Project 461454

Stroke in Canada has become a chronic disease; over 80% of Canadians who have a stroke will survive but rehabilitation approaches have fallen short of the goal of restoring function. The net result is more people living with disability after stroke. At present, there is a critical need for new rehabilitation interventions. Typical in-patient rehab concludes by 3 months following stroke. After this time rehab is provided inconsistently across Canada, depending on where people live (rural vs. cities) and on the demand for services in a particular area. Yet the late sub-acute phase of recovery (from 3 to 6 months after stroke) is a period of heightened potential for brain plasticity and recovery. One approach to filling this gap in care is to design interventions that can be completed at home or in the community so that regardless of where one lives rehab can continue. In past work funded by CIHR we developed a rehab game and showed that in people with chronic stroke (>6 months) practicing it promoted learning, and altered brain structure and function. Gamified rehab in this group also improved the ability to use the stroke affected arm in some people in the study. It is not clear why not everyone benefited. In the proposed work we will find out why by mapping brain function and structure before and after practice to determine who benefits. We will also see if gamified rehab can be completed earlier after stroke (at 3-6 months). It is critical that we identify brain based biomarkers that tell us who is most likely to improve in response to specific interventions. Our proposed work will illustrate who will benefit from a new intervention, that can be completed early after stroke and at home or in the community.