Over 100,000 people in the UK have a stroke each year. Arm weakness is the most prevalent impairment, and recovery is often poor, limiting functional independence. The most effective therapy for motor recovery is high repetition movement practice. However, this is currently not achievable in clinical practice, especially in the case of severe arm weakness.
How can high dose movement repetition be achieved in clinical settings? Newly available technologies can provide engaging therapy that stroke survivors can perform independently, in addition to standard therapy. Specifically, functional electrical stimulation (FES) can support individuals to perform greater movement repetition by reducing fatigue and promote larger movement amplitudes. Moreover, gamification through extended reality (XR) devices provide an ideal environment for portable and immersive neurorehabilitation.
This project aims to uncover the neurophysiological mechanisms and cortical biomarkers of stroke recovery when implementing high doses of movement repetition in XR settings combined with FES. Individual and longitudinal measurements of motor improvements and corticospinal excitability changes will further allow us to capture inter- and intra-individual variability for optimisation of precision medicine approaches, tailoring the therapy for individuals with a range of motor impairment severities and symptoms.
b) Skill development:
Quantitative: statistics, digital health/technologies (XR, FES), neurophysiological assessments (transcranial magnetic stimulation, electromyography), clinical assessments, AI-driven markerless motion capture.
Interdisciplinary: translational work across neuroscience, engineering/technology and healthcare.
c) Aims:
To investigate cortical mechanisms and biomarkers of stroke recovery when combining functional electrical stimulation (FES) with extended reality (XR) in individuals with moderate-to-severe arm weakness.
d) Objectives:
WP1: Investigating the neurophysiological mechanisms and biomarkers underpinning stroke motor recovery when implementing high doses of movement repetition in combined XR-FES settings.
Deliverables: motor performance markers (biomechanics) and cortical biomarkers for personalised tracking of stroke recovery parameters.
WP2: Personalised randomised controlled clinical trial (PRACTical) of high dose arm motor training in XR-FES settings, using baseline and longitudinal changes in motor performance and cortical biomarkers. Deliverables: multimodal digital healthcare platform for personalised approaches to stroke recovery. Specifically, tailored motor training parameters to achieve a speed-accuracy trade-off shift at a variety of task demands, corticospinal connectivity profiles through neuroplasticity as quantified by transcranial magnetic stimulation.
Year1:
• Review literature and update ethical approval
• Develop competencies in neurophysiological measurements, motion capture and virtual reality setup
• Run WP1 to determine key motor performance and corticospinal excitability biomarkers after FES/XR training.
Year2:
• Run WP2 to investigate personalised motor recovery in stroke survivors.
Year3&4:
• Complete recruitment, analyse, disseminate findings
