I explore novel interventions to improve extremity use in patients with stroke as well as mechanisms of cortical reorganization and inter-joint coordination associated with such changes. Within the past 23 years I have led several NIH funded clinical trials governing this concept. Since 2005, our lab has been emphasizing clinical measures of neural plasticity for interventions designed to improve posture in older adults or stroke survivors as well as to improve limb function in the latter group. Measures include extensive assessments using TMS and imaging studies. Our newest studies involve use of robotics and mixed reality, both of which have telerehabilitation capabilities and are directed toward home-based treatment post-stroke. Recently our stroke studies have also included obtaining buccal swaps to identify a polymorphism for brain derived nerve growth factor so that we can determine if a relationship exists between the presence of the polymorphism and limitations in reacquisition of motor function. We also study changes in upper extremity movement following stroke using home base robotic and telerehabilitation interfaces that complement our mixed reality studies. While our studies with stroke survivors have addressed primarily efforts to improve motoric function within the upper extremity, we have also done extensive work in monitoring lower extremity muscle activity to determine the extent to which selective feedback can enhance ambulation amongst stroke survivors. The collective experience in undertaking continuous work in stroke rehabilitation for over 40 years and working with stroke specialists who address motor difficulties faced by these patients, positions me to be of assistance for this project. More importantly, I helped to develop the concept of forced use and constraint induced movement therapy and served as PI for the successful EXCITE Trial. I partake in oversight of stroke and geriatric based clinical trials. In January 2014 I was asked to serve as co-chairman of the Recovery and Rehabilitation Working Group of the NINDS funded Stroke Network in which we are one of 25 sites which has now been refunded for another 5 years. This honor provides further opportunity to facilitate recruitment and retention strategies for clinical trials. chronic stroke survivors. Last, as co-PI for the Emory site during the North Star Neuroscience post-stroke brain stimulation study, I gained considerable experience with neurosurgeon Robert Gross in applying rehabilitation procedures to individuals receiving direct implanted subdural, sub-threshold motor stimulation. I have done considerable work using TMS to map motor cortical changes using constraint therapy and more recently in collaboration colleagues at Emory, combining TMS with recorded EEG responses to assess immediate cortical activity during TMS before and after motor retraining. As a member of 4 training grants, I have spent considerable time over the past two decades training future rehabilitation research scientists, an honor which has positioned me to serve as Associate Director for Training with the Atlanta VA Center for Visual and Neurocognitive Rehabilitation.
Motor control geriatrics stroke biofeedback movement science