The VA Center for Excellence in Exercise and Robotics for Neurological Disorders is focused on identifying and testing exercise-related ways to improve function and minimize disability in the context of neurological illness.
The director of the center is Richard Macko, MD, professor of Neurology, Medicine and Physical Therapy & Rehabilitation Science and director of the Academic Rehabilitation Program at the University of Maryland School of Medicine.
The center was funded in 2005 and is located in the Baltimore VA Medical Center. In addition to student and resident training in research, the Center is coordinating three distinct research studies examining different aspects of exercise and robotics:
This study compares the relative effectiveness on stroke survivors of a six-month treadmill training program progressed on velocity (the speed of the treadmill) versus one progressed on duration (time spent on the treadmill). All participants will train on a treadmill in a medically supervised environment three times a week for six months. Participants will be randomly assigned to either the velocity or duration group and progressed according to standardized guidelines.
At the conclusion of six months, all participants will be tested for improvements in level of cardiovascular fitness‚ functional gait‚ time walking and changes in the brain reflecting new gait learning. All participants will receive repeat testing three months after the conclusion of exercise to test the durability of these changes.
Advances in robotics technology present opportunities to develop novel rehabilitation strategies aimed at improving mobility in gait-impaired stroke patients. In this study, robotic devices attached to the weakened pelvis and ankle have been designed to assist the patient-initiated step to completion, thus allowing sufficient practice and repetition to improve ambulatory gait through treadmill training.
Specifically, this study will be the first to test the safety, tolerability and adjustment to the robot devices in healthy volunteers and then in stroke survivors. The second phase of the study will track whether the inclusion of the robot devices will significantly improve treadmill walking, compared to those treadmill walking without the devices, over a three-month training period. Changes in brain function as a result of the treadmill training will be measured using Functional Magnetic Resonance Imaging (fMRI) and electroencephalography (EEG), both when training ends and at three-months post exercise.
The REHAB program is designed to improve exercise adherence by improving participants’ confidence in their ability to exercise at home following discharge from rehabilitation. The program educates all survivors about the benefits of exercise. For the exercise group, it provides a home-based regimen of walking and customized daily “homework” tasks tailored to disability.
The program identifies and addresses barriers to mobility recovery during the sub–acute stroke recovery period. All participants will be called weekly for 12 weeks, and the exercise group will receive additional encouragement to exercise daily and maintain a record of activities. Participants will also wear activity monitors periodically during the study to track progress. Regular performance of individually designed exercise programs assists survivors in improving daily activities and normal function on tasks, with the ultimate goal of resuming social roles.