# Translation of in-clinic Gains to Gains in  Daily Life After Stroke

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2021 · $397,396

## Abstract

PROJECT SUMMARY/ABSTRACT
Stroke rehabilitation research has produced a number of efficacious and emerging interventions for improving
mobility, balance, and upper limb function. Trial outcomes are measured at the functional capacity level, where
capacity is defined as what a person is capable of doing in the structured environment of the clinic or
laboratory. It has long been assumed that improvements in capacity result in improvements in real-world
performance, where performance is defined as what a person actually does in daily life, outside of the clinic or
laboratory. Our data from the previous award cycle show a striking difference after intervention between
capacity and performance measured with wearable sensors, i.e. accelerometers. Group averages indicated
some improvement in capacity and in self-reported performance, but no improvement in actual performance. At
the individual level, no one showed improvements in performance, even those individuals who made
substantial changes in capacity. Given that a key purpose of providing rehabilitation services post stroke is to
improve performance in daily life, we have uncovered a major problem that merits investigation.
This project will examine the discrepancy between capacity and performance, with the long-term goal of using
the knowledge gained to develop new or modify current rehabilitation interventions that will improve
performance in daily life. We will study two prospective longitudinal cohorts to address three aims. Aim 1 will
seek to understand the scope of the problem within the field of neurorehabilitation. We will study a cohort of
people receiving outpatient services to determine whether the discrepancy between capacity and performance
is unique to upper limb interventions and/or stroke rehabilitation. Aim 2 is designed to learn when, how much,
and in whom, upper limb capacity gains translate to performance gains. We will study another cohort of
persons with first time stroke to map the natural trajectory of performance and its relationships to capacity and
other factors over the time course of stroke recovery (within 2 weeks out to 6 months). Aim 3 takes the
viewpoint that upper limb performance is a health behavior, or habit, which may be amenable to change. We
will capitalize on the same cohort as Aim 2 and explore the time course of stroke survivor attitudes and barriers
to performance.
Data from these cohorts will transform current practice with knowledge of when and with whom motor
rehabilitation interventions can improve performance in daily life. Rehabilitation research will be advanced by
knowledge about capacity vs. performance, and when and how capacity improvements can translate to
performance improvements. Our data will inform future research design and serve as a basis for developing
and testing of performance-level interventions to improve stroke outcomes in the real world, not just in the
clinic or laboratory.

## Key facts

- **NIH application ID:** 10113446
- **Project number:** 5R01HD068290-09
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Catherine Lang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $397,396
- **Award type:** 5
- **Project period:** 2012-02-01 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10113446

## Citation

> US National Institutes of Health, RePORTER application 10113446, Translation of in-clinic Gains to Gains in  Daily Life After Stroke (5R01HD068290-09). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10113446. Licensed CC0.

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