A Systematic Review of Racial Inclusivity in Stroke Rehabilitation Research

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SUMMARY: A failed attempt to conduct a systematic review of disparities in racial inclusivity in stroke rehabilitation research: A call to action Group Members: Adeline Beeler & Mikayla McNally Faculty Mentor(s): Dr. Sydney Schaefer & Dr. Keith Lohse Topic Overview:…

SUMMARY: A failed attempt to conduct a systematic review of disparities in racial inclusivity in stroke rehabilitation research: A call to action Group Members: Adeline Beeler & Mikayla McNally Faculty Mentor(s): Dr. Sydney Schaefer & Dr. Keith Lohse Topic Overview: Stroke is responsible for the death of an individual every four minutes in the United States. While all Americans are gravely affected by this statistic, Black Americans are at a significantly increased risk of first stroke incidence when compared to their white counterparts, majorly due to heightened prevalence of stroke risk factors. Not only does race contribute as a factor in stroke incidence, but it also has a considerable impact in the physical impairment of Black Americans following stroke occurrence. While it still remains unclear as to whether or not stroke plays a significant role in stroke rehabilitation efforts, there is a clearly demonstrated need for increased reporting or participation of Black Americans in stroke rehabilitation clinical trials to have the ability to conduct a systematic review of these racial disparities in the near future. In the analysis of 36 stroke rehabilitation-related clinical research studies, 80% of selected trials failed to report any participant racial demographics, with 77.3% of the NIH-funded trials not reporting, as well. Out of the 7 trials that did provide some sort of participant racial information, only 5 successfully provided statistically significant racial data compared to the remainder that simply categorized participants’ race as “white” or “other.” In order to fully investigate the effects of race on stroke rehabilitation, it is imperative that researchers collect and report equally distributed and diverse participant racial data when publishing clinical research. Potential methods of improvement for researchers to include more racially diverse subject populations include more comprehensive and in-depth advertising and recruitment strategies for their studies. Research Methods: In order to produce accurate analyses of the current state of the relationship between race and stroke rehabilitation efforts, 36 stroke rehabilitation clinical research trials from various locations across the United States were identified using the Centralized Open-Access Rehabilitation Database for Stroke (SCOAR). These trials were evaluated in order to extract relevant data, such as number of trial participants, average age of participants, if the research trial was funded by the National Institute of Health (NIH) or not, and any reported participant racial demographic details. Trends across these categories were compared between all trials to determine if any disparities existed in providing data sufficient to support the relationship between varying racial populations and stroke rehabilitation efforts. Future Project Efforts: Future efforts will include the completion of submitting a Point of View/Directions for Research article for publication to offer an opportunity for clinical and basic researchers to examine the discrepancies surrounding racial inclusivity in stroke rehabilitation clinical research. The aim is to improve the ability of clinicians to interpret the literature, translate research studies into practices, and better direct future experiments. Further identification of stroke rehabilitation clinical research trials will be necessary, as well as modifications to current written work content.

Date Created
2021-12
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Impacts of Age on Neuropsychological Task Performance

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The purpose of this study was to test the reproducibility of the current data set. It was hypothesized that older adults’ scores on the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) would decrease from their initial visit to their…

The purpose of this study was to test the reproducibility of the current data set. It was hypothesized that older adults’ scores on the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) would decrease from their initial visit to their one year follow-up visit and that greater overall age is associated with worse performance. Overall, the older adults with a follow-up visit in this study experienced greater decline on the RBANS DMI than on the RBANS total scaled score. There seems to be a negative trend in which individuals with higher first-visit VCI scores experience greater improvement on the first trial of the motor task with the non-dominant hand. The same trend can be seen in DMI scores where higher initial DMI scores are associated with greater improvement on the first non-dominant hand trial of the motor task. This initial trend suggests that visuospatial scores have an association with long-term change in the motor task. The number of participants in this data set were limited, thus more data will be needed to increase confidence in conclusions about these relationships in the future.

Date Created
2021-05
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Exploring the Utilization of Startle as a Therapy Tool in Individuals with Stroke

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Stroke is a debilitating disorder and 75% of individuals with stroke (iwS) have upper extremity deficits. IwS are prescribed therapies to enhance upper-extremity mobility, but current most effective therapies have minimum requirements that the individuals with severe impairment do not…

Stroke is a debilitating disorder and 75% of individuals with stroke (iwS) have upper extremity deficits. IwS are prescribed therapies to enhance upper-extremity mobility, but current most effective therapies have minimum requirements that the individuals with severe impairment do not meet. Thus, there is a need to enhance the therapies. Recent studies have shown that StartReact -the involuntary release of a planned movement, triggered by a startling stimulus (e.g., loud sound)- elicits faster and larger muscle activation in iwS compared to voluntary-initiated movement. However, StartReact has been only cursorily studied to date and there are some gaps in the StartReact knowledge. Previous studies have only evaluated StartReact on single-jointed movements in iwS, ignoring more functional tasks. IwS usually have abnormal flexor activity during extension tasks and abnormal muscle synergy especially during multi-jointed tasks; therefore, it is unknown 1) if more complex multi-jointed reach movements are susceptible to StartReact, and 2) if StartReact multi-jointed movements will be enhanced in the same way as single-jointed movements in iwS. In addition, previous studies showed that individuals with severe stroke, especially those with higher spasticity, experienced higher abnormal flexor muscle activation during StartReact trials. However, there is no study evaluating the impact of this elevated abnormal flexor activity on movement, muscle activation and muscle synergy alterations during voluntary-initiated movements after exposure to StartReact.
This dissertation evaluates StartReact and the voluntary trials before and after exposure to StartReact during a point-to-point multi-jointed reach task to three different targets covering a large workspace. The results show that multi-jointed reach tasks are susceptible to StartReact in iwS and the distance, muscle and movement onset speed, and muscle activations percentages and amplitude increase during StartReact trials. In addition, the distance, accuracy, muscle and movement onsets speeds, and muscle synergy similarity indices to the norm synergies increase during the voluntary-initiated trials after exposure to StartReact. Overall, this dissertation shows that exposure to StartReact did not impair voluntary-initiated movement and muscle synergy, but even improved them. Therefore, this study suggests that StartReact is safe for more investigations in training studies and therapy.
Date Created
2020
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Characterizing the Impact of Baseline Cognitive Status on Dual Task Performance: An Analysis of Postural and Cognitive Outcomes While Backward Protective Stepping

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INTRODUCTION: As people age, they become increasingly susceptible to falls, particularly when their attention is divided. Cognitive domains such as executive functioning and processing speed also decline over time and are associated with falls. A critical aspect to reducing falls…

INTRODUCTION: As people age, they become increasingly susceptible to falls, particularly when their attention is divided. Cognitive domains such as executive functioning and processing speed also decline over time and are associated with falls. A critical aspect to reducing falls are reactive steps, which are used to recover balance after a perturbation. Characterizing the relationship between cognition, dual tasking, and prioritization is necessary in order to decrease fall risk in older adults. Thus, the purpose of this analysis was to determine the effects of baseline cognitive status on dual task interference and prioritization of postural and cognitive tasks while reactive stepping. METHODS: 30 participants (Parkinson's disease (PD) n=16, healthy controls (HC) n=14) were divided into two groups based on their baseline cognitive status: the high-cog group (n=18) or the low-cog group (n=12). All participants experienced 7 perturbation trials where they were solely tasked with reactive stepping, 2 cognitive trials where they were solely tasked with verbally responding to an auditory Stroop test, and 7 trials that combined the two tasks. Cognitive and protective stepping performance was calculated for dual task interference and prioritization across groups. RESULTS: There were no outcome variables that showed the log-cog group performing worse than the high-cog group from single to dual task conditions. While examining the dual task interference between groups, the only significant outcome was that the low-cog group exhibited a subtle improvement in their step length performance under dual task conditions while the high-cog group did not. When comparing the prioritization scores, there was no statistically significant difference in prioritization between the high-cog and low-cog group. Albeit not significant across groups, the prioritization score for all outcomes was negative, indicating a stepping prioritization under dual task conditions for both groups. This analysis provides preliminary evidence that baseline cognitive status does not significantly affect dual task interference nor prioritization while reactive step dual tasking. While these effects should be treated with caution, these results would suggest that baseline cognitive status may not play a critical role in dual task interference or attentional allocation in both people with PD and healthy older adults.
Date Created
2020
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StartReact and its Effect on Functional Upper Extremity Motor Tasks

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The phenomenon known as startReact is the fast, involuntary execution of a planned movement triggered by a startling acoustic stimulus. StartReact has previously been analyzed in simple motor movements such as finger abduction tasks, hand grasp tasks, and elbow extension…

The phenomenon known as startReact is the fast, involuntary execution of a planned movement triggered by a startling acoustic stimulus. StartReact has previously been analyzed in simple motor movements such as finger abduction tasks, hand grasp tasks, and elbow extension tasks. More complex movements have also been analyzed, but there have been limited studies that look into functional complex tasks that require end-point accuracy. The objective of this project was to assess the ability to elicit startReact in tasks that simulate activities of daily living like feeding or picking up a glass of water. We hypothesized that a startReact response would be present in complex functional tasks, but the response would not be as accurate due to the increase in speed. Five subjects performed a simulated feeding task by moving kidney beans from one target to another where the end target changed in diameter as well as, a simulated drinking task where the subject moved a cup full of beads from one target to another. The hypothesis was supported due to a significant difference between no stimulus and stimulus trials for tricep muscle onset time, duration time, and the accuracy parameters of amount of beans dropped and weight in beads dropped. The results coincided with previous studies where subjects compensated for the change in diameter by increasing reaction time as the target diameter size decreased. The data obtained contradicted a previous study in relation to the duration time between the tasks due to our smallest diameter size having a faster duration time in comparison to the other diameter sizes. This study provides preliminary data that could assist researchers and clinicians in improving physical therapy methods for patients with impaired upper extremity motor movements.
Date Created
2020-12
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The Post Stroke Journey: A Survey Study of the Effects of Family Support and Psychological Factors on Rehabilitation Goals

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Stroke is the fifth most common cause of death in America and a leading cause of long-term adult disability, affecting more than 795,000 people a year ("American Stroke Association: A Division of the American Heart Association"). Many of these individuals…

Stroke is the fifth most common cause of death in America and a leading cause of long-term adult disability, affecting more than 795,000 people a year ("American Stroke Association: A Division of the American Heart Association"). Many of these individuals experience persistent difficulty with the execution of daily tasks as a direct consequence of a stroke. A key factor in the successful recovery of a stroke survivor is rehabilitation. Rehabilitation sessions can start within two days of the stroke if the patient is in stable condition, and often continues long after their release from the hospital ("American Stroke Association: A Division of the American Heart Association"). The rehabilitation sessions are driven by a team of rehabilitation care professionals which includes, but is not limited to a physical therapist, occupational therapist, and speech-language pathologist. These professionals are available to the stroke survivor as resources to assist in developing and organizing ways to achieve independence as opposed to dependence. Ultimately, a stroke survivor’s family typically provides the most important long-term support during recovery and rehabilitation ("American Stroke Association: A Division of the American Heart Association"). However, there is very little research that focuses on the impact that local family can have on the stroke survivor’s establishment and achievement of goals throughout their recovery and rehabilitation. This study examines this gap in knowledge.
Date Created
2020-05
Agent

The Impact of a Starting Acoustic Stimulus and Transcranial Magnetic Stimulation on Reaction Times in Unimpaired Adults

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Description
Motor skill acquisition, the process by which individuals practice and consolidate
movement to become faster, more accurate and efficient, declines with age. Initial skill acquisition is dominated by cortical structures; however as learning proceeds, literature from
rodents and songbirds suggests that there…

Motor skill acquisition, the process by which individuals practice and consolidate
movement to become faster, more accurate and efficient, declines with age. Initial skill acquisition is dominated by cortical structures; however as learning proceeds, literature from
rodents and songbirds suggests that there is a transition away from cortical execution. Recent
evidence indicates that the reticulospinal system plays an important role in integration and
retention of learned motor skills. The brainstem has known age-rated deficits including cell
shrinkage & death. Given the role of the reticulospinal system in skill acquisition and older
adult’s poor capacity to learn, it begs the question: are delays in the reticulospinal system
associated with older adult’s poor capacity to learn?
Our objective was to evaluate if delays in the reticulospinal system (measured via the
startle reflex) and corticospinal system (measured via Transcranial Magnetic Stimulation (TMS) are correlated to impairment of motor learning in older adults. We found that individuals with fast startle responses resembling those of younger adults show the most improvement and retention while individuals with delayed startle responses show the least. We also found that there was no relationship between MEP latencies and improvement and retention. Moreover, linear regression analysis indicated that startle onset latency exists within a continuum of learning outcomes suggesting that startle onset latency may be a sensitive measure to predict learning deficits in older adults. As there exists no method to determine an individual’s relative learning capacity, these results open the possibility of startle, which is an easy and inexpensive behavioral measure and can be used to determine learning deficits in older adults to facilitate better dosing during rehabilitation therapy.
Date Created
2020-05
Agent

Applying a Novel Integrated Persistent Feature to Understand Topographical Network Connectivity in Older Adults with Autism Spectrum Disorder

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Description
Autism spectrum disorder (ASD) is a developmental neuropsychiatric condition with early childhood onset, thus most research has focused on characterizing brain function in young individuals. Little is understood about brain function differences in middle age and older adults with ASD,…

Autism spectrum disorder (ASD) is a developmental neuropsychiatric condition with early childhood onset, thus most research has focused on characterizing brain function in young individuals. Little is understood about brain function differences in middle age and older adults with ASD, despite evidence of persistent and worsening cognitive symptoms. Functional Magnetic Resonance Imaging (MRI) in younger persons with ASD demonstrate that large-scale brain networks containing the prefrontal cortex are affected. A novel, threshold-selection-free graph theory metric is proposed as a more robust and sensitive method for tracking brain aging in ASD and is compared against five well-accepted graph theoretical analysis methods in older men with ASD and matched neurotypical (NT) participants. Participants were 27 men with ASD (52 +/- 8.4 years) and 21 NT men (49.7 +/- 6.5 years). Resting-state functional MRI (rs-fMRI) scans were collected for six minutes (repetition time=3s) with eyes closed. Data was preprocessed in SPM12, and Data Processing Assistant for Resting-State fMRI (DPARSF) was used to extract 116 regions-of-interest defined by the automated anatomical labeling (AAL) atlas. AAL regions were separated into six large-scale brain networks. This proposed metric is the slope of a monotonically decreasing convergence function (Integrated Persistent Feature, IPF; Slope of the IPF, SIP). Results were analyzed in SPSS using ANCOVA, with IQ as a covariate. A reduced SIP was in older men with ASD, compared to NT men, in the Default Mode Network [F(1,47)=6.48; p=0.02; 2=0.13] and Executive Network [F(1,47)=4.40; p=0.04; 2=0.09], a trend in the Fronto-Parietal Network [F(1,47)=3.36; p=0.07; 2=0.07]. There were no differences in the non-prefrontal networks (Sensory motor network, auditory network, and medial visual network). The only other graph theory metric to reach significance was network diameter in the Default Mode Network [F(1,47)=4.31; p=0.04; 2=0.09]; however, the effect size for the SIP was stronger. Modularity, Betti number, characteristic path length, and eigenvalue centrality were all non-significant. These results provide empirical evidence of decreased functional network integration in pre-frontal networks of older adults with ASD and propose a useful biomarker for tracking prognosis of aging adults with ASD to enable more informed treatment, support, and care methods for this growing population.
Date Created
2019
Agent

Comparing Protocols for Extracting, Amplifying, and Imaging ApoE ε4 Allele: Preliminary work for understanding Alzheimer’s Disease in asymptomatic individuals

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This thesis aimed to develop a consistent protocol used to effectively image the apolipoprotein E (ApoE) ε4 allele, which is a known genetic risk factor for Alzheimer’s Disease (AD). The research team used methods to extract DNA from saliva samples,…

This thesis aimed to develop a consistent protocol used to effectively image the apolipoprotein E (ApoE) ε4 allele, which is a known genetic risk factor for Alzheimer’s Disease (AD). The research team used methods to extract DNA from saliva samples, amplify the DNA using polymerase chain reaction (PCR), and image the results using gel electrophoresis and a transilluminator. Extensive literature review was used to optimize these techniques. Future studies will use these methods of characterizing the ApoE ε4 allele as preliminary work towards the goal of integrating this protocol into ongoing research in aging within the Motor Rehabilitation and Learning (MRL) Lab on Arizona State University’s campus.
Date Created
2019-05
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Delays in reticulospinal system are correlated with deficits in motor learning in older adults.

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Description
Motor skill acquisition, the process by which individuals practice and consolidate movement to become faster, more accurate and efficient, declines with age. Initial skill acquisition is dominated by cortical structures; however as learning proceeds, literature from rodents and songbirds suggests…

Motor skill acquisition, the process by which individuals practice and consolidate movement to become faster, more accurate and efficient, declines with age. Initial skill acquisition is dominated by cortical structures; however as learning proceeds, literature from rodents and songbirds suggests that there is a transition away from cortical execution. Recent evidence indicates that the reticulospinal system plays an important role in integration and retention of learned motor skills. The brainstem has known age-rated deficits including cell shrinkage & death. Given the role of the reticulospinal system in skill acquisition and older adult’s poor capacity to learn, it begs the question: are delays in the reticulospinal system associated with older adult’s poor capacity to learn?
Our objective was to evaluate if delays in the reticulospinal system (measured via the startle reflex) are correlated to impairment of motor learning in older adults. We found that individuals with fast startle responses resembling those of younger adults show the most learning and retention of that learning while individuals with delayed startle responses show the least. Moreover, linear regression analysis indicated that startle onset latency exists within a continuum of learning outcomes suggesting that startle onset latency may be a sensitive measure to predict learning deficits in older adults. As there exists no method to determine an individual’s relative learning capacity, these results open the possibility of startle, which is an easy and inexpensive behavioral measure, being used to predict learning deficits in older adults to facilitate better dosing during rehabilitation therapy.
Date Created
2019-05
Agent
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