Combined Aphasia and Robot-Assisted Arm Treatment for Chronic Stroke Survivors

PROJECT SUMMARY/ABSTRACT
Stroke is a leading cause of disability in the United States, frequently leading to both language and motor
impairment that creates barriers to participation in professional, social, and family settings. The modal
approach to rehabilitation separates treatment in language and motor domains, which contributes to the
time and expense of stroke recovery. Co-treatment approaches are desirable to both enhance treatment
efficiency and potentially lower costs, but the extent to which we can promote (and not dampen) recovery
by combining treatment across domains has not been systematically explored. In this project, we
integrate a computerized aphasia therapy targeting anomia into robot-assisted upper-extremity treatment
while preserving the critical aspects of each treatment. This work will provide a foundational test of
whether we can reduce impairment in both language and motor domains with a single combined
treatment. Our long-term goal is to create effective and efficient approaches to aphasia recovery in
chronic stroke survivors with both language and motor deficits by combining treatment across these
traditionally-distinct rehabilitation domains. The central hypothesis of this proposal is that we can reduce
impairment in each domain by combining treatments in a manner that retains the critical aspects of each.
This central hypothesis will be tested by pursuing three specific aims: 1) determine the whether
combining aphasia treatment with robot-assisted arm treatment can improve language outcomes in
chronic stroke; 2) determine whether combining aphasia treatment with robot-assisted arm treatment
supports motor recovery in chronic stroke; 3) explore whether combining aphasia treatment with robot-
assisted arm treatment specifically enhances retrieval of lexical items associated with arm movement.
Under the first two aims, we will directly test whether the combined treatment can reduce impairment in
each domain, a critical step towards developing a larger Phase II clinical trial. The third exploratory aim
tests whether the combining arm-based rehabilitation with aphasia treatment specifically enhances recall
of arm-related words that activate motor cortex in unimpaired individuals. The proposed research
represents an innovative approach to aphasia treatment within the larger context of stroke rehabilitation,
combining therapeutic methods across language and motor domains to promote recovery in chronic stroke.
The proposed research is significant because it tests the extent to which a combined language-motor
treatment can enhance word retrieval and simultaneously whether it supports motor treatment. This combined
treatment will form the basis of a Phase II trial as part of a future R01 powered to test the effectiveness of
combined treatment compared to traditional approaches. This line of research based on combining treatment
across domains has the potential to lead to a paradigm shift in stroke rehabilitation.

Grant Number: 5R21DC019955-02
NIH Institute/Center: NIH
Principal Investigator: Adam Buchwald