Project 460604

Background: Stroke is a leading cause of disability in Canada, with 85% of stroke survivors experiencing at least some movement, sensory and cognitive deficits. It is essential to maximize interactions between the motor, sensory and cognitive functions to drive neuroplasticity and optimize arm and hand recovery after stroke. Objectives: To evaluate the: 1) feasibility, and 2) efficacy of a personalized integrated cognitive-sensory-motor training intervention to improve arm and hand function in people with chronic stroke. Methods: Study design: a prospective pilot randomized controlled trial with two-arms. Sample size: 40 adults with upper limb deficits post-stroke (>6 months). Intervention: The intervention will consist of integrated COgnitive-Sensory-MOtor training (iCOSMO). iCOSMO will include robotic training of cognition, movement and joint position sensation using the Kinarm Exoskeleton, as well as touch sensations by exploring the surface properties of objects during reaching and object handling. The motor and sensory characteristics of the tasks will be emphasized using a cognitive approach whereby the therapist guides the participant to identify and correct errors in performance. iCOSMO will be individualized to the specificity and severity of upper limb deficits. The experimental group will receive 72 hours of iCOSMO intervention over 12 weeks. The control group will receive a dose-matched home-based motor task-specific training programme. Outcome measures: Feasibility will be evaluated by recruitment, intervention fidelity, programme completion rates, and participant satisfaction. Clinical assessments for efficacy will include Action Research Arm Test, Tactile Discrimination Test and robotic assessments using the Kinarm. Significance: This study will be the first to determine whether it is both feasible and beneficial to deliver a personalized intervention integrating sensory, motor and cognitive training to improve arm and hand function after stroke.