Educational Opportunities

Workshops

State of the Science (SOS) Workshop

Hosted by RIC & UCSD

Functional Restoration for the Stroke Survivor:

 Informing the Efforts of Engineers

Sea Lodge Hotel, La Jolla , CA

March 7–8, 2006

Guidelines for speakers AT SOS Workshop

Session Format

Workshop sessions will last 1½ hours with the exception of the Muscle Session which will last 2 hours and the Final Discussion which may be a bit shorter.

The objective of each session is to summarize our understanding of the State of the Science in relation to each topic listed, with the view towards:

• developing consensus about things that we know;
• defining critical approaches to address the things that we do not know; and
• proposing conceptual pathways or experimental approaches to fill in the gaps in our knowledge.

Session Breakdown

Moderators – 10 minutes

Moderators will introduce speakers, guide the discussion, and impose time limits on speakers.  The critical duty of the Moderator will be to attempt to establish consensus or to frame key unresolved questions for further investigation. 

Discussion Leaders – 25 minutes

Lead discussants will highlight key issues in the field, basing the presentation in part on his or her own laboratory observations, but also drawing on relevant material from others in the field. The lead discussant will focus on identifying the things that we know, and describing the areas where our knowledge is incomplete by trying to define realizable objectives.

We are suggesting that each discussion leader prepare 15 slides (e.g., in PowerPoint) to be presented in a 20 minute period with 5 minutes at the end for questions and answers.  To allow time for Workshop Respondents and Participants to prepare their responses and counterpoint slides, we hope to have all of these slide presentations available by Monday, February 20, 2006.

Respondents – 25 minutes

Each of 2 Respondents will be asked to prepare no more that three slides to critique, amplify, or oppose the material presented by the Discussion Leader. Respondents will receive lead discussant’s information two weeks before the meeting, and will be required to submit their slides by Monday, February 27, 2006.  Moderators will allow the 2 Respondents approximately 12 minutes each for them present their slides and to field questions.

Counterpoint – 30 minutes

All participants in the workshop are encouraged to present a counterpoint slide for one or multiple sessions.  Counterpoint slides can be in response to either the presentations of lead discussants or respondents.  Each Session Moderator will allow for no more than 2 minutes for each Counterpoint Respondent.  Therefore, if at all possible these slides should be provided to the Workshop coordinators before Monday, March 6^th.  At the very latest, Counterpoint slides should be loaded on the presentation computer prior to the session.

Discussion Summary and Recordings

All discussion will be taped, and a court reporter will capture both the presentations and the oral discussion that follows.  To ensure the best quality record, Workshop organizers will ask everyone who presents to speak into a microphone so that all comments are best captured by the court reporter.

Publication Plans

The plan is currently to synthesize this discussion into a manuscript, which will highlight the key advances and limitations in the field. The manuscript will be submitted for publication to Topics in Stroke Rehabilitation, a Medline listed quarterly journal.

Timeline

Presentations Requested:                                       Due Date:

Lead Discussant PowerPoint Slides (15)              Monday, February 20, 2006

Respondent’s Slides (3)                                          Monday, February 27, 2006

Counterpoint Slide (1)                                              Before, March 6^th if possible

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Session Questions for Speakers at SOS Workshop

Session 1                                                                

Moderator – Bruce Dobkin, MD, University of California Los Angeles (UCLA)

Physiology/Pathophysiology of Neural Plasticity

Discussion Leader: Jeffery Kleim, PhD, University of Florida Department of Neurosciences

Respondents:

·        Lumy Sawaki, MD PhD, Wake Forest

·        Nicho Hatsopoulos PhD, University of Chicago

Suggested Questions/Themes:

1.      What is the relation between structural and functional change in cortex following novel environmental exposure?

2.      Does there need to be structural change for permanent functional change to occur?

3.      What is the time course of changes in cortical function vs. structural change?

4.      Do we know what biological processes underlie these changes?

5.      What biochemical/synthetic pathways are engaged?

6.      Do changes in synaptic function precede overt structural changes in cortex?

7.      What mechanisms underlie changes in cortical maps in normal animals?

8.      Do similar mechanisms apply in pathological states, like stroke?

9.      Are there biases in certain areas of the nervous system towards plasticity?

10. What is the relationship between motor learning, motor adaptation, and plasticity?

Session 2                                                                

            Moderator - Sandro Mussa-Ivaldi, PhD,  Northwestern University and Rehabilitation Institute of Chicago

Motor Learning

Discussion Leader: Dave Reinkensmeyer, PhD, University of California-Irvine

Respondents:

·        Bob Scheidt, PhD, Marquette University

·        Kurt Thoroughman, PhD, Washington University in St. Louis

Suggested Questions/Themes:

1.      Terminology: What do we mean by the terms motor learning, plasticity and adaptation?

2.      What brain sites are engaged in motor learning?

3.      In practical terms, do lesions in particular areas adversely affect learning?

4.      How do we distinguish learning from other sources of behavioral change?

5.      What synaptic or structural processes underlie motor learning?

6.      Do different sensory systems play different roles in learning?

7.      Can we describe the time course of such learning mathematically?

Session 3                                                                

Moderator: Jim Patton (RIC/NU)

Upper Extremity Rehabilitation

Discussion Leader: Mindy Levin, PT, PhD, Physical Therapy Program, McGill University

Respondents:

·        Michelle Johnson, PhD,  ( Marquette ) – Confirmed

·        Jiping He, PhD, Arizona State University – Confirmed

Suggested Questions/Themes:

1.      Should a UE robot be used initially as a passive motion device, especially during early phases of stroke or SCI recovery?

2.      If a robot is to be used to impose forces, what types of loads should be used? Elastic, viscous, inertial, or a combination?

3.      What type of controllers should we use - impedance based (resistive) or “cooperative” (guidance) controllers?

4.      Do we know how to use robotics for restoration of three-dimensional (as compared with two-dimension) movements? How does gravity play a role?

5.      Should we use task based training algorithms? Is there a consensus on what we mean when we say task-based?

6.      What outcome measures should we use? Kinematic, kinetic or clinical scales including ADL’s?

7.      What is the relation between visual and cognitive attention and functional outcomes?

Session 4                                                                

Moderator –Richard Harvey, MD (RIC)

Neuroimaging/Brain Imaging

Discussion Leader: Steve Cramer, MD, University of California-Irvine

Respondents:

·        Steve Small, MD, PhD University of Chicago – Confirmed

·        Bruce Dobkin, MD (UCLA) – Tentatively Confirmed

Suggested Questions/Themes:

1.      What is the time course of cortical reorganization as evidenced by FMRi following application of environmental changes?

2.      What is the relation between structural change in cortex and imaging changes?

3.      What is the relation between recovery of function and imaging changes – do they co-vary in time?

4.      Technical issues – can DWT methods help us identify critical pathway damage in stroke?

5.      How can imaging help guide rehabilitation choices?

Session 5                                                                

Moderator: Sam Ward, MD, UCSD

Introductory Comments (Sam Ward, MD)-15 min            

Clinically Relevant Alterations in Skeletal Muscle

Discussion Leader: Rick Lieber, PhD, UC San Diego

Respondents:

·        Kenneth Baldwin, PhD, UC-Irvine

·        Vince Caiozzo, PhD, UC-Irvine

Suggested Questions/Themes:

1.      Structural and mechanical changes in muscle due to Spasticity

2.      Muscle physiological and biological response to "overload"

3.      Mechanical/biological control of muscle longitudinal growth

Session 6                                                                            

Moderator – David Reinkensmeyer, PhD (UC - Irvine )

Lower Extremity Rehabilitation

Discussion Leader: Susan Harkema, PhD, Neurological Surgery, University of

Louisville

Respondents:

·        Steve Kautz, PhD, VA and the University of Florida Gainesville – Confirmed

·        George Hornby, PT, PhD, (UIC/RIC) –Confirmed

Suggested Questions/Themes:

1.      Can robots be used to restore pattern generator function in SCI? What about stroke? Is the pattern generator altered?

2.      What control approaches are likely to be best? Position, impedance, or cooperative control strategies?

3.      Should robots be used as position control devices early in recovery?

4.      Should they be switched to force based controllers as recovery proceeds?

5.      How do we determine the transition point between control strategies?

6.      What do we do about restoration of axial muscle control, and of balance and posture?

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