![Page 1: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/1.jpg)
INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY – THE ULTrA
PROJECT
S.H. Brown, PhDDivision of KinesiologyUniversity of Michigan
Co-investigators: Edward Hurvitz MD, Dept of Physical Medicine and Rehabilitation; Colleen Lewis PhD, Grand Valley State University
Supported by the National Institute on Disability and Rehabilitation Research
![Page 2: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/2.jpg)
Movement Therapy
Role of task-based motor training to
improve upper limb function
Based on concept of plasticity within the
central nervous system (“use it or lose it”)
increase in synaptic connections,
neurotransmitters, growth factors
![Page 3: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/3.jpg)
Typically involves intensive practice (up to
10 hrs/day for several weeks)
e.g. constraint-induced therapy in stroke
Limitations:
Time commitment
Resources – clinical setting, rehabilitation
specialist required
Motivation/Adherence
![Page 4: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/4.jpg)
Motor Training in Children with
Hemiplegic CP
6 wk home training program (40 min 2x daily, 5x wk)
Improved upper limb coordination, grasp force control
Grasp Force
Grasp Force Variability
pre
post
![Page 5: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/5.jpg)
Purpose of the ULTrA Study
To determine if an internet-based home
training program will improve sensorimotor
function in adults with hemiplegic cerebral
palsy.
![Page 6: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/6.jpg)
Study Participants
N=12 (3 males, 9 females)
age range: 21-58 yrs
mild to moderate UL spasticity
home setting
greater Ann Arbor area, Flint, Lansing, Ohio, Windsor,
Canada
10/12 – no assistive devices
![Page 7: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/7.jpg)
ULTrA Program
8 wks – 40 min/day, 5 days/wk
monitored by interactive webcam – 2-3 times/wk
arm and hand performance data uploaded from home to lab via the internet after each training session
software-guided instructions for warm-up/training modules
pre/post laboratory-based movement assessment
![Page 8: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/8.jpg)
Research Personnel
Storage
ServerComputer
Computer
Study
Participant
ULTrA Training
System
Participant’s
ResidenceMotor Control
LaboratoryInternet
Real-Time
Audio/Video
Webcam Webcam
Data Transfer
![Page 9: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/9.jpg)
ULTrA Training Components
Visually-guided upper limb reaching (unilateral,
bilateral
Workspace – low - high targets; central – lateral targets)
Manipulation tasks (grasp-transfer-release,
stereognosis, card turning, object transfer)
Tactile discrimination tasks (N. Byl, UCSF)
![Page 10: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/10.jpg)
Training Board Tasks
![Page 11: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/11.jpg)
Unilateral Movement Duration
![Page 12: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/12.jpg)
Improvement in Reaching
Performance
![Page 13: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/13.jpg)
Bilateral Sequential Movements –
Interlimb Movement Time
![Page 14: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/14.jpg)
Improvement in Interlimb
Coordination
![Page 15: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/15.jpg)
Reach-Grasp-Release Duration
![Page 16: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/16.jpg)
Hand Manipulation - Stereognosis
![Page 17: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/17.jpg)
Variable Change in Stereognosis
![Page 18: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/18.jpg)
Tactile Discrimination
![Page 19: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/19.jpg)
Improvement in Tactile Discrimination
![Page 20: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/20.jpg)
Summary
Task-specific upper limb training can lead to marked
improvement in upper limb function in adults with CP.
Existing internet technology is an effective, low-cost
means of delivering movement-based therapy which can
be remotely monitored by rehabilitation professionals.
The ULTrA program provides quantitative data related to
performance throughout the training period without the
need to travel to a clinical/research setting.
![Page 21: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/21.jpg)
Future Directions
Expand program nationally and
internationally
Determine carryover, optimal training duration
Quantify spontaneous motor function
Expand training system to include
instrumented haptic devices, modify for
use in pediatric populations
![Page 22: INTERNET-BASED HOME TRAINING FOR ADULTS WITH …INTERNET-BASED HOME TRAINING FOR ADULTS WITH CEREBRAL PALSY –THE ULTrA PROJECT S.H. Brown, PhD Division of Kinesiology University](https://reader034.vdocument.in/reader034/viewer/2022042023/5e7a81384de0c7542f4748a3/html5/thumbnails/22.jpg)
Acknowledgements
National Institute on Disability and Rehabilitation
Research (H133G050151)
Alex Flick, Joe McCarthy, and members of the
Motor Control Laboratory
Department of Physical Medicine and
Rehabilitation
Nancy Byl, MsPT, PhD
Our study participants