROCESS AND OUTCOME INFORMATION

MECHANISMS IMPAIRING FINGER EXTENSION FOLLOWING STROKE

ORIGINS OF INCREASED MOTONEURON EXCITABILITY IN HEMISPHERIC STROKE

CONSTRAINT INDUCED MOVEMENT THERAPY FOR WALKING IN INDIVIDUALS POST STROKE

DEVELOPMENT OF AN ENGAGING TRAINING TOOL TO PROVIDE SUPERIOR MUSCLE COMPUTER INTERFACES FOR REHABILITATION OF NEUROMUSCULOSKELETAL INJURIES

NRI: INT: CO-ROBOT CONTROLLERS FOR HUMAN-LIKE PHYSICAL INTERACTION AND IMPROVED MOTOR LEARNING

EVALUATION OF POWERED PROSTHETIC LEGS FOR USE WITH TRANSFEMORAL OI RECIPIENTS

CLOSED LOOP CONTROL OF VIBRATION FOR MUSCLE SPASMS AFTER HUMAN SPINAL CORD INJURY: EFFICACY AND MECHANISM

MECHANISMS OF THERAPEUTIC ACTION IN SCI

PAIRED STIMULATION PLASTICITY FOR MOTOR RECOVERY - CERVICAL SPINAL CORD INJURY (SCI) OFTEN IMPAIRS THE REACH AND GRASP MOVEMENTS WHICH ARE SO IMPORTANT TO INDEPENDENT LIVING. TARGETED NEURAL STIMULATION IS A PROMISING APPROACH TO ENHANCE NEURAL CONNECTIONS AND IMPROVE FUNCTION. THIS INVOLVES ACTIVATING DIFFERENT PARTS OF A NEURAL CIRCUIT USING PAIRED STIMULI. BY CHANGING THE PRECISE TIME BETWEEN THE TWO STIMULI, IT IS POSSIBLE TO INCREASE OR DECREASE CONNECTION STRENGTH. MANY STUDIES HAVE APPLIED THIS CONCEPT TO CORTICAL CIRCUITS, BUT COMPARATIVELY LITTLE ATTENTION HAS BEEN PAID TO THE POTENTIAL FOR SUB-CORTICAL PLASTICITY TO AID RECOVERY. WE KNOW THAT REACHING AND GRASPING MOVEMENTS INVOLVE COORDINATED CONTROL BY CORTICOSPINAL AND RETICULOSPINAL DESCENDING TRACTS, ORIGINATING IN THE CORTEX AND BRAINSTEM RESPECTIVELY. THUS, EXPLOITING PLASTICITY IN SUB-CORTICAL CIRCUITS COULD ACCESS NEW AVENUES TO IMPROVE REHABILITATION. THIS PROJECT INVESTIGATES TWO PROMISING METHODS TO INDUCE PLASTICITY IN SUBCORTICAL MOTOR CIRCUITS IN HUMANS, BOTH WITH AND WITHOUT SCI: SPINAL PAIRED ASSOCIATIVE STIMULATION (SPINAL PAS) AND THE STARTLE PROTOCOL. SPINAL PAS COMBINES TRANSCRANIAL MAGNETIC STIMULATION (TMS) OF THE MOTOR CORTEX WITH SUPRAMAXIMAL PERIPHERAL NERVE STIMULATION, WHILE THE STARTLE PROTOCOL PAIRS TMS WITH A LOUD ACOUSTIC STIMULUS. WE HYPOTHESIZE THAT SPINAL PAS PRIMARILY TARGETS CORTICOSPINAL SYNAPSES, WHEREAS THE STARTLE PROTOCOL ENGAGES THE CORTICO-RETICULOSPINAL SYSTEM. THE FIRST AIM IS TO ELUCIDATE THE MECHANISMS OF THESE PROTOCOLS BY ASSESSING TRANSMISSION IN CORTICO- AND RETICULOSPINAL PATHWAYS TO MOTONEURONS IN HUMANS WITH AND WITHOUT SCI. UNDERSTANDING THESE MECHANISMS WILL GUIDE THE RATIONAL COMBINATION OF SPINAL PAS AND STARTLE TO ACHIEVE SYNERGISTIC AND AMPLIFIED PLASTICITY. THE SECOND AIM IS TO DEVELOP STRATEGIES TO ENHANCE THESE PLASTIC CHANGES BY COMBINING STIMULATION WITH TARGETED TASKS THAT ENGAGE SUBCORTICAL NETWORKS. WE WILL USE GRASPING BEHAVIORS INCLUDING PRECISION GRIP AND POWER GRIP IN HUMANS WITH AND WITHOUT SCI AS COMPLEMENTARY STRATEGIES TO FURTHER BOOST PLASTICITY AND OPTIMIZE FUNCTIONAL RECOVERY. THE OUTCOME WILL BE A MECHANISM-DRIVEN, OPTIMIZED STIMULATION PROTOCOL DESIGNED TO MAXIMIZE RECOVERY OF MOTOR FUNCTION. THIS RESEARCH WILL GENERATE FUNDAMENTAL KNOWLEDGE TO SUPPORT INNOVATIVE THERAPIES FOR INDIVIDUALS WITH SCI AND OTHER NEUROLOGICAL DISORDERS AFFECTING CORTICOSPINAL AND RETICULOSPINAL CONNECTIONS.

SPINAL CORD INJURY MODEL DEMONSTRATIONS

MOTOR LEARNING IN A CUSTOMIZED BODY-MACHINE INTERFACE FOR PERSONS WITH PARALYSIS

BIOMECHANICS AND STRENGTH IN THE DISTAL UPPER LIMB INFLUENCE MEDIAN NERVE HEALTH IN MANUAL WHEELCHAIR USERS - SUMMARY. DEVELOPMENT OF BEST PRACTICES TO PREVENT CARPAL TUNNEL SYNDROME (CTS) AMONG MANUAL WHEELCHAIR USERS IS CURRENTLY BLOCKED BY THE SCARCENESS OF BIOMECHANICAL ANALYSES AT THE WRIST. FOR EXAMPLE, DESPITE COMPARABLE PAIN AND INJURY PREVALENCE, THERE ARE 8-FOLD MORE SCIENTIFIC PUBLICATIONS FOCUSED ON THE SHOULDER THAN THE WRIST. TO PREVENT CTS AND PRESERVE INDEPENDENCE, THERE IS A CRITICAL NEED TO DETERMINE WHICH PATTERNS OF FORCES AND JOINT MOTIONS UTILIZED BY MANUAL WHEELCHAIR USERS IN THEIR DAILY LIFE INJURE THE MEDIAN NERVE. THE OVERALL OBJECTIVE FOR THIS APPLICATION IS TO ESTABLISH THAT BOTH THE PHYSICAL DEMANDS OF WHEELCHAIR PROPULSION AND MUSCULOSKELETAL CAPACITY AFFECT MEDIAN NERVE HEALTH IN MANUAL WHEELCHAIR USERS WITH SCI. OUR CENTRAL HYPOTHESIS IS THAT INSUFFICIENT MUSCLE STRENGTH, RELATIVE TO THE FORCE APPLIED BY THE HAND TO THE HANDRIM DURING PROPULSION, CAUSES THE DECLINES IN MEDIAN NERVE FUNCTION THAT ULTIMATELY LEAD TO CTS. OUR RATIONALE IS THAT BY ESTABLISHING THE BALANCE BETWEEN THE PHYSICAL DEMANDS OF WHEELCHAIR PROPULSION AND UPPER LIMB STRENGTH NEEDED TO PROTECT MEDIAN NERVE HEALTH, WE WILL ENABLE CLINICIANS TO IDENTIFY ASYMPTOMATIC INDIVIDUALS AT HIGH RISK FOR CHRONIC NERVE INJURY AND TO DESIGN PREVENTATIVE INTERVENTIONS THAT IMPROVE SAFETY FACTORS AND DECREASE CUMULATIVE RISK OF DEVELOPING CTS, SUCH AS TARGETED STRENGTHENING, OR OPTIMIZATION OF WHEELCHAIR FITTING. IN AIM 1, WE WILL DETERMINE IF CLINICAL MEASURES OF MEDIAN NERVE HEALTH ARE BETTER IN MANUAL WHEELCHAIR USERS WITH SCI WHO APPLY SMALLER HANDRIM FORCES DURING PROPULSION. ENABLED BY OUR INNOVATIVE MARKERLESS MOTION CAPTURE APPROACH, WE WILL MEASURE BOTH HANDRIM FORCE AND WRIST RANGE OF MOTION DURING OVERGROUND PROPULSION IN A LARGE- SCALE (N=200), CROSS-SECTIONAL STUDY. WE HYPOTHESIZE THAT PEOPLE WHO APPLY SMALLER FORCES TO THE HANDRIM DURING PROPULSION HAVE HEALTHIER MEDIAN NERVES, WHICH WE WILL QUANTIFY VIA CLINICAL NERVE CONDUCTION TESTS. WE WILL ALSO TEST IF WRIST RANGE OF MOTION DURING PROPULSION – OBSERVABLE WITHOUT ANY INSTRUMENTATION ON THE PARTICIPANT OR THEIR WHEELCHAIR USING OUR MARKERLESS METHODS – PREDICTS HANDRIM FORCE. IN AIM 2, WE WILL DETERMINE THE BALANCE BETWEEN HANDRIM FORCE AND UPPER LIMB STRENGTH REQUIRED TO PROTECT MEDIAN NERVE HEALTH. WE WILL MEASURE MAXIMUM GRIP, ISOMETRIC WRIST, AND ISOMETRIC PRONATION AND SUPINATION STRENGTH AMONG OUR 200 PARTICIPANTS. WE HYPOTHESIZE THAT THE RATIO BETWEEN HANDRIM FORCE AND MAXIMUM GRIP STRENGTH INCREASES WITH WORSE MEDIAN NERVE FUNCTION, AND WE WILL EVALUATE WHETHER INCLUDING THE OTHER STRENGTH MEASUREMENTS IMPROVES OUR MODEL OF MEDIAN NERVE HEALTH. DEVELOPMENT OF PERSONALIZED BIOMECHANICAL MODELS IN AIM 3 WILL ELUCIDATE INTERNAL MUSCLE LOADING IN THE DISTAL UPPER LIMB DURING PROPULSION AND PROVIDE THE FIRST ASSESSMENT OF THE ROLE OF ACTIVE MUSCLE FUNCTION IN MEDIAN NERVE INJURY. OUR INNOVATIVE METHODS DIRECTLY ADDRESS THE BOTTLENECKS OF MARKER-BASED METHODS THAT LIMIT DATA GENERATION AND CLINICAL TRANSLATION. COMBINED WITH OUR INTERDISCIPLINARY EXPERTISE, WE ARE POISED TO COLLECT AN UNPRECEDENTED AMOUNT OF DATA, PROVIDING A NEW FOUNDATION NEEDED TO PREVENT THE SECONDARY CONDITION OF CARPAL TUNNEL SYNDROME IN THIS ALREADY OVER-BURDENED POPULATION.

HUMAN AND MACHINE LEARNING FOR CUSTOMIZED CONTROL OF ASSISTIVE ROBOTS

UNDERSTANDING REAL-LIFE FALLS IN AMPUTEES USING MOBILE PHONE TECHNOLOGY

LEARNING AND ADAPTATION OF MULTI-JOINT ARM MOVEMENT

A NEUROMUSCULOSKELETAL INTERFACE FOR BIONIC ARMS: A RANDOMIZED CROSSOVER STUDY - LOSS OF AN ARM MAKES IT HARDER TO WORK, TO TAKE PART IN LEISURE ACTIVITIES, AND TO DO MANY OF THE TASKS NEEDED TO LEAD AN INDEPENDENT LIFE. USING AN ARTIFICIAL ARM (PROSTHESIS) CAN HELP WITH THESE ACTIVITIES, AND A LOT OF RESEARCH HAS GONE INTO DESIGNING ADVANCED PROSTHESES THAT CAN REPLACE THE MANY FUNCTIONS OF AN INTACT HAND AND ARM. HOWEVER, A PROSTHESIS IS TYPICALLY ATTACHED TO THE BODY USING A SOCKET, WHICH FITS OVER THE RESIDUAL LIMB. SOCKETS CAN CAUSE PROBLEMS WITH SKIN IRRITATION AND CAN BE UNCOMFORTABLE OR HOT TO WEAR FOR LONG PERIODS. ONE WAY AROUND THIS IS TO ATTACH THE PROSTHESIS DIRECTLY TO THE BONE OF THE RESIDUAL LIMB. THIS SOLVES THE PROBLEMS ASSOCIATED WITH WEARING A SOCKET, ALLOWS A WIDER RANGE OF MOVEMENT, AND THE MAKES THE PROSTHESIS FEEL MORE LIKE A PART OF THE USER’S BODY. THE PROSTHESIS IS ATTACHED TO A METAL ROD THAT IS INSERTED INTO THE ARM BONE DURING A TWO-STEP SURGERY. THE BONE THEN GROWS INTO THE METAL ROD, FORMING A STRONG PERMANENT ATTACHMENT. THIS PROCESS IS CALLED OSSEOINTEGRATION (OI). ANOTHER PROBLEM IS HOW TO CONTROL THE PROSTHESIS, I.E., HOW TO MAKE IT DO WHAT THE USER WANTS IT TO DO. SOME PROSTHESES ARE CONTROLLED USING SMALL ELECTRICAL SIGNALS (CALLED EMG SIGNALS) THAT ARE PRODUCED BY MUSCLES WHEN THEY CONTRACT. EMG SIGNALS ARE USUALLY RECORDED BY ELECTRODES PLACED ON THE SKIN OVER THE MUSCLE; THE SIGNALS ARE DECODED BY A COMPUTER ALGORITHM AND TURNED INTO CONTROL SIGNALS FOR THE PROSTHESIS. EMG SIGNALS RECORDED FROM THE SKIN SURFACE CAN BE UNRELIABLE, SO ANOTHER OPTION IS TO IMPLANT THE ELECTRODES ONTO THE MUSCLE. A SYSTEM CALLED OSSEOINTEGRATION OF PROSTHESES FOR THE REHABILITATION OF AMPUTEES (OPRA) USES OI TO ATTACH THE PROSTHESIS. A NEW VERSION OF THIS SYSTEM, E-OPRA, USES OI WITH IMPLANTED ELECTRODES. E-OPRA CAN ALSO BE USED TO STIMULATE PERIPHERAL NERVES SO THAT THE USER FEELS SOME SENSORY FEEDBACK FROM THE PROSTHESIS, WHICH ALSO MAY HELP WITH CONTROL OF THE DEVICE. OUR OBJECTIVE IS TO PERFORM TWO CLINICAL TRIALS TO FIRST TEST WHETHER E-OPRA PROVIDES BETTER FUNCTION AND COMFORT THAN OPRA, AND SECOND TO FIND OUT WHETHER E-OPRA IS BETTER WITH OR WITHOUT SENSORY FEEDBACK. OUR RATIONALE IS THAT DIRECTLY ATTACHING THE PROSTHESIS TO THE SKELETON HAS MANY ADVANTAGES OVER USE OF A SOCKET, THAT IMPLANTED ELECTRODES WILL PROVIDE CLEANER, MORE STABLE AND RELIABLE EMG SIGNALS THAN ELECTRODES AT THE SKIN SURFACE, AND THAT SENSORY FEEDBACK WILL HELP THE USER CONTROL THEIR DEVICE. WE THEREFORE EXPECT THAT THE E-OPRA SYSTEM WITH SENSORY FEEDBACK WILL PROVIDE IMPROVED PROSTHESIS CONTROL AND FUNCTION COMPARED TO CONVENTIONAL SOCKET-BASED SYSTEMS OR OI WITHOUT SENSORY FEEDBACK.

THE FUNCTIONAL IMPORTANCE OF POWERED WRIST FLEXION FOR TRANSRADIAL PROSTHETIC USERS. NEW AWARD.

SPINAL CORD INJURY MODEL SYSTEMS PROGRAM

DRRP ON KT TO PROMOTE PATIENT-CENTERED CARE THROUGH USE OF STANDARDIZED ASSESSMENTS

NRI: SMALL: MODELING, QUANTIFICATION, AND OPTIMIZATION OF PROSTHESIS-USER INTERFACE

DETERMINING THE FUNCTIONAL IMPORTANCE OF A POWERED MULTIFUNCTION WRIST

BUILDING ADVANCED CEREBRAL PALSY ASSISTIVE CARE SOLUTIONS (BACPACS) - CEREBRAL PALSY (CP) IS THE MOST COMMON CAUSE OF PEDIATRIC DISABILITY IN THE UNITED STATES, AFFECTING 2-3 OF EVERY 1000 CHILDREN. THE GOAL OF OUR FIVE-YEAR RERC IS TO ENHANCE CLINICAL CARE FOR CHILDREN WITH CP BY MAXIMIZING THEIR MOBILITY AND QUALITY OF LIFE THROUGH A COMPREHENSIVE APPROACH EVALUATING THE EFFECTIVENESS OF ASSISTIVE AND THERAPEUTIC TECHNOLOGIES THAT TARGET MUSCLES, NERVES, AND BIOMECHANICS. OUR RERC HAS THREE PRIMARY OBJECTIVES: 1) DEVELOP ASSISTIVE DEVICES THAT ARE SPECIFICALLY DESIGNED FOR CHILDREN, 2) EVALUATE THE EFFECTIVENESS OF NOVEL INTERVENTIONS THAT TO PROMOTE LONG-TERM BENEFITS FOR CHILDREN WITH CP, AND 3) DEVELOP CLINICAL MONITORING AND PREDICTION SYSTEMS TAILORED TO CHILDREN WITH CP THAT CAN INFORM PERSONALIZED THERAPY. THE OUTCOMES OF THIS RERC WILL INCLUDE: 1) PARENTS AND CAREGIVERS HAVING MORE POTENTIAL THERAPEUTIC OPTIONS WHEN SEEKING TREATMENT FOR THEIR CHILDREN, 2) CLINICIANS GAINING ACCESS TO MONITORING AND PREDICTIVE CLINICAL TOOLS THAT CAN GUIDE THEIR DEVELOPMENT OF TREATMENT PLANS ON A MORE INDIVIDUALIZED BASIS, AND 3) CHILDREN WITH CP HAVING ACCESS TO NEW POWERED ASSISTIVE DEVICES THAT CAN BE MODIFIED TO GROW WITH THEM. THE PRODUCTS OF OUR RERC FOR CHILDREN WITH CP WILL BE 1) NOVEL THERAPEUTIC PARADIGMS FOR IMPROVING MOBILITY AND QUALITY OF LIFE, INCLUDING AT-HOME THERAPY DEVICES, NERVOUS SYSTEM STIMULATION, AND PHARMACOLOGICAL TREATMENT–R1, R2; 2) A MACHINE-LEARNING MODEL TO PREDICT A CHILD’S RESPONSIVENESS TO THERAPEUTIC INTERVENTIONS–R3; 3) AN AUTOMATED MONITORING SYSTEM TO EVALUATE THE EFFECTIVENESS OF TREATMENT ON GAIT–D1; AND 4) A POWERED, LOW-COST EXOSKELETON THAT CAN BE EASILY MODIFIED AS A CHILD GROWS TO CONTINUALLY ASSIST THEIR INDEPENDENT MOBILITY–D2.

MONOAMINERGIC MODULATION OF MOTOR FUNCTION IN SUBACUTE INCOMPLETE SCI

REHABILITATION ENGINEERING RESEARCH CENTERS

REHABILITATION ENGINEERING RESEARCH CENTERS

FUNCTIONAL REMAPPING OF HAND CONTROL

THE PURPOSE OF THIS COOPERATIVE AGREEMENT IS TO FUND RESEARCH TO THE AWARDEE IN THE AMOUNT OF 450,000 ON CONTRACT HR0011-16-2-0025

FLEXIBLE EPIDERMAL ELECTRODES FOR INTUITIVE CONTROL OF POWERED ARM AND LEG PROSTHESES

COMBINATORIAL TREATMENT FOR REACH-AND-GRASP RECOVERY IN CHRONIC CONTUSIVE CERVICAL SCI.

INTEGRATING HUMAN AND MACHINE LEARNING FOR ENABLING CO-ADAPTIVE BODY-MACHINE INTERFACES

RETHINKING SYMMETRY: A NEW FRAMEWORK FOR POWERED KNEE PROSTHESES - PROJECT SUMMARY MILLIONS OF INDIVIDUALS AROUND THE WORLD ARE AFFECTED BY TRANSFEMORAL LOWER LIMB LOSS, REDUCING THEIR MOBILITY AND PROFOUNDLY IMPACTING THEIR QUALITY OF LIFE. REDUCED MOBILITY IS A MAJOR CONTRIBUTOR TO ADVERSE PHYSICAL AND MENTAL HEALTH OUTCOMES, INCLUDING LIMITED SOCIAL PARTICIPATION, INABILITY TO RETURN TO WORK, AND INCREASED DEPRESSION. RESTORING THE MAXIMUM POSSIBLE MOBILITY IS, THUS, A CRITICAL CONCERN. PROSTHETIC DEVICES ARE ACCEPTED TREATMENT OPTIONS FOR LOWER LIMB AMPUTATION, BUT EVEN ADVANCED PROSTHESES LIKE MICROPROCESSOR-CONTROLLED KNEES (MPKS) FALL SHORT OF RESTORING PRE-AMPUTATION GAIT FUNCTION. POWERED PROSTHETIC KNEES OFFER THE POTENTIAL TO RESTORE JOINT TORQUE AND REPLICATE HUMAN LIMB FUNCTIONS. HOWEVER, THEIR INCREASED MASS AND INERTIA OFTEN DIMINISH THEIR BENEFITS AND LIMIT USER ADOPTION. WHILE REDUCING THE MASS OF A POWERED PROSTHESIS HAS A PRACTICAL LIMIT, A MORE STRAIGHTFORWARD AND TRACTABLE APPROACH TO OVERCOME THESE LIMITATIONS IS TO REDUCE THE INERTIA OF THE DEVICE BY PLACING THE POWERTRAIN ABOVE THE KNEE INSTEAD OF BELOW IT, CONCENTRATING THE MASS MORE PROXIMAL TO THE TRUNK. THIS REDISTRIBUTES, RATHER THAN REDUCES, THE MASS TO IMPROVE GAIT. WHILE STUDIES OF HAVE SHOWN THAT ABOVE-KNEE MASS PLACEMENT IS SUPERIOR TO BELOW-KNEE MASS PLACEMENT IN PASSIVE PROSTHETIC KNEES, THE BUILD HEIGHT OF CURRENT POWERED DEVICES HAS PREVENTED DIRECT TESTING OF THIS APPROACH. SPECIFICALLY, MOVING THE POWERTRAIN ABOVE THE KNEE WOULD NECESSITATE MOVING THE PROSTHETIC KNEE CENTER SUBSTANTIALLY BELOW THE SOUND KNEE, INTRODUCING A LARGE DEGREE OF ASYMMETRY. ALTHOUGH A MODERATE AMOUNT OF KNEE HEIGHT ASYMMETRY HAS BEEN SHOWN TO ACTUALLY IMPROVE STEP TIME SYMMETRY WHEN USING A PASSIVE PROSTHESIS, THE DISPARITY IN KNEE HEIGHT REQUIRED FOR POWERTRAIN REPOSITIONING IN CURRENT DEVICES WOULD LIKELY HAVE ADVERSE IMPACTS ON GAIT. HOWEVER, OUR NEW LOW-PROFILE POWERED KNEE PROTOTYPE HAS A SMALL BUILD HEIGHT THAT MAKES POWERTRAIN REPOSITIONING POSSIBLE. THE PROPOSED STUDY SEEKS TO GAIN FUNDAMENTAL BIOMECHANICAL INSIGHTS ON HOW MASS PLACEMENT, KNEE HEIGHT, AND POWERED ASSISTANCE INTERACT TO AFFECT GAIT. IN AIM 1, WE WILL UTILIZE PREDICTIVE SIMULATION AND BIOMECHANICAL MODELING TECHNOLOGY TO PERFORM IN SILICO TESTING OF VARIOUS KNEE HEIGHT AND MASS PLACEMENT CONFIGURATIONS OF A PROSTHESIS ON VIRTUAL SUBJECTS WITH DIFFERING PHYSICAL CHARACTERISTICS, SUCH AS RESIDUAL LIMB LENGTH. THIS ALLOWS OUR TEAM TO TEST A WIDE ARRAY OF CONFIGURATIONS IN A RAPID AND EFFICIENT MANNER. IN AIM 2, WE WILL PERFORM HUMAN SUBJECTS TESTING TO ASSESS HOW KNEE HEIGHT ASYMMETRY AND MASS PLACEMENT AFFECT GAIT WHEN USING A PASSIVE PROSTHETIC KNEE. FINALLY, IN AIM 3, WE WILL ASSESS HOW THE PLACEMENT OF THE POWERTRAIN, WHICH ACCOUNTS FOR MOST OF THE MASS AND INFLUENCES KNEE JOINT HEIGHT IN OUR LOW-PROFILE POWERED KNEE PROTOTYPE, AFFECTS WALKING PERFORMANCE IN LOWER LIMB PROSTHESIS USERS. THIS WORK LEVERAGES OUR NEW DEVICE TO SYSTEMATICALLY INVESTIGATE HOW MASS PLACEMENT, KNEE HEIGHT ASYMMETRY, AND POWERED ASSISTANCE INTERACT TO AFFECT MOBILITY. UNLIKE PRIOR STUDIES, WHICH EXAMINE THESE FACTORS IN ISOLATION AND ONLY IN PASSIVE KNEES, OUR WORK WILL GENERATE FOUNDATIONAL DATA NEEDED TO INFORM EVIDENCE-BASED DESIGN OF NEXT-GENERATION POWERED PROSTHESES TO OPTIMIZE OUTCOMES.

EVALUATING THE UTILIZATION AND EFFICIENCY OF WEARABLE EXOSKELETONS FOR SCI REHABILITATION

REHABILITATION ENGINEERING RESEARCH CENTERS

MUSCLE FIBROSIS IN CACHEXIA - PROJECT SUMMARY CACHEXIA IS A MUSCLE-WASTING SYNDROME THAT AFFECTS HALF OF ALL CANCER PATIENTS AND A QUARTER OF ALL PATIENTS WITH CHRONIC DISEASES. SCIENTIFICALLY, CACHEXIA IS DEFINED BY MUSCLE LOSS IN PARALLEL TO SYSTEMIC INFLAMMATION (E.G. IL- 6 SIGNALING). CACHEXIA EXISTS ON A SPECTRUM THAT LEADS TO PROGRESSIVE FUNCTIONAL DECLINE AND A REFRACTORY END- STAGE. REFRACTORY CACHEXIA IS NOT RESPONSIVE TO PRIMARY TREATMENT, ANTI-INFLAMMATORY THERAPIES, OR EXERCISE, WHICH ARE EFFECTIVE IN EARLIER PHASES. THE KEY REGULATORS OF THE TRANSITION TO THE REFRACTORY PHASE OF CACHEXIA ARE UNKNOWN. SUSTAINED INFLAMMATION LEADS TO TISSUE EXTRACELLULAR MATRIX (ECM) REMODELING AND FIBROSIS. IN MUSCLE, THE ECM REGULATES MUSCLE PHYSIOLOGY AND FUNCTION, WHICH CAN BECOME DISRUPTED IN DISEASE. WHILE MUSCLE FIBROSIS IS LINKED TO INCREASED MORTALITY IN CANCER PATIENTS, THE RELATIONSHIP BETWEEN ECM AND REFRACTORY CACHEXIA IS UNKNOWN. SINCE CURRENT PRECLINICAL MODELS OF CACHEXIA ARE NOT DESIGNED TO DISTINGUISH EARLY AND REFRACTORY PHASE BIOLOGY, WE DEVELOPED A NEW MOUSE MODEL WITH AN EXTENDED LIFESPAN, EXPANDING THE OPPORTUNITY TO PROBE EARLY AND REFRACTORY PHASE CACHEXIA PHENOMENA. THE SCIENTIFIC GOAL OF THIS APPLICATION IS TO DETERMINE WHETHER MUSCLE FIBROSIS IS A BARRIER TO RESPONSIVENESS TO THERAPY IN REFRACTORY CACHEXIA IN OUR NOVEL MODEL. AIM 1 INVESTIGATES THE INDIVIDUAL AND COMBINE EFFECTS OF ANTI-IL-6 AND ANTI-FIBROSIS TREATMENTS AT EARLY AND REFRACTORY STAGES OF CACHEXIA ON MUSCLE MECHANICS, FUNCTION, WASTING, AND SURVIVAL. WE HYPOTHESIZE THAT DUAL TREATMENT WITH ANTI-INFLAMMATORIES AND ANTI-FIBROTIC WILL REHABILITATE THE CACHEXIA PHENOTYPE AT PREVIOUSLY REFRACTORY STAGES. AIM 2 DIRECTLY EXAMINES THE ROLE OF CACHEXIA RELATED FIBROSIS IN RESPONSE TO EXERCISE. WE HYPOTHESIZE THAT ANTI- FIBROTIC THERAPIES WILL IMPROVE THE EFFICACY OF BOTH ENDURANCE AND RESISTANCE EXERCISES DURING THE REFRACTORY CACHEXIA. THESE STUDIES WILL EXPAND OUR KNOWLEDGE OF THE BIOLOGY OF REFRACTORY CACHEXIA, BROADEN OUR UNDERSTANDING OF THE ROLE OF ECM IN CACHEXIA, AND INITIATE PRECLINICAL EVALUATION OF SYNERGISTIC THERAPIES. THIS IS AN APPLICATION FOR A K08 CAREER DEVELOPMENT AWARD FOR ISHAN ROY, MD, PHD, PHYSICIAN SCIENTIST AT SHIRLEY RYAN ABILITYLAB (SRALAB) AND ASSISTANT PROFESSOR AT THE DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION AT NORTHWESTERN UNIVERSITY (NU). THE CAREER GOAL OF THIS APPLICATION IS FOR DR. ROY TO GAIN EXPERTISE IN THE FIELDS OF MUSCLE PHYSIOLOGY, EXERCISE SCIENCE, AND ECM BIOLOGY. COMBINED WITH HIS PRIOR BACKGROUND IN IMMUNOLOGY AND CANCER BIOLOGY, DR. ROY WILL THEN APPLY HIS NEW TRAINING TO THE FIELD OF CACHEXIA BIOLOGY. RICHARD LIEBER, PHD IS THE PRIMARY MENTOR AND AN EXPERT IN MUSCLE PHYSIOLOGY AND REHABILITATION. G.R. SCOTT BUDINGER, MD IS CO-MENTOR AND AN EXPERT IN INFLAMMATION AND TISSUE FIBROSIS. BOTH SRALAB AND NU HAVE MADE A SIGNIFICANT COMMITMENT TO DR. ROY’S CAREER DEVELOPMENT AND THIS APPLICATION REPRESENTS THE NEXT STEP IN ESTABLISHING A MENTORSHIP AND TRAINING PLAN TO ACHIEVE DR. ROY’S CAREER GOAL OF INDEPENDENCE.

DEVELOPING A DAILY LIFE MEASURE OF DEPRESSION FOR PERSONS WITH APHASIA AND EXAMINING ITS RELATION WITH COMMUNICATIVE CONFIDENCE - APHASIA IS A MULTI-MODALITY DISTURBANCE OF LANGUAGE THAT IS OFTEN ACQUIRED AFTER A LEFT HEMISPHERE STROKE. POST-STROKE DEPRESSION IS TWO TIMES HIGHER IN PERSONS WITH APHASIA (PWAS) THAN IN THE GENERAL STROKE POPULATION. POST-STROKE DEPRESSION IS ASSOCIATED WITH WORSE LANGUAGE AND COGNITIVE PERFORMANCE AND OVERALL DECREASED QUALITY OF LIFE. HOWEVER, PWAS ARE TYPICALLY EXCLUDED FROM STUDIES OF POST-STROKE DEPRESSION DUE TO A LACK OF VALID ASSESSMENT TOOLS. MORE IMPORTANTLY, STUDIES OF DEPRESSION IN PWAS ONLY ASSESS DEPRESSION USING WEEKLY RETROSPECTIVE MEASURES THUS IGNORING THE DAY-TO-DAY VARIABILITY IN MOOD. AN INNOVATIVE APPROACH TO ASSESSING THE DYNAMIC NATURE OF DEPRESSION IS ECOLOGICAL MOMENTARY ASSESSMENT (EMA). EMAS INVOLVE REPEATED SAMPLING OF DATA OVER TIME IN THE REAL-TIME IN REAL-WORLD ENVIRONMENTS. EMAS ARE BRIEF THUS MINIMIZING RESPONSE BURDEN AND ARE TYPICALLY COLLECTED USING MOBILE PHONES WHICH ARE OWNED BY MORE THAN 85% OF AMERICANS. EMAS ARE ECOLOGICALLY VALID BUT HAVE NOT BEEN USED IN PWAS DUE TO THEIR LANGUAGE DISTURBANCES. A GOAL OF THIS STUDY IS TO USE USER-CENTERED DESIGN TO CREATE AND VALIDATE AN APHASIA-FRIENDLY EMA OF DEPRESSION AND INVESTIGATE ITS ASSOCIATION WITH COMMUNICATIVE CONFIDENCE (N = 95). HAVING THE CONFIDENCE TO COMMUNICATE DESPITE APHASIA IS A ROBUST PREDICTOR OF OVERALL QUALITY OF LIFE. AIM 1 OF THE STUDY WILL ADAPT A USER-CENTERED DESIGN BY INVOLVING PWAS, THEIR CAREGIVERS, AND SPEECH-LANGUAGE PATHOLOGISTS TO DESIGN AND CONSTRUCT BRIEF (~LESS THAN 60S) EMA MEASURE OF DEPRESSION. VALIDITY OF THE EMA MEASURE WILL BE ESTABLISHED USING A CONVERGENT VALIDITY APPROACH AND USE AS ITS VALIDATOR AN ESTABLISHED DEPRESSION SCALE FOR PWAS. AIM 2 WILL ESTABLISH THE VALIDITY OF THE EMA ASSESSMENT OF DEPRESSION USING A SMARTPHONE-BASED MEASURE OF PHYSICAL ACTIVITY (I.E., STEP COUNT). REDUCED PHYSICAL ACTIVITY IS A ROBUST CORRELATE OF DEPRESSION IN BOTH NEUROLOGICALLY HEALTHY INDIVIDUALS AND THOSE WITH STROKE. AIM 3 WILL INVESTIGATE THE RELATIONSHIP BETWEEN DEPRESSION AND COMMUNICATIVE CONFIDENCE AND TEST THE INCREMENTAL VALIDITY OF THE EMA MEASURE OVER THE RETROSPECTIVE WEEKLY MEASURE OF DEPRESSION. USABILITY AND FEASIBILITY OF THE EMA WILL ALSO BE ESTABLISHED. LASTLY, AN EXPLORATORY AIM WILL DETERMINE THE ASSOCIATION BETWEEN SMARTPHONE-BASED PHYSICAL ACTIVITY AND COMMUNICATIVE CONFIDENCE. THE PROPOSED CAREER DEVELOPMENT AWARD AIMS TO PROVIDE DR. ASHAIE WITH TRAINING ACTIVITIES THAT WILL INCREASE HIS KNOWLEDGE OF (1) PSYCHOPATHOLOGY ESPECIALLY DEPRESSION, (2) USER-CENTERED DESIGN, (3) EMA METHODS, AND (4) ANALYZING SMARTPHONE-BASED SENSOR DATA. THE TRAINING GOALS WILL BE ACCOMPLISHED THROUGH MENTORED TRAINING, FORMAL COURSEWORK, AND SEMINARS AND WORKSHOPS. HIS INTERDISCIPLINARY MENTORSHIP TEAM CONSISTS OF LEADING EXPERTS IN DEPRESSION AND TRANSDIAGNOSTIC RESEARCH (DR. SHANKMAN), USER-CENTERED DESIGN (DR. REDDY), DESIGNING DEPRESSION ASSESSMENTS (DR. GRIFFITH), STATISTICS (DR. SIDDIQUE), AND ANALYZING PASSIVE SMARTPHONE-BASED SENSOR DATA (DR. JAYARAMAN). THE K23 WILL ENABLE DR. ASHAIE TO SUBMIT AN R01 AND BECOME AN NIH-FUNDED INDEPENDENT SCIENTIST WHOSE WORK IN DEPRESSION ASSESSMENT CAN LEAD TO BETTER DEPRESSION MANAGEMENT AND ULTIMATELY IMPROVE PWA’S QUALITY OF LIFE.

PATHOPHYSIOLOGY OF POST AMPUTATION PAIN "3 YEAR EFFORT

MOBILE REHABILITATION FOR DAILY LIFE PARTICIPATION POST-STROKE

INTENSIVE ATTENTION TRAINING TO TREAT BRAIN FOG IN INDIVIDUALS WITH LONG-COVID - ACCORDING TO RECENT ESTIMATES, ONE IN SEVEN AMERICAN ADULTS WHO HAVE HAD COVID-19 IS CURRENTLY EXPERIENCING LONG-COVID SYMPTOMS. DEFICITS IN ATTENTION, EXECUTIVE FUNCTIONS AND MEMORY ARE COMMON IN PEOPLE WITH LONG-COVID, AND ARE OFTEN REFERRED TO AS “BRAIN FOG”. THE FUNCTIONAL IMPACT OF BRAIN FOG CAN BE PROFOUND, AFFECTING INDIVIDUALS’ ABILITIES TO PERFORM DAILY ACTIVITIES AND MAINTAIN SOCIAL RELATIONSHIPS. WHILE THE PHENOMENON OF BRAIN FOG IS WIDELY DOCUMENTED, VERY LITTLE IS KNOWN ABOUT POTENTIAL TREATMENTS. HOWEVER, USEFUL INSIGHT CAN BE DRAWN FROM RESEARCH ON PEOPLE WITH MILD TRAUMATIC BRAIN INJURIES, WHO OFTEN EXPERIENCE SIMILAR COGNITIVE DEFICITS, AND ARE KNOWN TO BENEFIT FROM ATTENTION PROCESSING TRAINING. IN THIS PROJECT, A TEAM OF SCIENTISTS AND CLINICIANS WILL WORK WITH STAKEHOLDERS TO DEVELOP AN INTERVENTION PROTOCOL FOR PEOPLE WITH LONG-COVID BRAIN FOG. THE OBJECTIVES ARE 1) TO ASSESS THE FEASIBILITY AND ACCEPTABILITY OF INTENSIVE ATTENTION PROCESSING TRAINING IN A SAMPLE OF PEOPLE WITH LONG-COVID; 2) TO IDENTIFY ATTENTION-RELATED OUTCOME MEASURES THAT WOULD BE APPROPRIATE TO USE IN A FUTURE CLINICAL TRIAL OF THE INTERVENTION, AND 3) TO PROVIDE A PRELIMINARY EVALUATION OF THE EFFICACY OF THE INTERVENTION COMPARED TO WAITLIST CONTROL. ANTICIPATED OUTCOMES ARE A TREATMENT PROTOCOL TARGETING COGNITIVE DEFICITS IN INDIVIDUALS WITH LONG-COVID, AND THE DATA NECESSARY FOR THE DESIGN OF A FUTURE CLINICAL TRIAL THAT WILL INVESTIGATE THE EFFECTIVENESS OF THE PROPOSED INTERVENTION. THE EXPECTED PRODUCTS WILL BE PEER-REVIEWED PUBLICATIONS AND RESEARCH PRESENTATIONS, AN INTERVENTION MANUAL, AND A DATABASE THAT COULD BE USED TO ASSESS INTERVENTION EFFECTIVENESS IN A FUTURE CLINICAL TRIAL.

TIMING OF TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) COMBINED WITH SPEECH AND LANGUAGE THERAPY (SLT): AN INTERVENTION DEVELOPMENT STUDY FOR APHASIA

DISABILITY AND REHABILITATION RESEARCH PROJECTS

FIELD INITIATED

IMPROVING ELECTRONIC WRITTEN COMMUNICATION IN PERSONS WITH APHASIA: A CLINICAL TRIAL

FIELD INITIATED PROJECTS PROGRAM MOTIVATIONAL INTERVIEWING AND PHYSICAL ACTIVITY CHANGE IN PARKINSON'S DISEASE

NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH - DISABILITY AND REHABILITATION RESEARCH PROJECTS

NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH - DISABILITY AND REHABILITATION RESEARCH PROJECTS

FIELD INITIATED

MRI-NAVIGATED 3-CHANNEL TMS WITH 64-CHANNEL EEG INSTRUMENT

NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH - DISABILITY AND REHABILITATION RESEARCH PROJECTS

FIELD INITIATED

AN INNOVATIVE RESIDUAL LIMB-LENGTHENING DEVICE

DISABILITY AND REHABILITATION RESEARCH PROGRAM: ROBOT-AIDED DIAGNOSIS, PASSIVE-ACTIVE ARM MOTOR AND SENSORY REHABILITATION POST STROKE

CAREER: ROBOT LEARNING FROM MOTOR-IMPAIRED INSTRUCTORS AND TASK PARTNERS

DEVELOPMENT OF A HAND EXOSKELETON FOR REHABILITATION FOLLOWING STROKE

DYNAMIC ALLOCATION OF AUTONOMY FOR LIMITED-BANDWIDTH HUMAN-ROBOT TEAMS BASED ON MEASURES OF TRUST IN THE HUMAN

NSF/SBE-BSF:INTEGRATION OF KINESTHETIC AND TACTILE INFORMATION IN PERCEPTION, ACTION, AND LEARNING

QUANTIFYING SELECTIVE MOTOR CONTROL IN PRETERM INFANTS: A COMPUTER VISION APPROACH - PROJECT SUMMARY SELECTIVE MOTOR CONTROL (SMC), OR ISOLATION OF ONE JOINT AT A TIME, IS DIFFICULT FOR INDIVIDUALS WITH CEREBRAL PALSY (CP). IMPAIRED SMC IS THE LARGEST CONTRIBUTOR TO GROSS AND FINE MOTOR ABILITIES IN PEOPLE WITH CP, CAUSED BY EARLY DAMAGE TO THE CORTICOSPINAL TRACT (CST). THE DEVELOPMENT OF SMC COOCCURS WITH ORGANIZATION OF THE CST, THEREFORE, SMC MAY BE PRODUCED MORE OFTEN AS THE CST MYELINATES. GIVEN THAT A REDUCTION IN SMC IS A KEY CLINICAL FEATURE OF SPASTIC CP IN CHILDHOOD, REDUCED SMC MAY ALSO BE DETECTABLE IN YOUNG INFANTS WITH CP. HOWEVER, LITTLE IS KNOWN ABOUT THE DEVELOPMENT OF SMC IN INFANTS (WITH AND WITHOUT CP) BECAUSE SMC HAS TRADITIONALLY BEEN QUANTIFIED BY ASKING A SUBJECT FOR A MOTOR RESPONSE TO A VERBAL COMMAND, EXCLUDING INFANTS FROM TRADITIONAL MEASUREMENT METHODS. OUR TEAM RECENTLY ADDRESSED THIS LIMITATION BY CREATING AN OBSERVATIONAL MEASURE OF SMC, CALLED BABYOSCAR (OBSERVATIONAL SELECTIVE CONTROL APPRAISAL). BABYOSCAR MEASURED AT 3 MONTHS OF AGE, IS VALID, RELIABLE, AND PREDICTIVE OF FUTURE CP DIAGNOSIS, BODY TOPOGRAPHY OF CP DISTRIBUTION AND MOTOR FUNCTION IN CHILDREN WITH CP. HOWEVER, IT REQUIRES OBSERVER TRAINING, RELIES ON OBSERVER INTERPRETATION, AND PROVIDES A BINARY SCORE FOR PRESENCE OR ABSENCE OF SMC BY JOINT. AS A RESULT OF THESE LIMITATIONS, THERE IS A FUNDAMENTAL NEED FOR TECHNOLOGY WHICH CAN QUANTIFY SMC AND INFANT JOINT KINEMATICS, ALLOWING FOR MORE PRECISE, ACCURATE, AND EFFICIENT MEASUREMENT. RECENT ADVANCES IN COMPUTER VISION TECHNIQUES MAKE IT POSSIBLE TO QUANTIFY MOTION USING VIDEO RECORDINGS, ALTHOUGH THESE METHODS ARE LESS MATURE FOR INFANTS. IN THIS PROPOSAL, WE WILL DEVELOP A COMPUTER VISION ALGORITHM FOR RELIABLY TRACKING LIMB KINEMATICS IN INFANTS AND USE THIS TO AUTOMATE SCORING OF SMC. THIS APPROACH IS SAFE AND IMPERCEPTIBLE TO THE INFANT, AS IT DOES NOT REQUIRE ANY TOUCH OR HANDLING; THEREFORE, WE ARE ABLE TO LONGITUDINALLY MEASURE THE EVOLVING MOVEMENT BEHAVIOR AND JOINT MOTIONS THAT OCCUR IN PRETERM INFANTS HOSPITALIZED IN A NEONATAL INTENSIVE CARE UNIT AND AFTER THEY TRANSITION HOME. THE ABILITY TO STUDY THIS EARLY AND EVOLVING BEHAVIOR WITH THE PRECISION AND ACCURACY THAT COMPUTER VISION ALLOWS, WILL HELP US TO UNDERSTAND FUNDAMENTAL QUESTIONS ABOUT THE ONTOGENY OF HUMAN MOVEMENT BEHAVIOR AND ALLOW A NON-INVASIVE MEASURE OF THE HEALTH OF THE CST FROM WHICH THESE BEHAVIORS ARE DERIVED. IN THIS PROPOSAL WE WILL EXPLORE THE EVOLUTION OF THESE EARLY MOVEMENT BEHAVIORS AND COMPARE THEM WITH TWO-YEAR NEURODEVELOPMENTAL OUTCOMES, INCLUDING THE PRESENCE OF CP. USING THIS APPROACH, WE WILL BE ABLE TO DETERMINE HOW THE COURSE OF SMC AND INFANT KINEMATICS MAY DIFFER IN INFANTS WITH CP COMPARED TO INFANTS WITHOUT CP. FURTHERMORE, WE PROPOSE TO VALIDATE A COMPUTER VISION ALGORITHM CAPABLE OF OBTAINING CONTINUOUS MEASURES OF SMC AND ACCURATE JOINT KINEMATICS USING A SINGLE CAMERA SET UP. THIS ALGORITHM COULD ALLOW GREATER ACCESS TO SMC AND KINEMATIC MEASUREMENT IN INFANCY AS IT WOULD ALLOW DATA COLLECTION TO OCCUR USING COMMONLY AVAILABLE SMARTPHONES. BY HARNESSING THE POWER OF TECHNOLOGY TO MEASURE INFANT MOVEMENT BEHAVIOR MORE ACCURATELY, WE WILL BE ABLE TO CREATE MORE TARGETED AND EFFECTIVE INTERVENTIONS FOR INFANTS WITH CP, OPTIMIZING THEIR FUNCTIONAL ABILITIES.

TRANSFORMING NEUROMUSCULAR DIAGNOSIS AND TREATMENT BY VIRTUAL MUSCLE BIOPSY (VBX)

FROM IMPAIRMENT TO PARTICIPATION: A SYSTEMS APPROACH TO UNDERSTANDING THE COMPLEXITY OF APHASIA - PROJECT SUMMARY LANGUAGE IS VITAL TO MUCH, IF NOT ALL, ASPECTS OF A PERSON’S LIFE. FOR THOSE PERSONS WITH APHASIA (PWA), A LANGUAGE DISORDER, THE IMPACT OF APHASIA EXTENDS BEYOND THE LANGUAGE IMPAIRMENT TO COGNITION, PARTICIPATION, AND PSYCHOSOCIAL ASPECTS. TO ADDRESS THE NEEDS OF PWA, HISTORICALLY TWO CONCEPTUALIZATIONS OF APHASIA AND APPROACHES TO REHABILITATION HAVE EMERGED IN THE FIELD: IMPAIRMENT-FOCUSED AND LIFE PARTICIPATION. THE IMPAIRMENT-FOCUSED APPROACH PUTS PROMINENCE ON LANGUAGE IMPAIRMENT, AND MORE RECENTLY ALSO UNDERLYING COGNITIVE IMPAIRMENTS THAT IMPACT LANGUAGE PROCESSING. THE LIFE PARTICIPATION APPROACH PUTS PROMINENCE ON PARTICIPATION GOALS, AND THE ENVIRONMENT AND PSYCHOSOCIAL NEEDS OF THE PERSON TO REACH THEIR GOALS. THE FIELD OF CLINICAL APHASIOLOGY HAS LONG RECOGNIZED THE IMPORTANCE OF BOTH APPROACHES; HOWEVER, THERE REMAINS NO QUANTITATIVE MODEL TO DETERMINE THE DEGREE OF INTERACTIVITY AND RELATIVE IMPACT OF IMPAIRMENT AND LIFE PARTICIPATION VARIABLES IN PWA AT ASSESSMENT. THIS LACK OF MODEL LIMITS THE ABILITY TO MAKE INFORMED DECISIONS ABOUT WHAT TO TARGET IN APHASIA REHABILITATION. THE LONG-TERM GOAL OF THIS PROPOSAL IS TO DEVELOP A COMPLEXITY MODEL OF APHASIA TO TRANSFORM CONCEPTUALIZATION AND REHABILITATION OF APHASIA THAT MAXIMALLY IMPROVES BOTH THE APHASIA (IMPAIRMENT) AND ITS IMPACT (PARTICIPATION) IN A PARSIMONIOUS AND EFFICIENT WAY. THE CENTRAL HYPOTHESIS OF THIS PROJECT IS THAT IMPAIRMENT VARIABLES (E.G., COMPREHENSION AND NAMING ABILITY) AND LIFE PARTICIPATION VARIABLES (E.G., MENTAL HEALTH, SOCIAL ROLES AND ACTIVITIES) INFLUENCE EACH OTHER IN COMPLEX WAYS. THE USE OF CUTTING-EDGE, DATA-DRIVEN TECHNIQUES FROM COMPLEX SYSTEMS SCIENCE WILL PROVIDE A WAY TO MODEL THE CONSTELLATION OF RELATIONSHIPS BETWEEN IMPAIRMENT AND LIFE PARTICIPATION VARIABLES, WITH THE ABILITY TO IDENTIFY CENTRAL VARIABLES AND CLUSTERS OF VARIABLES THAT ARE TIGHTLY CONNECTED (AIM 1). FURTHERMORE, THESE TECHNIQUES WILL PROVIDE A METHOD TO DETECT PUTATIVE CAUSAL RELATIONSHIPS BETWEEN VARIABLES (E.G., NAMING IMPAIRMENT CAUSES LOWER COMMUNICATION CONFIDENCE), WHICH IS A CRITICAL NEED IN CLINICAL APHASIOLOGY RESEARCH WHERE SAMPLE SIZES ARE RELATIVELY SMALL, AND LARGE RANDOMIZED CONTROLLED TRIALS ARE NOT ALWAYS FEASIBLE (AIM 2). LASTLY, THE PROGNOSTIC VALUE OF THE COMPLEXITY MODEL OF APHASIA WILL BE INVESTIGATED BY TESTING WHETHER THE MOST CENTRAL AND CAUSAL VARIABLES FROM THE MODEL PREDICT POST-TREATMENT OUTCOMES (AIM 3). THIS PROJECT BENEFITS FROM LEVERAGING A LARGE EXISTING DATASET OF PWA (N = 61) WHO PARTICIPATED IN INTENSIVE COMPREHENSIVE APHASIA PROGRAMS (ICAPS) BETWEEN THE YEARS 2016-2024. THE USE OF THE ICAPS DATA IS CRITICAL FOR CAPTURING MEASURES OF BOTH APHASIA APPROACHES AT ASSESSMENT. BY THE ACCOMPLISHING THE AIMS OF THIS PROJECT, A FOUNDATIONAL MODEL WILL BE ESTABLISHED FROM WHICH FUTURE WORK WILL A) EXPAND THE COMPLEXITY APHASIA MODEL TO INCLUDE BRAIN STRUCTURE AND FUNCTION DATA – A CRITICAL SET OF VARIABLES GIVEN THE LEADING CAUSE OF APHASIA IS STROKE – AND B) DEVELOP IDIOGRAPHIC (I.E., INDIVIDUAL-LEVEL) COMPLEXITY MODELS OF APHASIA FOR PRECISION MEDICINE.

INTERMITTENT HYPOXIA INITIATED MOTOR PLASTICITY IN INDIVIDUALS WITH MULTIPLE SCLEROSIS - PROJECT SUMMARY/ABSTRACT MULTIPLE SCLEROSIS (MS) IS AN IMMUNE-MEDIATED NEURODEGENERATIVE DISEASE OF THE CENTRAL NERVOUS SYSTEM THAT CAUSES LOCALIZED DAMAGE TO MYELIN, RESULTING IN LOSS OF FUNCTION, DISABILITY, AND REDUCED QUALITY OF LIFE. ALTHOUGH DISEASE-MODIFYING DRUGS CAN HELP REDUCE THE FREQUENCY OF RELAPSES AND ONSET OF NEW SYMPTOMS, THIS APPROACH IS INSUFFICIENT FOR OPTIMAL RECOVERY FROM EXISTING SYMPTOMS. ONE POTENTIAL APPROACH TO OVERCOME FUNCTIONAL IMPAIRMENTS RELATED TO EXISTING MOTOR DEFICITS IS THROUGH DEVELOPMENT OF THERAPEUTIC STRATEGIES THAT INDUCE NEUROPLASTICITY. THE OBJECTIVE OF THIS PROPOSAL IS TO INVESTIGATE THE POTENTIAL OF A NOVEL THERAPEUTIC INTERVENTION — ACUTE INTERMITTENT HYPOXIA (AIH) — THAT HAS SHOWN SIGNIFICANT PROMISE TO ENHANCE NEUROPLASTICITY IN PERSONS WITH SPINAL CORD INJURY BUT HAS NOT YET BEEN STUDIED IN MS. AIH CONSTITUTES A BRIEF, REPEATED REDUCTION IN OXYGEN CONCENTRATION WHICH STIMULATES THE SEROTONERGIC PATHWAY AND ENHANCES ACTIVITY OF SEROTONIN RECEPTORS. THIS RESULTS IN INCREASED SYNTHESIS OF PLASTICITY-RELATED PROTEINS THAT POTENTIATE SYNAPTIC TRANSMISSION AND DRIVE PLASTICITY. WE HYPOTHESIZE THAT A REPEATED AIH PROTOCOL WILL IMPROVE VOLUNTARY LIMB FUNCTION IN INDIVIDUALS WITH MS. WE ALSO HYPOTHESIZE THAT AIH WILL INDUCE SUSTAINED CHANGES IN NEURAL ACTIVITY WITHIN THE CENTRAL NERVOUS SYSTEM, WHICH CONTRIBUTE TO THERAPEUTIC PLASTICITY. WE TEST THIS HYPOTHESIS USING A DOUBLE-BLIND, SHAM-CONTROLLED AND CROSSOVER TRIAL IN MS PATIENTS WITH ESTABLISHED MOTOR DEFICITS AND CONTROLLED RELAPSE ACTIVITY WHO ARE ADMINISTERED MILD DOSES OF INTERMITTENT HYPOXIA (OR SHAM HYPOXIA) FOR FIVE DAYS. WE EXAMINE THE RESULTING EFFECTS BY QUANTIFYING CHANGES IN STRENGTH, FUNCTION AND WALKING PERFORMANCE IMMEDIATELY AND 1-WEEK POST-INTERVENTION. WE ALSO USE ADVANCED FUNCTIONAL MAGNETIC RESONANCE IMAGING TECHNIQUES TO MEASURE CHANGES IN NEURAL ACTIVATION DURING VOLUNTARY ANKLE FLEXION AND INTRINSIC CONNECTIVITY IN THE SOMATOMOTOR CORTICES AT REST, WHICH HAVE BOTH SHOWN PLASTICITY-RELATED CHANGES DURING SUCCESSFUL MOTOR REHABILITATION STRATEGIES. ADDITIONAL CLINICAL MRI SCANS AT ENROLLMENT AND 1-WEEK POST-INTERVENTION WILL BE MONITORED FOR RADIOLOGIC SIGNS OF NEW DISEASE ACTIVITY AS PART OF PARTICIPANT SAFETY MONITORING. THIS PROPOSAL WILL DETERMINE THE EXTENT TO WHICH PRIMING THE CENTRAL NERVOUS SYSTEM WITH AN APPROACH KNOWN TO INDUCE PLASTICITY IMPROVES FUNCTION IN MS, AND PROVIDE EVIDENCE OF THE NEURAL MECHANISMS DRIVING THESE THERAPEUTIC EFFECTS. THE INSIGHTS GAINED FROM THIS WORK WILL INFORM THE DEVELOPMENT OF MORE EFFECTIVE THERAPIES COMBINING DAILY AIH WITH TASK SPECIFIC TRAINING FOR IMPROVEMENT OF FUNCTION AND QUALITY OF LIFE IN INDIVIDUALS WITH MS.

NOVEL ACTIONS OF ACUTE INTERMITTENT HYPOXIA IN HEMISPHERIC STROKE - PROJECT SUMMARY/ABSTRACT STROKE IS THE SECOND LEADING CAUSE OF DEATH AND A LEADING CAUSE OF LONG-TERM DISABILITY WORLDWIDE. DESPITE THE SPONTANEOUS RECOVERY THAT OCCURS FOLLOWING A HEMISPHERIC STROKE, MORE THAN HALF OF STROKE PATIENTS HAVE SUBSTANTIAL RESIDUAL IMPAIRMENTS, IMPOSING A SIGNIFICANT HUMAN AND ECONOMIC BURDEN. THE OBJECTIVE OF THIS PROPOSAL IS TO INVESTIGATE THE POTENTIAL OF A NOVEL THERAPEUTIC INTERVENTION — ACUTE INTERMITTENT HYPOXIA (AIH). THIS TECHNIQUE HAS SHOWN SIGNIFICANT PROMISE IN PERSONS WITH SPINAL CORD INJURY (SCI) AND IN OUR PRELIMINARY STUDIES ON STROKE. AIH CONSTITUTES A BRIEF, RAPID REDUCTION IN OXYGEN CONCENTRATION WHICH STIMULATES THE SEROTONERGIC PATHWAYS OF THE BRAINSTEM, AND ENHANCES ACTIVITY OF SEROTONIN RECEPTORS IN THE BRAIN AND SPINAL CORD. THIS RESULTS IN INCREASED SYNTHESIS OF A KEY PROTEIN CALLED BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF), POTENTIATING SYNAPTIC TRANSMISSION AND DRIVING PLASTICITY IN THE CNS. IN PERSONS WITH SCI, AIH HAS BEEN DEMONSTRATED TO BE SAFE AND CAUSE BROAD-RANGING CHANGES IN THE CNS, INCLUDING TRANSIENT IMPROVEMENTS IN RESPIRATORY FUNCTION, LOCOMOTOR FUNCTION, AND HAND DEXTERITY. IN THIS PROPOSAL WE WILL EXTEND OUR PROMISING RESEARCH ON AIH-INITIATED PLASTICITY IN SCI PATIENTS TO PERSONS WITH STROKE. OUR SPECIFIC AIMS ARE TO (1) TO ASSESS THE LIMB SEGMENTAL DISTRIBUTION OF AIH-INDUCED INCREASES IN MUSCLE ACTIVATION IN PARETIC LIMBS OF STROKE SURVIVORS, COMPARING STRENGTH MEASUREMENTS TAKEN BEFORE AND AFTER AN AIH SEQUENCE; (2) TO DETERMINE WHETHER AIH INCREASES THE SEVERITY OF SPASTICITY USING REFLEX THRESHOLD MEASUREMENTS IN SPASTIC MUSCLES. HERE, WE PLAN TO USE A LINEAR MOTOR (LINMOT USA INC.) TO ESTIMATE REFLEX THRESHOLD IN ELBOW FLEXORS BEFORE AND AFTER AIH ADMINISTRATION; (3) TO EVALUATE THE SPATIAL DISTRIBUTION OF MOTOR UNIT ACTIVATION IN LIMB MUSCLES USING SURFACE EMG GRIDS AND TO IMPLEMENT MOTOR UNIT DECOMPOSITION PROTOCOLS TO DETERMINE WHICH TYPES OF MOTOR UNIT ARE ACTIVATED FOLLOWING AIH ADMINISTRATION. IN THE SHORT-TERM, THIS STUDY WILL HELP US GAIN A GREATER UNDERSTANDING OF THE EFFICACY AND UNDERLYING MECHANISM OF AIH-INDUCED PLASTICITY IN STROKE. IN THE LONG-TERM, THIS RESEARCH WILL HELP ESTABLISH AIH AS BOTH A NOVEL THERAPEUTIC MODALITY IN AND OF ITSELF FOR THE TREATMENT OF STROKE, AND ALSO AS AN ADJUNCT TECHNIQUE TO BE COMBINED WITH OTHER INTERVENTION TECHNIQUES. THIS TRANSLATIONAL PROPOSAL EXEMPLIFIES THE NIH EXPLORATORY/DEVELOPMENTAL RESEARCH GRANT PROGRAM (R21) AS IT FOSTERS DEVELOPMENTAL RESEARCH FOR AN EMERGING INTERVENTION THAT HAS THE POTENTIAL FOR SEVERAL UNIQUE CLINICAL APPLICATIONS.

SAFETY AND COGNITIVE EFFECTS OF ACUTE INTERMITTENT HYPOXIA-INDUCED NEUROPLASTICITY IN TBI - THE PURPOSE OF THIS STUDY IS TO DETERMINE WHETHER ACUTE INTERMITTENT HYPOXIA (AIH) IS SAFE TO ADMINISTER TO MEDICALLY STABLE CHRONIC TRAUMATIC BRAIN INJURY (TBI) PATIENTS. THERE IS EVIDENCE INDICATING THAT AIH PROMOTES CENTRAL NERVOUS SYSTEM (CNS) NEUROPLASTICITY. AIH STIMULATES OXYGEN-SENSITIVE SEROTONERGIC NEURONS IN THE BRAINSTEM’S RAPHE NUCLEUS LEADING TO SEROTONIN RELEASE INTO DIFFERENT REGIONS OF THE CNS. THIS RELEASE LEADS TO ACTIVATION OF SEROTONIN RECEPTORS ON OR NEAR CORTICAL NEURONS AND INCREASED SYNTHESIS OF MULTIPLE TROPHIC FACTORS INCLUDING BRAIN-DERIVED NEUROTROPHIC FACTOR, VASCULAR ENDOTHELIAL GROWTH FACTOR, AND ERYTHROPOIETIN. THESE ACTIONS ALSO INFLUENCE THE FUNCTIONING OF NEUROTRANSMITTERS SUCH AS GABA. GREATER EXPRESSION OF GROWTH FACTORS IN THE BRAIN FACILITATES NEUROPLASTICITY BY INCREASING SYNAPTIC STRENGTH, CORTICAL NEURON AND INTERNEURON EXCITABILITY, AND INTRA- AND INTER-BRAIN REGION CONNECTIVITY. OF NOTE IS THAT HYPOXIA INDUCED NEUROPLASTICITY ONLY OCCURS WITH ACUTE INTERMITTENT EXPOSURE BUT IS NOT EVOKED BY CONTINUOUS HYPOXIA OF THE SAME DURATION. IS AIH SAFE TO ADMINISTER TO TBI PATIENTS? THE PREPONDERANCE OF PRIOR ANIMAL AND HUMAN EVIDENCE SUGGESTS THAT DAILY EPISODES OF MILD AIH DO NOT NEGATIVELY IMPACT IMPORTANT SAFETY PARAMETERS SUCH AS RESTING BLOOD PRESSURE, ARTERIAL PRESSURE, HEART RATE, HEART RATE VARIABILITY, CARDIAC OUTPUT, OR COGNITIVE FUNCTION. TO DATE, AIH PROTOCOLS THAT INDUCE BENEFICIAL NEUROPLASTICITY WITHOUT TRIGGERING PATHOLOGICAL SEQUELAEHAVE BEEN RESTRICTED TO BRIEF EPISODES OF MODEST HYPOXIA WITH A LOW CYCLE NUMBER, SUCH AS 15 X 90-SECOND EPISODES OF 10% INSPIRED OXYGEN. RECENT STUDIES IN HUMANS WITH CHRONIC SPINAL CORD INJURY AND STROKE DEMONSTRATES THAT THESE MODEST AIH EPISODES REPEATED FOR FIVE CONSECUTIVE DAYS CAN BE SAFELY TOLERATED WITHOUT PATHOLOGICAL CONSEQUENCES. ANOTHER RECENT STUDY SHOWED THAT EVEN A 4-WEEK PROTOCOL OF MODERATE DAILY AIH (CYCLING 9%/21% OXYGEN EVERY 1.5 MINUTES, 15 CYCLES PER DAY, FOR 4 WEEKS) DOES NOT ELICIT ADVERSE MEDICAL CONSEQUENCES OR COGNITIVE IMPAIRMENT. THUS, THE CUMULATIVE EVIDENCE SUGGESTS THAT REPETITIVE AIH MAY BE SAFELY USED TO STUDY WHETHER IT CAN ENHANCE NEUROBEHAVIORAL FUNCTIONING IN TBI PATIENTS WITHOUT DELETERIOUS EFFECTS. IN THIS STUDY, WE WILL ADMINISTER MILD AIH TO 16 PATIENTS ON FOUR DIFFERENT DAYS SPREAD OVER TWO WEEKS, STARTING WITH NORMAL OXYGEN CONCENTRATION (TARGET SPO2 OF 98%) AND THEN PROGRESSIVELY REDUCING THE OXYGEN CONCENTRATIONS OVER THE NEXT THREE SESSIONS (TO 93%, 87%, & 82%). OUR PRIMARY OBJECTIVE IS TO DETERMINE WHETHER IT IS SAFE TO ADMINISTER MILD AIH TO CHRONIC TBI PATIENTS WITH PERSISTENT FUNCTIONAL IMPAIRMENTS, BUT WHO ARE CLINICALLY STABLE. AS A SECONDARY OBJECTIVE IN THIS STUDY, WE WILL ASSESS WHETHER MILD AIH ADMINISTRATION HAD ANY POST-SESSION OR CUMULATIVE EFFECTS POST-STUDYON MEMORY AND COGNITION, CORTICAL ACTIVATION USING PAIRED-PULSE INHIBITION, OR WHETHER PRE-STUDY BRAIN ARCHITECTURE OR FUNCTIONAL CONNECTIVITY AS DETECTED BY STRUCTURAL AND RESTING-STATE FUNCTIONAL MAGNETIC RESONANCE IMAGING PREDICTS RESPONSE TO AIH. IF THERE ARE NO ADVERSE EFFECTS OF MILD AIH IN THIS STUDY, CLINICAL TRIALS USING MILD AIH ALONE OR IN CONJUNCTION WITH NEUROBEHAVIORAL THERAPIES COULD EVALUATE WHETHER AIH FACILITATES IMPROVED FUNCTIONAL PERFORMANCE AFTER TBI.

REHABILITATION RESEARCH AND TRAINING CENTERS (RRTCS) PROGRAM

IMPROVING CROUCH GAIT IN CHILDREN WITH CP THROUGH ERROR AUGMENTATION - CHILDREN WITH CEREBRAL PALSY (CP) COMMONLY EXHIBIT PATHOLOGIC GAIT PATTERNS. CROUCH GAIT, WHICH IS CHARACTERIZED BY EXCESSIVE STANCE PHASE KNEE FLEXION AND MAY BE ACCOMPANIED BY OTHER DEFICITS AT THE HIP AND/OR ANKLE, IS A COMMON AND DEBILITATING GAIT DISORDER IN CHILDREN WITH CP. LEFT UNTREATED OR INADEQUATELY ADDRESSED, CHILDREN WITH CROUCH GAIT WILL EXPERIENCE PROGRESSIVE GAIT DETERIORATION, LEADING TO A LOSS OF AMBULATION IN A LARGE PORTION OF ADOLESCENTS WITH CP. WHILE CROUCH GAIT IS ONE OF THE MOST FREQUENTLY OBSERVED GAIT DEVIATIONS IN CHILDREN WITH CP, CURRENT INTERVENTION APPROACHES INCLUDING SURGICAL AND NON-SURGICAL HAVE NOT BEEN OPTIMIZED TO EFFECTIVELY ADDRESS THESE KEY GAIT DEFICITS IN MANY CHILDREN WITH CP. SPECIFICALLY, SURGICAL INTERVENTIONS, WHICH TYPICALLY TARGET THE HAMSTRINGS, REMAIN THE DOMINANT INTERVENTIONS BUT OUTCOMES ARE VARIABLE ACROSS DIFFERENT STUDIES. SIMILARLY, MUSCLE STRENGTHENING PROGRAMS HAVE BEEN DEVELOPED TO IMPROVE CROUCH GAIT, BUT STUDIES SHOWED INCONSISTENT OUTCOMES. HAMSTRINGS BOTULINUM TOXIN INJECTIONS HAVE BEEN SHOWN TO MODESTLY IMPROVE KNEE KINEMATICS 2 WEEKS POST INJECTION, BUT THE EFFECTS MOSTLY DISAPPEARED BY ~12 WEEKS, LEADING TO A REPEATED INJECTIONS OF BOTULINUM TOXIN DURING GROWTH. ROBOTIC ASSISTANCE HAS BEEN USED TO IMPROVE CROUCH GAIT IN CHILDREN WITH CP, ALTHOUGH THE EFFECT WAS NOT RETAINED AFTER THE REMOVAL OF THE ASSISTANCE FORCE. THUS, THERE IS A CLEAR NEED FOR THE DEVELOPMENT OF NEW INTERVENTIONS FOR IMPROVING CROUCH GAIT IN CHILDREN WITH CP, WHICH REQUIRES A THOROUGH EXAMINATION OF THE MOTOR LEARNING MECHANISMS OF THE INTERVENTIONS. THE OVERALL OBJECTIVE OF THIS STUDY IS TO DETERMINE WHETHER THE APPLICATION OF A TARGETED RESISTANCE TORQUE TO THE KNEE JOINT DURING OVERGROUND WALKING WILL INDUCE IMPROVEMENTS IN CROUCH GAIT IN CHILDREN WITH CP. OUR CENTRAL HYPOTHESIS IS THAT INCREASING ERRORS BY APPLYING A TARGETED PERTURBATION TORQUE TO THE KNEE JOINT DURING OVERGROUND WALKING WILL FACILITATE MOTOR LEARNING AND INDUCE IMPROVEMENT IN CROUCH GAIT IN CHILDREN WITH CP. SPECIFICALLY, IN AIM 1, WE WILL DETERMINE THE EFFECT OF ERROR SIZE ON MOTOR LEARNING TO IMPROVE CROUCH GAIT IN CHILDREN WITH CP. WE EXPECT TO SEE A GREATER IMPROVEMENT IN CROUCH GAIT IN CHILDREN WITH CP AFTER APPLYING A TARGETED RESISTANCE TORQUE TO THE KNEE JOINT DURING THE SWING PHASE OF GAIT IN COMPARISON TO ASSISTANCE TORQUE DURING WALKING. IN AIM 2, WE WILL DETERMINE THE EFFECT OF ERROR VARIABILITY ON MOTOR LEARNING TO IMPROVE CROUCH GAIT IN CHILDREN WITH CP. WE EXPECT TO SEE A LONGER RETENTION OF IMPROVED CROUCH GAIT IN CHILDREN WITH CP AFTER APPLYING A VARIED RESISTANCE TORQUE TO THE KNEE JOINT IN COMPARISON TO A CONSTANT RESISTANCE TORQUE DURING OVERGROUND WALKING. RESULTS FROM THIS STUDY ARE EXPECTED TO DEMONSTRATE THE EFFECT OF ERROR SIZE AND ERROR VARIABILITY ON THE MOTOR LEARNING OF IMPROVED CROUCH GAIT IN CHILDREN WITH CP. THE RESULTS OF THIS STUDY ARE EXPECTED TO HAVE AN IMPORTANT POSITIVE IMPACT BY PROVIDING A STRONG JUSTIFICATION FOR THE DEVELOPMENT OF AN EFFECTIVE INTERVENTION FOR IMPROVING CROUCH GAIT IN CHILDREN WITH CP THAT IS MORE EFFECTIVE THAN THE BEST PHYSICAL INTERVENTIONS CURRENTLY AVAILABLE.

TRANSCRANIAL DIRECT CURRENT STIMULATION AND APHASIA LANGUAGE THERAPY

CRCNS: DATA SHARING: A JOINT DATABASE OF EXPERIMENTS AND MODELS OF REACHING MOVEMENT

ROBOTIC_GAIT_TRAINING_IMPROVES_LOCOMOTOR_FUNCTION_IN_CHILDREN_WITH_CEREBRAL_PALSY

DEGENERATION OF MOTONEURONS CAUDAL TO SPINAL LESION

LOCOMOTOR ADAPTATION IN INDIVIDUALS POST-STROKE

FIELD INITIATED

FIELD INITIATED

SYMMETRICAL WALKING ENHANCED NEUROPLASTICITY POST-STROKE

MOBIL-WISE: MOBILE PHONE REMOTE COACHING AFTER WORKSITE JOINT ADVENTURE EXPOSURE

ACQUISITION OF ADVANCED POLYJET MULTIMATERIAL 3D PRINTER

CPS: SYNERGY: COLLABORATIVE RESEARCH: LEARNING CONTROL SHARING STRATEGIES FOR ASSISTIVE CYBER-PHYSICAL SYSTEMS

ACCELERATING PHYSICAL THERAPY EXERCISE MONITORING: FACILITATORS, FIDELITY, AND FITNESS.

VALIDATING NON-LINGUISTIC LABORATORY BIOMARKERS OF DEPRESSION IN PERSONS WITH APHASIA - APHASIA IS A MULTI-MODALITY DISTURBANCE OF LANGUAGE THAT IS MORE COMMON THAN DISORDERS SUCH AS PARKINSON’S DISEASE AND HAS A GREATER NEGATIVE IMPACT ON QUALITY OF LIFE THAN ALZHEIMER’S DISEASE AND MANY CANCERS. PERSONS WITH APHASIA (PWAS) ARE THOUGHT TO BE AT A HIGHER RISK FOR DEPRESSION THAN OTHER STROKE SURVIVORS. DEPRESSION IS ALSO THOUGHT TO WORSEN LANGUAGE AND COGNITIVE PERFORMANCE IN PWAS AND DECREASE THEIR QUALITY OF LIFE. HOWEVER, IDENTIFYING DEPRESSION IN PWAS IS CHALLENGING AS THEIR LANGUAGE DISTURBANCES MAKE IT DIFFICULT TO ASSESS DEPRESSIVE SYMPTOMS USING TRADITIONAL METHODS SUCH AS QUESTIONNAIRES AND INTERVIEWS AS THESE METHODS REQUIRE PWAS TO REPORT ON THEIR INNER EXPERIENCES (E.G., THEIR SADNESS, EXPERIENCE OF PLEASURE, ETC.). AN ALTERNATIVE APPROACH TO DIAGNOSTIC INTERVIEWS OR QUESTIONNAIRES IS TO UTILIZE LABORATORY-ASSESSED BIOMARKERS THAT REQUIRE MINIMAL LANGUAGE ABILITIES AND HAVE SHOWN TO ROBUSTLY IDENTIFY DEPRESSION IN NEUROLOGICALLY HEALTHY INDIVIDUALS. A GOAL OF THIS STUDY IS THUS TO ASSESS THE ABILITY OF THREE LABORATORY TESTS TO DETECT DEPRESSION IN PWAS (N=46): (A) HEART-RATE VARIABILITY AT REST, (B) PUPIL DILATION, AND (C) GAZE DURATION (A MEASURE OF BIASED ATTENTION) TO NEGATIVELY AND POSITIVELY VALENCED IMAGES. A CHALLENGE OF THIS STUDY IS THAT WITHOUT A GOLD-STANDARD WAY TO ASSESS DEPRESSION IN PWAS, IT IS DIFFICULT TO TRULY KNOW WHETHER THE THREE BIOMARKERS ARE VALIDLY ASSESSING DEPRESSION IN PEOPLE WHO HAVE DIFFICULTY VERBALLY REPORTING ON THEIR INNER EXPERIENCES. AIM 1 OF THE STUDY WILL THEREFORE APPLY A NOVEL CONVERGENT VALIDITY APPROACH AND USE AS ITS VALIDATOR A COMPOSITE REFERENCE STANDARD BASED ON MULTIPLE INDICATORS OR PROXIES OF DEPRESSION - SPECIFICALLY, INFORMANT (E.G., FAMILY MEMBER, CAREGIVER) REPORT OF PWAS (A) DEPRESSION SYMPTOMS, (B) PRE-MORBID HISTORY OF PWAS DEPRESSION (A ROBUST PREDICTOR OF FUTURE DEPRESSION IN NON-NEUROLOGICAL AND NEUROLOGICAL PATIENTS), AND (C) A SELF-REPORT DEPRESSION SCALE ADAPTED FOR PWAS. COMPOSITE REFERENCE STANDARDS ARE ROUTINELY EMPLOYED TO EVALUATE NEW TESTS WHEN GOLD-STANDARD AND IMPERFECT DIAGNOSTIC TESTS EXIST, BUT THIS APPROACH HAS NOT BEEN USED TO ASSESS DEPRESSION IN PWA. AIM 2 WILL TEST WHETHER LABORATORY- ASSESSED BIOMARKERS PREDICT PWAS DAY-TO-DAY EXPERIENCES OF AFFECT AND SOCIAL INTERACTION (A CRITICAL FACTOR FOR SUCCESSFUL REHABILITATION), USING EXPERIENCE SAMPLING METHODOLOGY (ESM). ESM IS AN APPROACH THAT REQUIRES BRIEF, FREQUENT (MULTIPLE PER DAY), AT-HOME ASSESSMENTS (IN THIS CASE, FROM CAREGIVERS). ESM MINIMIZES RECALL BIAS AND INCREASES ECOLOGICAL VALIDITY OF ASSESSMENTS. LASTLY, AIM 3 WILL ESTABLISH THE RETEST RELIABILITY OF LABORATORY-ASSESSED BIOMARKERS OF DEPRESSION BY RE-ADMINISTERING ALL MEASURES TO PWAS 7 DAYS LATER. THE PROPOSED PROJECT HAS THE POTENTIAL FOR HIGH IMPACT FOR PWAS SINCE ACCURATE DIAGNOSIS OF DEPRESSION IN PWAS CAN LEAD TO BETTER MANAGEMENT OF DEPRESSION, WHICH CAN POSITIVELY IMPACT LINGUISTIC AND COGNITIVE FUNCTIONING AND IMPROVE PWA’S QUALITY OF LIFE. THE PROJECT WILL LAY THE FOUNDATION FOR A FUTURE RESEARCH PLATFORM FOR THE EARLY- STAGE PI THAT EXAMINES WHETHER THE LABORATORY-ASSESSED BIOMARKERS PREDICT DIFFERENT DEPRESSION TREATMENT RESPONSES AND LANGUAGE AND FUNCTIONAL IMPROVEMENTS RELATED TO THE TREATMENTS LONGITUDNALLY.

MOTIVATIONAL INTERVIEWING AND PHYSICAL ACTIVITY BEHAVIOR CHANGE IN ARTHRITIS

ACCELERATING NERVE REGENERATION WITH BOTULINUM TOXIN AND ELECTRICAL STIMULATION THERAPIES - PROJECT SUMMARY PERIPHERAL NERVE INJURIES ARE AN UNDER-APPRECIATED PUBLIC HEALTH PROBLEM. THERE ARE ABOUT 200,000 NEW CASES PER YEAR IN THE USA. RECOVERY IS INCOMPLETE FOR THE VAST MAJORITY OF PATIENTS WHO SUFFER FROM ONE BECAUSE NERVE REGROWTH IS SLOW AND INEFFICIENT. UNFORTUNATELY, THERE ARE NO APPROVED TREATMENTS TO IMPROVE THE PROCESS OF NERVE REGENERATION. WE HAVE IDENTIFIED TWO COMPLIMENTARY THERAPIES IN ORDER TO TARGET THE (I) EARLY AND (II) LATE PHASES OF THE NERVE REGENERATION PROCESS. THEY EACH MAY WORK AS STAND-ALONE THERAPY OR POTENTIALLY IN COMBINATION, AS WE PREDICT THEY WILL HAVE AN ADDITIVE BENEFIT ON NERVE REPAIR. THE PRESENT PROPOSAL WILL SET THE STAGE FOR A FOLLOW UP CLINICAL TRIAL TO BRING THE MOST PROMISING THERAPY TO PATIENTS. WE BELIEVE WE CAN MAKE RAPID PROGRESS TOWARDS THIS GOAL BECAUSE ONE THERAPY REPRESENTS A REPURPOSING OF AN ALREADY FDA-APPROVED DRUG, AND THE OTHER THERAPY IS A FORM OF ELECTRICAL STIMULATION THAT ALREADY HAS SHOWN EFFICACY IN SMALL CLINICAL TRIALS FOR NERVE INJURY. THE ELECTRICAL STIMULATION THERAPY IS IN NEED OF A NEW MODE OF DELIVERY TO REMOVE BARRIERS TO CLINICAL IMPLEMENTATION, WHICH WE OFFER BY MEANS OF NOVEL TRANSIENT BIO-ELECTRIC IMPLANT SYSTEM. OVERALL, THIS PROPOSAL WILL DELIVER A NEW HORIZON IN HOW WE CAN IMPROVE THE TREATMENT OF PATIENTS WITH PERIPHERAL NERVE INJURIES TO MAXIMIZE THEIR FUNCTIONAL RECOVERY.

ELECTRICAL STIMULATION OF MOTOR CORTEX: A CANDIDATE ADJUVANT TO STROKE THERAPY?

ROLE OF MUSCLE STEM CELLS IN SARCOMERE ADDITION AND CONTRACTURES

NRI: COLLABORATIVE RESEARCH: UNIFIED FEEDBACK CONTROL AND MECHANICAL DESIGN FOR ROBOTIC, PROSTHETIC, AND EXOSKELETON LOCOMOTION

ACUPUNCTURE AS A NOVEL TECHNIQUE FOR TREATING INSOMNIA INTHE OUTPATIENT TRAUMATIC BRAIN INJURY POPULATION: A RANDOMIZED CONTROLLED TRIAL

MODELING AND IDENTIFICATION OF MULTI-JOINT ARM DYNAMICS POST STROKE

INTERPRETING COPD DYSPNEA CHANGE: SENSITIVITY, RESPONSIVENESS AND PREDICTIVE VALIDITY OF THE DMQ-CAT

BIOMECHANICAL MODELING OF TENDON TRANSFER IN TETRAPLEGIA

SINE: SUMMER INTERNSHIPS IN NEURAL ENGINEERING

DEVELOPMENT OF AN ACCESSIBLE LONELINESS INTERVENTION FOR PEOPLE WITH APHASIA AND OTHER POST-STROKE COMMUNICATION DIFFICULTIES - LONELINESS (PERCEIVED SOCIAL ISOLATION) IS A SERIOUS AND GROWING PUBLIC HEALTH PROBLEM. STROKE SURVIVORS ARE AT INCREASED RISK FOR DEVELOPING LONELINESS AND THE MULTIPLE PHYSIOLOGICAL AND PSYCHOSOCIAL PROBLEMS THAT ARE ASSOCIATED WITH IT. WHEN A PERSON HAS ADDITIONAL COMMUNICATION PROBLEMS SUCH AS APHASIA, APRAXIA OF SPEECH, OR DYSARTHRIA, THE RISK MAY BE INCREASED AND THE ASSOCIATED PROBLEMS EXACERBATED. TO DATE, FEW STUDIES HAVE ADDRESSED LONELINESS IN STROKE SURVIVORS WITH COMMUNICATION DIFFICULTIES AND INTERVENTIONS TO MITIGATE THE EFFECTS OF LONELINESS AND IMPROVE HEALTH, FUNCTION, AND COMMUNITY PARTICIPATION IN THIS POPULATION ARE SCARCE. OBJECTIVES OF THIS “PROOF OF PRODUCT” DEVELOPMENT STUDY ARE TO (1) CONDUCT A SERIES OF FOCUS GROUPS AND SEMI-STRUCTURED INTERVIEWS WITH KEY STAKEHOLDERS TO BETTER UNDERSTAND THE EXPERIENCE OF LONELINESS, IDENTIFY VARIOUS FACTORS THAT CONTRIBUTE TO LONELINESS IN THIS POPULATION, AND GAIN INPUT ABOUT A POTENTIAL INTERVENTION; (2) DEVELOP A THEORETICALLY GROUNDED INTERVENTION FOR LONELINESS AND ITERATIVELY REFINE THE INTERVENTION BY TESTING IT WITH PERSONS WITH STROKE-RELATED COMMUNICATION DIFFICULTIES; (3) ASSESS THE FEASIBILITY AND ACCEPTABILITY OF THE INTERVENTION PROTOTYPE TO ENSURE ALL TECHNICAL REQUIREMENTS ARE MET; 4) TEST POTENTIAL OUTCOME MEASURES TO DETERMINE THEIR SUITABILITY FOR A FUTURE EARLY EFFICACY STUDY; AND (5) DEVELOP TRAINING MATERIALS TO ENSURE THAT NEW USERS OF THE INTERVENTION ARE LIKELY TO ADOPT THE INTERVENTION THROUGHOUT THE PROJECT, WE INCORPORATE FEEDBACK FROM KEY STAKEHOLDERS. ANTICIPATED OUTCOMES INCLUDE FEASIBILITY, ACCEPTABILITY AND ACCESSIBILITY FOR PERSONS WITH STROKE-RELATED COMMUNICATION DISABILITIES. THE PRODUCT OF THIS GRANT, A TREATMENT PROTOTYPE ADDRESSING LONELINESS, MAY ALSO BENEFIT INDIVIDUALS WITH OTHER NEUROLOGICAL COMMUNICATION DEFICITS WHO ARE LONELY, AND ULTIMATELY IMPROVE THEIR COMMUNITY PARTICIPATION.

MECHANISMS UNDERLYING IMPAIRED POSTURAL CORRECTIONS FOLLOWING STROKE

FIELD-INITIATED PROGRAM

A COMPUTATIONAL FRAMEWORK FOR OPTIMIZING KNEE REHABILTATION

FIELD-INITIATED PROGRAM

COLLABORATIVE RESEARCH: MULTI-DOMAIN COMPUTATIONAL FRAMEWORK FOR SIMULATING MUSCULOSKELETAL SYSTEMS

MOTOR LEARNING FOR THE CONTROL OF AN ASSISTIVE DEVICE

ENGAGING RETICULOSPINAL INPUTS TO IMPROVE WALKING - ABSTRACT LOCOMOTOR RECOVERY IS ONE OF THE MOST IMPORTANT GOALS OF INDIVIDUALS WITH SPINAL CORD INJURY (SCI). AMBULATORY DEFICITS SEVERELY IMPACT DAILY FUNCTIONS RESULTING IN LOWER QUALITY OF LIFE FOR PEOPLE LIVING WITH PARALYSIS DUE TO SCI. ALTHOUGH STUDIES HAVE SHOWN THAT LOCOMOTOR TRAINING IMPROVES LOCOMOTOR FUNCTION IN PEOPLE WITH CHRONIC SCI, THE BENEFITS REMAIN LIMITED. OUR OVERALL HYPOTHESIS IS THAT WE CAN ENGAGE ADDITIONAL DESCENDING MOTOR PATHWAYS, SUCH AS THE RETICULOSPINAL TRACT (RST), TO IMPROVE LOCOMOTOR FUNCTION IN HUMANS WITH CHRONIC INCOMPLETE SCI. THE GOALS OF THIS PROPOSAL ARE: (1) EXAMINE THE CONTRIBUTION OF THE RST TO LOWER LIMB MUSCLES DURING LOCOMOTION, AND (2) TO COMBINE NON-INVASIVE PAIRED RST ACTIVATION AND ELECTRICAL MUSCLE STIMULATION WITH TREADMILL TRAINING TO IMPROVE MOTOR OUTPUT IN INDIVIDUALS WITH CHRONIC INCOMPLETE SCI. IN AIM 1, WE PROPOSE TO MEASURE THE EFFECTS OF A LOUD AUDITORY STIMULUS TO ENGAGE THE RST ON THE AMPLITUDE AND LATENCY OF ELECTROMYOGRAPHIC RESPONSES IN MULTIPLE LOWER LIMB MUSCLES SUCH AS THE QUADRICEPS FEMORIS, HAMSTRINGS, SOLEUS, AND TIBIALIS ANTERIOR BILATERALLY DURING LOCOMOTION IN INDIVIDUALS WITH AND WITHOUT SCI. IN AIM 2, WE PROPOSE TO TEST THE EFFECTS OF A NOVEL INTERVENTION THAT USES REPEATED PAIRED LOUD AUDITORY AND ELECTRICAL STIMULATION OF MUSCLE AFFERENTS COMBINED WITH LOCOMOTOR TRAINING ON WALKING SPEED AND VOLUNTARY MUSCLE STRENGTH. HERE, INDIVIDUALS WITH CHRONIC INCOMPLETE SCI WILL BE RANDOMLY ASSIGNED TO A GROUP THAT WILL RECEIVE 10 SESSIONS OF A STARTLE STIMULUS AND ELECTRICAL STIMULATION COMBINED WITH LOCOMOTOR TRAINING OR 10 SESSIONS OF A NON- STARTLE STIMULUS COMBINED WITH LOCOMOTOR TRAINING. TAKEN TOGETHER, THE RESULTS OF THESE STUDIES WILL PROVIDE FUNDAMENTAL INFORMATION ABOUT THE CONTRIBUTIONS OF THE RST TO LOCOMOTION IN HUMANS WITH AND WITHOUT SCI AND WILL FURTHERMORE OPEN NOVEL AVENUES FOR IMPROVING LOCOMOTOR FUNCTION IN INDIVIDUALS LIVING WITH PARALYSIS DUE TO SCI.

DISSEMINATION OF A SCALABLE AND FAIR OPEN-SOURCE MOTION ANALYSIS FRAMEWORK - PROJECT SUMMARY/ABSTRACT ADVANCES IN COMPUTER VISION-BASED BIOMECHANICAL ANALYSIS AND HUMAN POSE ESTIMATION HAVE HELPED EXPAND ACCESS TO QUANTITATIVE METHODS FOR MOVEMENT ANALYSIS. THESE ADVANCEMENTS HAVE HIGHLIGHTED THE UTILITY OF MARKERLESS MOTION CAPTURE (MMC) FOR OVERCOMING THE LOGISTICAL CHALLENGES PRESENTED BY MARKER-BASED SYSTEMS. FOR EXAMPLE, MMC ELIMINATES THE CUMBERSOME AND TIME-CONSUMING PROCESS OF MARKER PLACEMENT, AND MMC SYSTEMS CAN CAPTURE DETAILS THAT CANNOT BE OBTAINED BY MARKER-BASED SYSTEMS. HOWEVER, COMMERCIALLY AVAILABLE MMC SYSTEMS OFTEN FAIL TO MEET CLINICIANS’ AND RESEARCHERS’ NEEDS, AND THE PROPRIETARY NATURE OF THESE SYSTEMS PREVENTS RESEARCHERS FROM PERSONALIZING THE SYSTEMS AND ADDRESSING THE ISSUES SPECIFIC TO THEIR ENVIRONMENT. OUR TEAM HAS DEVELOPED MMC ACQUISITION SOFTWARE DESIGNED TO INTEGRATE INTO CLINICAL WORKFLOWS, AS WELL AS CUTTING-EDGE ALGORITHMS FOR BIOMECHANICAL ANALYSIS, WHICH ARE SUPPORTING SEVERAL NIH-FUNDED PROJECTS. OUR COLLABORATORS USING OUR SOFTWARE ALREADY REPORT ITS MANY STRENGTHS, WHICH SPEAKS TO THE GAPS WE ARE FILLING, INCLUDING WHOLE-BODY TRACKING OF ARMS AND HANDS. WHILE WE HAVE SUCCESSFULLY DEPLOYED THIS SOFTWARE IN MULTIPLE NIH-FUNDED RESEARCH LABS, THERE ARE STILL BARRIERS TO MAKING THE SYSTEM BROADLY ACCESSIBLE. FOR EXAMPLE, ITS IMPLEMENTATION REQUIRES ON-SITE ENGINEERING SUPPORT. ADDITIONALLY, OUTPUT DATASETS AND METADATA ARE NOT READILY SHAREABLE DUE TO THE FACT THAT THEY CONTAIN IDENTIFIABLE INFORMATION FROM SUBJECTS, SUCH AS RAW VIDEOS, SO ADDITIONAL PROCESSING STEPS ARE REQUIRED FOR DE-IDENTIFICATION OF DATA. THE OVERALL OBJECTIVE OF THIS RESEARCH SOFTWARE ENGINEER R50 PROPOSAL IS TO APPLY BEST SOFTWARE PRACTICES TO THIS CODE AND TRANSFORM OUR CURRENT VIDEO ACQUISITION AND BIOMECHANICAL ANALYSIS SOFTWARE, WHICH WORKS WELL FOR OUR RESEARCH PROJECTS WITH EXPERIENCED ENGINEERING SUPPORT, INTO A HIGH-QUALITY OPEN-SOURCE PRODUCT THAT IS EASY TO DEPLOY IN NEW LABS AND SUPPORTS FAIR DATA SHARING AND REPRODUCIBLE RE-ANALYSIS OF EXPORTED DATASETS. SPECIFICALLY, WE WILL ENSURE OUR SOFTWARE IS TRULY ACCESSIBLE TO A BROAD RESEARCH AND CLINICAL AUDIENCE BY DEVELOPING A ROBUST, USER-FRIENDLY, EASY-TO-DEPLOY, OPEN-SOURCE, AND FAIR4RS MARKERLESS MOTION CAPTURE ACQUISITION SYSTEM AND BIOMECHANICAL ANALYSIS PIPELINE (AIM 1). FURTHER, WE WILL FACILITATE RESEARCHERS’ ABILITY TO SHARE AND ACCESS MOVEMENT DATA BY IMPLEMENTING A DATA LAYOUT THAT PRODUCES DE-IDENTIFIED, FAIR- COMPLIANT DATASETS AND METADATA THAT CAN BE EASILY IMPORTED AND EXPORTED (AIM 2). WE ANTICIPATE THAT THESE IMPROVEMENTS WILL DEMOCRATIZE ACCESS TO MMC BY PROVIDING RESEARCHERS AND CLINICIANS A ROBUST AND RELIABLE SOFTWARE RESOURCE THAT CAN BE EASILY IMPLEMENTED ACROSS A DIVERSE RANGE OF SETTINGS, AND THIS SOFTWARE WILL IMPROVE DATA SHARING BY PRODUCING DATASETS THAT CAN EASILY BE IMPORTED TO AND EXPORTED FROM REPOSITORIES FOR BROAD DISSEMINATION.

MUSCLE METABOLISM AND MECHANICAL EFFICIENCY IN CEREBRAL PALSY

FUNCTIONAL REORGANIZATION OF FINGER MOVEMENTS TO IMPROVE HAND DEXTERITY

VA AWARDS GRANTS TO QUALIFYING ORGANIZATIONS TO PLAN, DEVELOP, MANAGE, AND IMPLEMENT PROGRAMS TO PROVIDE ADAPTIVE SPORTS OPPORTUNITIES FOR DISABLED VETERANS AND DISABLED MEMBERS OF THE ARMED FORCES AS AUTHORIZED UNDER 38 UNITED STATES CODE 521A.

PARALYZED VETERANS OF AMERICA ADAPTIVE SPORTS PROGRAMS

DISABILITY REHABILITATION RESEARCH PROJECTS

REHABILITATION RESEARCH AND TRAINING CENTERS

AIDING IN THE PHYSICAL AND EMOTIONAL REHABILITATION OF DISABLED VETERANS NATIONWIDE THROUGH FLY FISHING

GRANTS FOR ADAPTIVE SPORTS PROGRAMS FOR DISABLED VETERANS AND DISABLED MEMBERS OF THE ARMED FORCES.

TO CATALYZE ADAPTIVE SPORTS PARTICIPATION FROM LOCAL TO ELITE LEVELS AMONG DISABLED VETERANS AND DISABLED MEMBERS OF THE ARMED FORCES VIA VA AND PART

PREPARATION OF A MONOGRAPH ON TARGETED REINNERVATION

SHIRLEY RYAN ABILITYLAB ADAPTIVE SPORTS PROGRAM

2015 INTERNATIONAL WORKSHOP ON ROBOTICS AND INTERACTIVE TECHNOLOGIES FOR NEUROSCIENCE AND REHABILITATION

SHIRLEY RYAN ABILITYLAB ADAPTIVE SPORTS PROGRAM

NEUROMODULATORY STRATEGIES TARGETING CORTICAL AND SPINAL PATHWAYS TO FACILITATE PARETIC LEG MOTOR CONTROL DURING WALKING IN INDIVIDUALS WITH STROKE - PROJECT SUMMARY/ABSTRACT THIS PROJECT AIMS TO: (AIM 1) DETERMINE THE EFFECTS OF TRANSCUTANEOUS SPINAL CORD STIMULATION (SCS) WITH CONSTRAINT FORCE TO THE NON-PARETIC LEG DURING TREADMILL WALKING ON PARETIC LEG MOTOR CONTROL IN INDIVIDUALS WITH STROKE; AND (AIM 2) DETERMINE THE COMBINED EFFECTS OF TRANSCUTANEOUS SCS AND NON-INVASIVE BRAIN STIMULATION (NIBS) WITH CONSTRAINT FORCE TO THE NON-PARETIC LEG DURING TREADMILL WALKING ON PARETIC LEG MOTOR CONTROL IN INDIVIDUALS WITH STROKE. AFTER A STROKE, INDIVIDUALS OFTEN RELY ON THEIR NON-PARETIC LEG DURING WALKING, COMPENSATING FOR THE IMPAIRED MOTOR CONTROL AND MUSCLE WEAKNESS IN THE PARETIC LEG. CURRENT GAIT TRAINING APPROACHES AFTER STROKE, SUCH AS TREADMILL TRAINING, HAVE SHOWN IMMEDIATE BENEFITS ON WALKING FUNCTION, YET MORE THAN 50% OF STROKE PATIENTS STILL STRUGGLE WITH IMPAIRED WALKING POST-TREATMENT. THIS PERSISTENT DIFFICULTY IN WALKING MAY BE ATTRIBUTED, AT LEAST IN PART, TO THE REPETITIVE USE OF THE COMPENSATORY STRATEGIES. SUCH STRATEGIES CAN FURTHER EXACERBATE THE MOTOR IMPAIRMENT OF THE PARETIC LEG, CONTRIBUTING TO GREATER GAIT ASYMMETRY AND HIGHER RISK OF FALLS. THEREFORE, THERE IS A CRITICAL NEED TO DEVELOP GAIT INTERVENTIONS TARGETING PARETIC LEG MOTOR CONTROL DURING WALKING AFTER STROKE. PREVIOUSLY, WE FOUND THAT THE APPLICATION OF CONSTRAINT FORCE TO THE NON- PARETIC LEG DURING TREADMILL WALKING FACILITATES THE USE OF THE PARETIC LEG IN INDIVIDUALS POST-STROKE. IN THIS PROPOSAL, WE AIM TO UTILIZE NON-INVASIVE NEUROMODULATORY APPROACHES DURING THIS CONSTRAINT FORCE INDUCED GAIT TRAINING TO FURTHER ENHANCE PARETIC LEG MOTOR CONTROL DURING WALKING POST-STROKE. OUR PRELIMINARY RESULTS SUGGEST THAT COMBINING TRANSCUTANEOUS SCS WITH THE APPLICATION OF CONSTRAINT FORCE TO THE NON-PARETIC LEG DURING TREADMILL WALKING FACILITATES GREATER STEP LENGTH, STANCE TIME, STEP HEIGHT, MUSCLE ACTIVITY, AND PROPULSIVE FORCE OF THE PARETIC LEG COMPARED TO CONSTRAINT FORCE INDUCED GAIT TRAINING ALONE (AIM 1). WE ALSO PROPOSE THAT TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) COMBINED WITH SCS DURING GAIT TRAINING MAY PROVIDE FURTHER IMPROVEMENTS. ONE OF THE POPULAR VIEWS INTO THE MECHANISM OF SCS IS THAT STIMULATION INCREASES EXCITABILITY OF THE SPINAL CIRCUITS AND MODULATES THE RESPONSIVENESS TO CORTICOSPINAL INPUTS. GIVEN THAT INDIVIDUALS POST-STROKE DEMONSTRATE REDUCED DESCENDING CORTICAL DRIVE DUE TO DAMAGED CORTICOSPINAL TRACT (CST), IT IS POSSIBLE THAT THE ADDITION OF TDCS, TO UPREGULATE THE CST INPUTS, ENHANCES THE EFFECTIVENESS OF SCS WHICH MAY FURTHER IMPROVE PARETIC LEG MOTOR CONTROL DURING WALKING. RESULTS FROM THIS PROPOSAL MAY PROVIDE VALUABLE INSIGHTS TO DEVELOP EFFECTIVE GAIT REHABILITATION STRATEGIES TO OPTIMIZE WALKING RECOVERY IN INDIVIDUALS WITH STROKE.

SHIRLEY RYAN ABILITYLAB ADAPTIVE SPORTS PROGRAM FROM RIC MILITARY SPORTS PROGRAMS

PROVIDING ADAPTIVE SPORT ACTIVITIES DESIGNED TO ENHANCE THE REHABILITATIVE AND THERAPEUTIC HEALTH OF VETERANS AND SERVICEMEMBERS

NEUROMECHANICS OF DIFFERENTIAL MOTOR UNIT ACTIVATION IN MULTIFUNCTIONAL MUSCLES

FIELD INITIATED

COMPUTATIONAL AND TRANSLATIONAL MOTOR CONTROL

INNOVATIONS IN AMPUTATION SURGERY AND PROSTHESES

HAPTIC IDENTIFICATION OF VIRTUAL SURFACES

REGULATION OF MULTIJOINT ARM MECHANICS FOLLOWING STROKE

NRI: FND: COLLAB: AN OPEN-SOURCE ROBOTIC LEG PLATFORM THAT LOWERS THE BARRIER FOR ADVANCED PROSTHETICS RESEARCH

GRANTS FOR ADAPTIVE SPORTS PROGRAMS FOR DISABLED VETERANS AND DISABLED MEMBERS OF THE ARMED FORCES.