Robotic Interventions for Spasticity Treatment

Post-stroke patients will be recruited when they are referred to Shirley Ryan AbilityLab's stroke rehabilitation outpatient clinics at Shirley Ryan Ability Lab's flagship hospital, or satellite SRAlab locations (e.g. Arlington Heights, Wheeling, Glenview, Homewood, Northbrook, or Burr Ridge) or participate in SRALab inpatient rehabilitation. The researchers will also recruit from local physicians or from the Clinical Neuroscience Research Registry (CNRR). Furthermore, participant interest and eligibility may also be confirmed from the patient medical record. If eligible and interested, they will be consented and enrolled, and the location of research visits will be based on participant preference: at SRAlab's flagship hospital (355 E Erie St, Chicago, 60611) or at SRAlab Burr Ridge (7600 County Line Road, Burr Ridge, 60527). Eligible participants will then be randomized (using a pre-generated sequence of block randomization numbers) to receive either 1) conventional robotic CPM training, 2) training with visual biofeedback (games) or 3) training with visual (game) and haptic (robotic assistance) biofeedback. Participants will complete a 60 min session to perform 30 minutes of their assigned type of training. The goal of this study is to compare the efficacy of the three different rehabilitation training conditions. For each condition, 3 sessions per week for a total of 4 weeks will be completed in addition to the daily PT sessions. Each training session will be 60 min long and include experimental setup, vitals monitoring (i.e., blood pressure, heart rate, oxygen saturation level), and training time. The maximum training time for each session will be 30 minutes. For healthy participants, they will use their dominant foot for all training sessions, designated by asking the healthy participant the question "which leg do you use to kick a ball?". For clinical participants, they will use their affected/weaker foot for all training sessions. Full clinical assessments will be performed before (T0), mid (T3) and after (T6) training sessions, as well as 1 month after finishing all training sessions and 3 months after finishing all training sessions. Note that additional 180 min will be allotted before or after the 60 min training session to perform all clinical assessments: Flexion/extension range of motion (ROM), Maximal Volitional Electromyographic Activity (MVEA), Maximum Voluntary Contraction Torque (MVCT), Modified Ashworth Scale (MAS), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), Functional Gait Assessment (FGA). After the final training session at T6, patients will complete a subjective experience survey: Game Experience, Stroke Specific Quality of Life (SSQoL), Short Form 36. CONDITION 1 - CONTINUOUS PASSIVE MOVEMENT (CPM) TRAINING. At the beginning of the session, the participant's vitals (i.e., blood pressure, heart rate, oxygen saturation level) will be measured. Participants will then be seated and secured to the chair with a gait belt and the research personnel will assist with the placement of their limb into the M1 device. Velcro straps will be adjusted to prevent movement between the M1 device and the participant's foot. The shank Velcro straps will also be adjusted to provide support to the knee. Three sensors will then be placed either on the tibialis anterior (TA) or extensor halluces longus (EHL), vastus lateralis (VL) and biceps femoris longus (BF), and soleus (S) or gastrocnemius (GAS) muscles on the designated limb after cleaning the skin with alcohol prep pads by a researcher. Then, the ROM of the ankle joint, MVEA and MVCT of the ankle will be measured. The participant will then be asked to perform up to 30 min of ankle CPM training. The trajectory, ROM, and rate of oscillations provided during the CPM training will vary according to the participant's functional capacity. The total session time will be 60 min, including the vital measurements, experimental setup, and CPM training. CONDITION 2 - VISUAL FEEDBACK. At the beginning of the session, the vitals will be measured. Participants will then be seated and secured to the chair with a gait belt and the research personnel will assist with the placement of their limb into the M1 device. Velcro straps will be adjusted to prevent movement between the M1 device and the participant's foot. Shank Velcro straps will also be adjusted to provide support to the knee. Three sensors will then be placed either on the tibialis anterior (TA) or extensor halluces longus (EHL), vastus lateralis (VL) and biceps femoris longus (BF), and soleus (S) or gastrocnemius (GAS) muscles on the designated limb after cleaning the skin with alcohol prep pads by a researcher. Then, the ROM of the ankle joint, MVEA and MVCT of the ankle will be measured. Based on the ROM of the ankle, the movement of the game avatar will be adjusted (calibrated so that the ROM of the participant corresponds to the maximum movement required by the avatar to play the game). Participants will perform 30 min of training with visual biofeedback (games). Participants will be observed while playing the games to note any software challenges they may encountered while playing. CONDITION 3 - HAPTIC + VISUAL FEEDBACK. At the beginning of the session, the vitals will be measured. Participants will then be seated and secured to the chair with a gait belt and the research personnel will assist with the placement of their limb into the M1 device. Velcro straps will be adjusted to prevent movement between the M1 device and the participant's foot. Shank Velcro straps will also be adjusted to provide support to the knee. Three sensors will then be placed either on the tibialis anterior (TA) or extensor halluces longus (EHL), vastus lateralis (VL) and biceps femoris longus (BF), and soleus (S) or gastrocnemius (GAS) muscles on the designated limb after cleaning the skin with alcohol prep pads by a researcher. Then, the ROM of the ankle joint, MVEA and MVCT of the ankle will be measured. Based on the ROM of the ankle, the movement of the game avatar and assistance provided by the M1 device will be adjusted (calibrated). Participants will perform up to 30 min of training with visual biofeedback (games) and haptic biofeedback. The assistive torque that is provided by the M1 robot with respect to the EMG signals will be adjusted according to the participant. Participants will be observed while playing the games to note any software or hardware challenges they may encountered while playing.