������

Current Projects - Motor Control Lab

Remote dynamic cycling for customized off-site rehabilitation in Parkinson’s disease (in collaboration with Dr. Aasef Shaikh, Louis Stokes Cleveland VA Medical Center)

Parkinson's disease (PD) progressively deteriorates motor function. Successful rehabilitation, leading to a favorable course of movement disorders in PD, is contingent upon frequent, regular, and patient-specific exercise regimen that is customized to the individual needs. Latter requires regular interventions from the provider and frequent visits to the rehab facility. Lack of access, poor social support, inability to travel, home-bound status, or pandemics are significant hurdles in delivering effective rehab to the PD patients. The investigators' vision is to offer customized and cost-effective PD rehab using a remotely operated technology near or at the patients' homes. This technology would be remotely monitored and customized online to titrate therapeutic outcomes optimized for each patient. The proof of this concept was already established in the investigators' laboratory, a technology called dynamic cycling. The highlight of this technology is a stationary bike operating at a rapid speed (cadence) with programmable variability in speed and power/torque hence promoting motor performance superior to traditional motorized bikes (i.e. static cycling). The next

step towards the ultimate vision of at-home exercise therapy is remotely operated dynamic bike. The investigators have already built remotely operated dynamic bike; the current proposal will objectively examine the efficacy of a novel, remotely delivered and remotely adjusted dynamic cycling paradigm using remotely monitored motor outcomes. Comparison will be made with remote static cycling. The study will be launched at three community-based wellness locations to assure the subject safety, ease of access, compliance, and as needed support. The immediate clinical impact is that the technology will be immediately deployed to the Veteran's group homes, nursing homes, and community-based VA clinics. The project will provide sufficient information to carry the investigators' ultimate vision, at-home dynamic cycling serving three critical needs: 1) customized therapy, 2) easy access, and 3) safety and cost-effectiveness.

Study in Parkinson Disease of Exercise Phase 3 Clinical Trial: SPARX3 (Multi-site NIH Funded Trial)

The objective is to establish the efficacy of progressive high intensity endurance exercise as first-line therapy for recently diagnosed people with PD. This study is a Phase III efficacy trial of high intensity endurance exercise on a treadmill for slowing the disease progression of PD. We will conduct a 12-month multi-center, randomized, controlled (two doses of intensity), evaluator-blinded study of high intensity endurance exercise. The two levels of treadmill exercise are moderate intensity (4 days/wk for 30 minutes per session while exercising on a treadmill at 60-65% HRmax) and high intensity (4 days/wk 30 minutes per session while exercising on a treadmill at 80-85% HRmax). The proposed study is designed to test three specific aims. First, to establish the efficacy of high intensity endurance to slow the progression of PD as measured by the change in the MDS-Unified Parkinson Disease Rating Scale (MDS-UPDRS Part III) score over 6 and 12 months. Second, to ascertain the effect of high dose endurance on the progression of PD over 6 and 12 months as measured by a number of clinically meaningful and widely accepted measures of disease progression in early PD including:

improvements ambulatory capacity (sum of 5 MDS-UPDRS items: falling, freezing, walking, gait, postural stability), distance covered in 6 minute walk, an increased number of steps during the week, improved cognitive function, increased VO2 max and improved quality of life compared to those in the 60-65% HR max group. Third, to test the effects of high intensity progressive endurance exercise on PD over 12 months on biomarkers of dopaminergic neuronal integrity and blood-derived biomarkers of inflammation.

Equipment - Motor Control Lab

This laboratory is equipped with three custom-designed “SMART bikes.” Motor function assessment tools include a Noraxon Electromyogram Core Wireless (EMG) system, the Kinesia One Motor Assessment System (Great Lakes Neurotechnology) and an electronic reaching table (designed by collaborators at Rockwell Automation). Mobility, gait and posture assessment equipment includes the Noraxon Myomotion System (wireless biomechanical sensors), a Biodex Balance System, and a Biodex Unweighing System with safety harness.