# Progressive Abduction Loading Therapy: A Phase IIb Stroke Rehabilitation Trial with Longitudinal Tracking

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2023 · $547,953

## Abstract

Project Summary
Preclinical rehabilitation studies in the chronic phase of upper extremity stroke recovery have demonstrated the
capacity to improve independent joint control in individuals with severe impairment, by reducing the expression
of abnormal shoulder abduction/elbow flexion coupling, or flexion synergy, following a science-based data-driven
intervention approach. Two decades of quantitative motor systems research underpins the concept of
systematically targeting independent joint control in this population. The leading hypothesis explaining stroke-
related loss of independent joint control is the increased reliance on contralesional corticoreticulospinal tract for
the production of movement in the affected arm. Partial restoration of independent joint control demonstrated in
preclinical studies logically extend this hypothesis by attributing improved movement to optimized use of residual
ipsilesional corticospinal tract likely originating in the ischemic penumbra. The anatomical circuit of residual
ipsilesional corticospinal tract is the only neural pathway available for the production of independent joint control,
or in functional terms, outward reaching against gravity. With neuroimaging studies of individuals with severe
chronic stroke supporting this hypothesis, it brings to light the supposition that optimized use of penumbral
corticospinal tract may be achieved early in recovery, specifically the critical period of neural plasticity, in
individuals with severe initial motor impairment. Stroke practice guidelines conclude that individuals with severe
initial motor impairment are in the greatest need of novel and efficacious rehabilitation interventions. Therefore,
our central hypothesis is that administration of progressive abduction loading therapy, shown to elicit sustained
improvements in individuals with severe chronic stroke, will augment conventional acute and subacute
rehabilitation through improved reaching function and attenuated development of loss of independent joint
control. To test this hypothesis, we will recruit individuals with severe initial motor impairment and administer
progressive abduction loading therapy as adjuvant to conventional in-patient and day-rehabilitation. A
comparison group of dosage-matched reaching practice without abduction loading will be utilized. Study
participants will be evaluated at admission, weekly until discharge, and then every other month until 1 year
following baseline. Between group comparisons will be made over the duration of the first year of recovery (Aim
1). Approximately half of the study participants will transition to day-rehabilitation following in-patient
rehabilitation and continue to receive the study interventions. The effect of extending progressive abduction
loading therapy into subacute recovery will be tested with the addition of a dichotomous variable of enrollment
in day-rehabilitation or not (Aim 2). Efficacy and dosage data will provide a go-no-go signal for t...

## Key facts

- **NIH application ID:** 10694834
- **Project number:** 5R01HD096071-05
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Michael D. Ellis
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $547,953
- **Award type:** 5
- **Project period:** 2019-09-06 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10694834

## Citation

> US National Institutes of Health, RePORTER application 10694834, Progressive Abduction Loading Therapy: A Phase IIb Stroke Rehabilitation Trial with Longitudinal Tracking (5R01HD096071-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10694834. Licensed CC0.

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