Overview

Overview

The primary aims of this laboratory are twofold:

  1. To investigate the effectiveness of current and novel neurorehabilitation interventions based on neural mechanisms of recovery.
  2. To facilitate the clinical adoption of efficacious interventions with consideration of healthcare policy by increasing the awareness of cost-effectiveness and cost-utility in neurorehabilitation research.

Active projects:

I-SCORE trial: Intensive Stroke Cycling for Optimal Recovery and Economic value

Conventional recovery following stroke occurs by a process of relearning lost skills through repetitive practice. Despite best efforts in therapy, more than half of individuals with stroke do not fully recover.

Aerobic exercise shows promise as a tool in neurorehabilitation that may work to optimize motor recovery. Using aerobic exercise to “prime” the brain may also result in a more cost-effective approach to rehabilitation. Furthermore, the side-effects of aerobic exercise are generally favorable, resulting in improved physical function along many dimensions, including cardiovascular fitness, lower limb function, and potentially decreasing risk for recurrent stroke.

In our current study, a total of 66 individuals with history of stroke in the past 3-9 months are randomized into one of two groups – aerobic exercise on a facilitated rate exercise bike followed by abbreviated sessions of motor retraining physical and occupational therapies or a time-matched group of occupational therapy and physical Therapy. All patients will receive 90 minutes of therapy 2x week for 12 weeks. The study will investigate the effectiveness of each approach, determine cost-effectiveness in the short- and long-term, and identify the biological mechanisms of neuro-recovery.

For more information, please contact Dr. Susan Linder or Courtney Miller.

Neuro-fitness Community Exercise

The American College of Sports Medicine recommends that adults should participate in aerobic activity for a minimum of 30 minutes, 5X/week and activities for strength and endurance 2x/week. The benefits of exercise are well-documented, resulting in improved cardiovascular health, cognition, mood, quality of life, and reduced morbidity and mortality. Unfortunately, individuals with disability due to conditions such as stroke and multiple sclerosis (MS) experience logistical, behavioral, and practical barriers to regular exercise participation. It can be difficult to adapt to a disability to exercise in a safe and effective manner. As a result, high levels of physical inactivity are observed. In addition to physical inactivity, this complex population experiences considerable medical, social, and behavioral health-related comorbidities, further perpetuating disability. We have spent over a decade investigating the benefits of aerobic exercise in people with stroke and MS, demonstrating that with guidance of skilled therapists, these individuals can safely and effectively participate in training that meets guideline recommendations. Furthermore, we have found that exercise combined with lifestyle modification has positive effects on mobility, cardiovascular health, community re-integration, quality of life, and mood.

A pro bono community-based program combining group-based exercise and lifestyle modification education will overcome barriers to physical activity and wellness in this population of underserved individuals with disability, leading to improved function and quality of life. Sessions will be overseen by a neurological PT or exercise physiologist experienced in administering exercise and wellness initiatives to individuals with disability.

Participating locations:
Cleveland Clinic Langston Hughes Community Health & Education Center, Cleveland, OH
Cleveland Clinic W.O. Walker Center, Cleveland, OH
Cleveland Clinic Mercy Hospital, Canton, OH

For more information, please contact Courtney Miller or Ann Bischof-Bockbrader for more information.

Stroke Patient Research Registry

The purpose of this registry is to connect stroke survivors with stroke related research studies occurring at Cleveland Clinic and area hospitals. Participants will provide researchers with contact information so they may be given details about ongoing and future research studies.

To be eligible to be included in the registry, a person must be over 18 years of age, diagnosed with a stroke, and able to understand study risks and provide informed consent.

If you wish to participate click on the link below to sign an electronic informed consent for this research registry. The consent will go over your rights as a participant and will explain the registry in more detail.

Stroke Registry

Feel free to contact the study coordinators, Ann Bischof-Bockbrader or Donayja Harris, regarding any questions you may have.

Publications

Publications

  1. Linder SM, Davidson S, Rosenfeldt A, Lee J, Koop MM, Bethoux F, Alberts JL. Forced and voluntary aerobic cycling interventions improve walking capacity in individuals with chronic stroke. Archives of physical medicine and rehabilitation.2020.
  2. Linder SM, Rosenfeldt AB, Davidson S, Zimmerman N, Penko A, Lee J, Clark C, Alberts JL. Forced, not voluntary, aerobic exercise enhances motor recovery in persons with chronic. Neurorehabil Neural Repair. 2019;33(8):681-90.
  3. Linder SM, Davidson S, Rosenfeldt A, Penko A, Lee J, Koop MM, Phelan D, Alberts JL. Predictors of improved aerobic capacity in individuals with chronic stroke participating in cycling interventions. Arch Phys Med Rehabil.2020;101:717-21.
  4. Rosenfeldt AB, Linder SM, Davidson S, Clark C, Zimmerman NM, Lee JJ, Alberts JL. Combined aerobic exercise and task practice improve health-related quality of life after stroke: a preliminary analysis.Arch Phys Med Rehabil. 2019;100(5):923-930.
  5. Linder SM, Rosenfeldt AB, Dey T, Alberts JL. Forced Aerobic Exercise Preceding Task Practice Improves Motor Recovery Post-Stroke. American Journal of Occupational Therapy.2017;70(1): 7102290020p1-7102290020p9. PMCID: PMC5317391.
  6. Johnson, JK, Longhurst, JK, Gevertzman, M, Jefferson, C, Linder, SM, Bethoux, F, and Stilphen, M (2024). The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial. JMIR formative research, 8, e54599. https://doi.org/10.2196/54599
  7. Davidson S, Bischof-Bockbrader A, Zimmerman E, Rosenfeldt AB, Alberts JL, and Linder SM. (2024) Characterizing Heart Rate Response During Upper Extremity Repetitive Task Practice in Chronic Stroke. Am J Occup Ther March/April, Vol. 78(2), 7802180240. doi: https://doi.org/10.5014/ajot.2024.050478
  8. Linder SM, Bischof-Bockbrader A, Davidson S, Li Y, Lapin B, Singh T, Lee J, Bethoux F, and Alberts JL. (2024) The Utilization of Forced-Rate Cycling to Facilitate Motor Recovery Following Stroke: A Randomized Clinical Trial. Neurorehabilitation and neural repair. Apr;38(4):291-302.
  9. Linder SM, Lee J, Bethoux F, Persson D, Bischof-Bockbrader A, Davidson S, Li Y, Lapin B, Roberts J, Troha A, Maag L. (2024) An 8-week Forced-rate Aerobic Cycling Program Improves Cardiorespiratory Fitness in Persons With Chronic Stroke: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. May 1;105(5):835-42.
  10. Simmons SB, Skolaris A, Love R, Fricker T, Penko AL, Li Y, Lapin B, Streicher M, Bethoux F, Linder SM. (2024) Intensive Aerobic Cycling Is Feasible and Elicits Improvements in Gait Velocity in Individuals With Multiple Sclerosis: A Preliminary Study. International Journal of MS Care. May 1;26(3):119-24.
  11. Simmons SB, Harris D, Skolaris A, Fricker T, Li Y, Lapin B, Galioto R, Bethoux F, Linder SM. (2023) Aerobic cycling reduces fatigue and improves pain in persons with multiple sclerosis: A preliminary study. Multiple Sclerosis and Related Disorders. Dec 1;80:105102.
Members & Collaborations

Members & Collaborations