Work package 3: The study of female stroke survivors – University of Copenhagen

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Work package 3

The study of female stroke survivors

Work package-leader: Henning Langberg

Work package 3 will evaluate the effect of new stroke rehabilitations strategies. Compared with males, female stroke survivors have lower functional recovery and poorer quality of life (Gargano & Reeves, 2007). The potential use of tablets/iPads in rehabilitation of fine-motor skills will be investigated as will the use of strategically exercise sessions to enhance motor memory.

Work package 3 will explore the mechanism underlying neuroplasticity and examine potential gender differences following motor practice. This may facilitate the development of novel, more effective rehabilitation interventions.

Furthermore, compliance, motivation and life quality in female stroke survivors undergoing the tablet- and physical therapy will be examined.

BackgroundTil toppen

Stroke is the largest cause of serious and long-term disability in the world. The World Health Organization has estimated that more than 15 million people is subjected to strokes annually, and this number is expected to continue to increase with the aging population and growing epidemics of obesity, diabetes, hypertension, and physical inactivity (WHO 2002). Compared with males, female stroke survivors have lower functional recovery and poorer quality of life 3 months post discharge. Differences which cannot be explained by females’ greater age at stroke onset or other demographic or clinical characteristics (Gargano & Reeves, 2007).

There is no cure for stroke, the only means of improving function is through rehabilitation. Thus, recent research has focused on developing rehabilitation strategies that enhance functional outcome post-stroke. Recovery of motor function after stroke involves relearning motor skills and is mediated by neuroplasticity. It has become clear that a high dose of task-specific practice is necessary to drive the neural reorganization needed to optimally promote function post-stroke (Lang et al 2009). Compliance is made difficult by the repetitive nature of traditional therapies that may not be intellectually stimulating or engaging. The use of games might enhance motivation and prolong adherence and thus provide a more engaging method to rehabilitation of fine-motor therapy in stroke rehabilitation (Rand et al 2013).

In addition, stroke survivors show deficits in the ability to retain gains in motor skill learning between physical therapy sessions, which may be due to impairments in the consolidation of motor memory. It has been demonstrated that acute cardiovascular exercise can enhance motor memory in able-bodied males, however the exact mechanism is still purely understood (Roig et al 2013). Understanding the relationship between motor skill acquisition, cardiovascular exercise and the mechanisms of neuroplasticity may facilitate the development of novel, more effective rehabilitation interventions.

Overall aimTil toppen

The motivation of the current research project is to investigate the potential use of a tablet in fine-motor (re)learning as well as the potential beneficial effect of acute cardiovascular exercise on motor memory. In addition, the aim is to obtain a better understanding of the underlying mechanism of neuroplasticity.

Hypotheses

  • The use of a tablet enhances fine-motor skills in able-bodied subjects and stroke survivors.
  • Male and females will show similar improvements.
  • The tablet can enhance the compliance of home-based fine-motor practice.
  • Applying cardiovascular exercise following motor practice can have a beneficial effect on motor memory in stroke rehabilitation.
  • The descending corticospinal drive to the motoneurons increases after motor practice and more so after acute cardiovascular exercise.
  • The activity between frontale and parietale cortical areas decreases with motor practice and more so after acute cardiovascular exercise.

DesignTil toppen

Able-bodied subjects will be randomly divided into three groups. Two groups will practice a visuomotor accuracy-tracking task on a tablet, where one of the groups will perform cardiovascular exercise immediately afterwards. The last group will constitute the control group. Electrophysiological measurements from the brain and muscles will be collected using electroencephalography (EEG) and electromyography (EMG) respectively.

Electrophysiological measurements will be collected in order to investigate changes at cortical and subcortical level pre and post training (Nielsen et al 2008). Stroke survivors will be introduced to the same study setup in order to examine how motor practice and cardiovascular exercise affects the damaged corticospinal drive. The second half of the project will be to transfer the findings from the laboratory research into a stroke treatment intervention in a clinical setting.

Til toppenReferences

Gargano, J. W., & Reeves, M. J. (2007). Sex differences in stroke recovery and stroke-specific quality of life: results from a statewide stroke registry. Stroke; a Journal of Cerebral Circulation, 38(9), 2541–8.

Lang, C.E., Macdonald, J.R., Reisman, D.S., Boyd, L., Jacobson Kimberley, T., Schindler-Ivens, S.M., Hornby, T.G., Ross, S.A. & Scheets, P.L. (2009) Observation of amounts of movement practice provided during stroke rehabilitation. Archives of physical medicine and rehabilitation, 90, 1692-1698.

Nielsen, J. B., Brittain, J.-S., Halliday, D. M., Marchand-Pauvert, V., Mazevet, D., & Conway, B. a. (2008). Reduction of common motoneuronal drive on the affected side during walking in hemiplegic stroke patients. Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology, 119(12), 2813–8.

Rand D, S.-M.T., Dudkiewicz I, Kizony R & Zeilig G (2013) The use of the iPad for poststroke hand rehabilitation; A pilot study. International Conference on Virtual Rehabilitation (ICVR). IEEE, pp. 109–113.

Roig, M., Nordbrandt, S., Geertsen, S. S., & Nielsen, J. B. (2013). The effects of cardiovascular exercise on human memory: a review with meta-analysis. Neuroscience and Biobehavioral Reviews, 37(8), 1645–66.

Thomas, A. G., Dennis, A., Bandettini, P. a, & Johansen-Berg, H. (2012). The effects of aerobic activity on brain structure. Frontiers in Psychology, 3(March), 86.

World Health Organization. The World Health Report: Reducing Risks, Promoting Healthy Life. Geneva: World Health Or- ganization; 2002. (2002).Til toppen


ResearchersTil toppen

Researchers, work package 3