# Exoskeleton Research: Myoelectric orthosis for rehab of severe chronic arm motor deficits

> **NIH VA I01** · LOUIS STOKES CLEVELAND VA MEDICAL CENTER · 2022 · —

## Abstract

Current rehabilitation methods fail to restore normal arm function for many stroke survivors,
particularly those with severe deficits. The main objective of this study is to test efficacy and
evaluate underlying neurophysiological mechanisms of a novel approach to treat persistent
severe arm deficits after stroke with a combination of MyoPro™ and motor learning-based
therapy. We will also estimate cost effectiveness of this therapeutic approach. Rationale: Motor
learning-based therapy is one of the most effective stroke rehabilitation methods available,
however its application is challenging for individuals with severe arm impairment because of
their limited ability to practice volitional arm movement effectively. The MyoPro is an exoskeletal
myoelectrically controlled orthotic device that is custom fitted to an individual’s paretic arm and
assists the user to move the paretic arm. MyoPro can help with motor learning-based therapy
for individuals with severe motor deficits as it motivates practice because even weak muscle
activity is translated into patient-initiated arm movement. Preliminary results of motor-learning
therapy using MyoPro in our laboratory showed an increase in Fugl-Meyer for Upper extremity
score (FM) of 7.44 points following 18 weeks of training (18 in-clinic therapy sessions over 9
weeks followed by 9 weeks of home practice) for chronic stroke survivors with baseline FM≤30.
However, comparison of the same dose of combination therapy with motor-learning alone
remains to be determined. Study Design: Using a randomized, controlled design, individuals
with chronic severe stroke (≥6 months post; Fugl Meyer UE score ≤30;n=60) will participate in
either MyoPro+motor learning (M+ML) or motor learning alone (ML-alone). The study
intervention will include 9 weeks of in-clinic training (18 sessions;1.5 hours each) followed by 9
weeks of home practice and a 6-week follow-up. Aim 1 is to determine whether M+ML results
in greater treatment gains compared to ML-alone. The primary outcome will be change in FM.
Secondary outcome measures will assess overall paretic arm performance and will include:
kinematics, muscle tone (Modified Ashworth Scale; MAS), grip/pinch/arm dynamometry,
sensory function (Semmes Weinstein mono-filament test, joint proprioception), arm function
(Arm Motor Ability Test (AMAT);actigraphy) and quality of life (Stroke Impact Scale (SIS)).
Aim 2 is to characterize structural and functional brain changes after treatment. Outcomes
include corticospinal excitability (motor evoked potential recruitment curve (MEP-rc)), and
functional connectivity (resting state function Magnetic Resonance Imaging(rs-fMRI). Aim 3 is to
identify baseline factors associated with greater functional improvement with treatment.
Outcomes are as follows: baseline integrity of the stroke-affected corticospinal tract (lesion load,
MEP-rc; Diffusion Tensor Imaging); baseline motor ability of the affected arm (FM); baseline
functional connectivity (rs-fM...

## Key facts

- **NIH application ID:** 10420277
- **Project number:** 1I01RX003674-01A2
- **Recipient organization:** LOUIS STOKES CLEVELAND VA MEDICAL CENTER
- **Principal Investigator:** SVETLANA PUNDIK
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-04-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10420277

## Citation

> US National Institutes of Health, RePORTER application 10420277, Exoskeleton Research: Myoelectric orthosis for rehab of severe chronic arm motor deficits (1I01RX003674-01A2). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10420277. Licensed CC0.

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