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State of the Science (SOS) Workshop: Hosted by RIC & UCSD Functional Restoration for the Stroke Survivor: Informing the Efforts of Engineers March 7&8, 2006 La
Jolla, CA Last updated 2/15/2006 10:20 AM Session
1
Moderator – Bruce Dobkin, MD, Physiology/Pathophysiology
of Neural Plasticity Discussion Leader: Jeffery Kleim,
PhD, Respondents:
Suggested Questions/Themes:
1) What is the relation between structural and
functional change in cortex following novel environmental exposure? 2) Does there need to be structural change for
permanent functional change to occur? 3) What is the time course of changes in cortical
function vs. structural change? 4) Do we know what biological processes underlie these
changes? Do changes in synaptic
function precede overt structural changes in cortex? 5) What mechanisms underlie changes in cortical maps
in normal animals? 6) Do similar mechanisms apply in pathological states,
like stroke? 7) Are certain areas of the nervous system more likely
to show plasticity? 8) What is the relationship between motor learning,
motor adaptation, and plasticity? Session
2
Moderator - Sandro
Mussa-Ivaldi, PhD, Northwestern University and Rehabilitation Institute
of Motor Learning Discussion Leader: Dave Reinkensmeyer, PhD,
University of California-Irvine Respondents:
Suggested Questions/Themes: 1) Terminology: What do we mean by the terms motor
learning, plasticity and adaptation? 2) Are certain brain sites preferentially engaged in
motor learning? Do lesions in such
areas adversely affect learning? 3) How do we distinguish learning from other sources
of behavioral change? 4) What synaptic or structural processes underlie
motor learning? 5) Do different sensory systems such as vision or proprioception play different roles in learning? 6) What are the external signals that provoke motor
learning, and can we influence these signals with robotic devices? 7) Are studies of short-term motor adaptation relevant
to motor recovery following stroke? 8) What limits motor recovery following stroke? 9) How can we use models of motor learning to
develop optimal robotic training strategies? What information do we
need to include in those models? Session
3
Moderator: Jim Patton
(RIC/NU) Upper Extremity Rehabilitation Discussion Leader: Mindy Levin, PT, PhD, Physical
Therapy Program, Respondents:
Suggested Questions/Themes: 1) What is meant by robotic therapy? 2) What are the goals of robotic therapy? Are they
different from standard therapeutic goals? 3)
What is the evidence
for effectiveness of robotic therapy on movement recovery and functional
recovery? What constitutes effectiveness? 4) What is the most effective application approach
studied to date? What type of loads should be used? Elastic, viscous,
inertial or combination? What type of controller should be used - impedance
based (resistive) or cooperative (guided – assistive)? 5) Is effectiveness related to recovery level? If so,
what are the goals for early/late therapy and severe/moderate/mild recovery? 6) What determines what type of therapy may benefit
which patients? 7) What theoretical or device system needs to be
developed to meet the needs of rehabilitation? Session
4
Moderator –Richard Harvey,
MD (RIC) Neuroimaging/Brain Imaging Discussion Leader: Steve Cramer, MD, University of
California-Irvine Respondents:
Suggested Questions/Themes: 1) What is the time course of cortical reorganization
as evidenced by FMRi following application of
environmental changes? 2) How are structural and physiological changes in
cortex correlated with different imaging techniques? 3) What is the relationship between neurophysiological changes in the motor system, as
detected by TMS, and recovery of function? 4) Can any of the functional imaging methods, with or
without lesion data or clinical measures, help us predict who will respond
best to an intervention such as a robotic therapy 5) Technical issues – can Diffusion Tensor Imaging
(DTI) methods help us identify critical pathway damage in stroke? 6) How does the level of physical effort while
performing skilled tasks affect cortical imaging in fMRI? 7) Can the pattern of cortical changes predict
functional outcome? 8) What role might the supplementary motor area play
in motor relearning after stroke? 9) Can diffusion and perfusion weighted imaging help
guide neurological care and rehabilitation approaches after stroke? Session
5
Moderator: Samuel R. Ward, PT, PhD, UCSD Introductory Comments (Sam
Ward, PT, PhD)-15 min Clinically Relevant Alterations in Skeletal Muscle Discussion Leader: Rick Lieber, PhD, UC Respondents:
Suggested Questions/Themes: 1) What are some of the most significant structural
and/or functional changes that occur in muscle secondary to altered use? 2) What are the most common measures of muscle
adaptation? What are the most useful measures of muscle adaptation? 3) What is the evidence for or against the statement
that “all muscles adapt equally?” 4) Is serial sarcomere
adaptation subject to the same “rules” as parallel adaptation? 5) What “signal” to muscles transduce
when they adapt? (stress, strain, calcium, etc.) 6) What types of clinical treatments can actually
affect muscles? 7) What changes occur in muscle compared to connective
tissue? 8) To what extent does neural and/or mechanical input
affect muscle condition? Session 6
Moderator – David
Reinkensmeyer, PhD (UC - Lower Extremity Rehabilitation Discussion Leader: Susan Harkema,
PhD, Neurological Surgery, University of Respondents:
Suggested Questions/Themes: 1) Can robots be used to restore pattern generator
function in SCI? What about stroke? Is the pattern generator altered in
stroke? 2) What control approaches are likely to be best?
Position, impedance, or cooperative control strategies? ·
Should robots
be used as position control devices early in recovery? ·
Should they be
switched to force based controllers as recovery proceeds? ·
How do we
determine the transition point between control strategies? 3) What do we do about restoration of axial muscle
control, and of balance and posture? 4) What are there key differences between lower
extremity rehabilitation and upper extremity rehabilitation? 5) How can we use animal models of gait training to
assist in optimizing strategies for humans? 6) What limits recovery of gait following stroke? 7) How important is over ground locomotor
training vs. locomotor training on a treadmill? 8) What hard evidence is there that the way manual or
robotic assistance is applied to a patient affects their recovery? |