Novel Spatial-Motor Approaches to Improve Spatial Neglect and Walking Deficits Post-Stroke
Emory University
Summary
The purpose of this study is to understand how prism adaptation training with and without electrical stimulation changes visuospatial behavior, motor system neurophysiology, and walking dysfunction.
Description
Spatial Neglect (SN) is defined as pathological asymmetric spatial behavior causing functional disability and occurs in greater than 50% of individuals with right hemisphere stroke. SN post-stroke is associated with increased fall risk, increased hospital length of stay, poorer rehabilitation outcomes, and severe long-term disability. Prism adaptation therapy (PAT) is an evidence-based treatment for SN after stroke, however, the effects of SN on gait are not well known. Neuromuscular electrical stimulation delivered via surface electrodes is a common therapeutic adjunct in stroke rehabilitatio…
Eligibility
- Age range
- 18–90 years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: Young Adults Able Bodied (YAB) Individuals * 18-30 years * Able-Bodied (healthy without any physical disability or neurological disorder) Older Adults Able-Bodied Individuals (OAB) * 45-90 years * Able-Bodied (healthy without any physical disability or neurological disorder) Individuals with right hemisphere stroke (40-90 years) * \>3 months following stroke. * Presence of Aiming SN * Ability to walk \>10m with or without assistive devices. * Unilateral left-sided hemiparesis with gross arm strength of ≤ grade 4/5 on the Medical Research Council Scale * Ability to fol…
Interventions
- DevicePrism adaptation therapy (PAT) + Electrical stimulation (E-stim)
PAT requires one to wear prism lenses while making arm-reaching movements toward visual targets. For treating left-sided neglect, a person wears the prism lenses that shift the visual field, including the images of the target and of one's own reaching arm, certain degrees to the right depending on the diopter of the lens (e.g., the 20-diopter lens shifts the visual field by 11.4 degrees). The visual system adapts over the repetitive practice of the arm reaching toward the target. The person eventually achieves success with a leftward movement reaching the actual target. Electrical stimulation (E-stim) involves parameters and settings commonly used in clinical practice as well as research for pain relief and other applications, commonly referred to as transcutaneous electrical nerve stimulation (TENS). TENS and E-stim are delivered using FDA-approved, commercially available portable clinical transcutaneous electrical stimulators (e.g. Empi TENS Unit).
- DevicePrism adaptation therapy (PAT) + Sham Stimulator
Participants in the PAT with sham stim condition group will receive sham electrical stimulation treatment (electrodes will be attached but the stimulator will not be turned on) to the left upper limb with the same placement of electrodes while undergoing PAT.
- OtherGait Training
After PAT, participants will complete multiple 30-seconds to 4-minute bouts of walking on the treadmill or overground at speeds ranging from self-selected to fast speeds (faster than comfortable self-selected speed), with rest breaks between bouts.
Locations (3)
- Emory Rehabilitation HospitalAtlanta, Georgia
- Emory University Hospital (EUH)Atlanta, Georgia
- Executive ParkAtlanta, Georgia