Upper extremity trials to improve motor recovery and arm use
We know high doses of repetitive practice can improve arm function post-stroke, but how can we deliver more therapy without great expense or resources? Dr. Eng paved the way in developing effective treatments to improve arm function after stroke that required little cost and could be easily implemented in today’s health care system. She and her doctoral student, Jocelyn Harris developed the Graded Repetitive Arm Supplementary Program (GRASP), which is a patient self-managed arm and hand exercise program. Her team showed that this novel method of service delivery improved arm function over a control group in a multi-site randomized controlled trial during subacute rehabilitation published in the journal Stroke. For more information, please visit the GRASP page of this website. Variations of GRASP have been tested (Home-GRASP, Group program in the community and Virtual program for chronic stroke) by team members Dr. Lisa Simpson and Dr. Chieh-ling Yang. Drs. Eng, Simpson and Carlo Menon (Professor with ETH Zurich) spearheaded the development of a wearable sensor to measure “grasp counts” of the hand. This device was paired with GRASP and shown to improve everyday use of the arm and hand in a multi-site RCT.
Mobility trials to improve walking and to reduce secondary complications after stroke
Secondary complications such as heart disease, falls and fractures are common after stroke. Dr. Eng’s team (including Dr. Marco Pang, Dr. Dan Marigold) contributed to the development of the group-based community program, Fitness and Mobility Exercise (FAME) Program (fameexercise.com) for stroke. In a series of randomized controlled trials (including a 11-site, 186 patient trial), FAME improved cardiovascular fitness, bone density, postural reflexes, walking, balance, and reduced falls over active controls (e.g., weight-bearing exercises, tai chi). Importantly, Dr. Teresa Liu-Ambrose (co-Director of the Centre for Aging SMART) undertook the first study to show that exercise (FAME) can improve cognition in chronic stroke in a 2022 RCT published in JAMA Network Open where cognition was the primary outcome.
Dr. Eng developed the DOSE protocol and operated it across 6 sites over 3 provinces. The protocol was unique in being progressed by heart rate and step counters to reach specified targets. Physical therapists and rehabilitation assistants could utilize any exercises or equipment that was available to them (e.g., steppers, treadmill) to reach these targets. The 4-week once daily DOSE protocol improved walking function and quality of life by clinically meaningful amounts when applied on stroke rehabilitation admission. Gains in walking endurance were retained at a 1 year follow-up period over usual care and the study was published in the journal Stroke. As a follow-up, she then delivered a stepped-wedge implementation randomized controlled trial across 12 sites in 6 provinces (n=306) of this protocol that showed that the protocol could be successfully implemented to change the practice of entire inpatient stroke units.
CanStroke Recovery Clinical Trials Platform
Dr. Eng helped to establish the CanStroke Recovery Trials Platform which is the world’s first clinical trial platform dedicated to stroke recovery. She currently serves on the executive. This is a national platform that operates high impact clinical trials across Canada. The Platform includes harmonized training programs for coordinators; standardized outcome measures; and mentorship of the next generation of researchers to gain expertise in stroke recovery clinical trial operation. CanStroke is currently operating trials that test pharmaceuticals to improve brain recovery; exercise protocols delivered by videoconferencing that can reach all regions of Canada; as well as wearable devices that can help motivate practice to improve function.