Using AI Systems to Optimize the Clinical Outcome of Stroke Patients

Summary

This project addresses the imminent challenge of providing adequate motor rehabilitation to a growing number of stroke survivors amidst the ageing population, decreasing age of stroke, and shortage of physical/occupational therapists in Hong Kong through AI and precision rehabilitation. To reduce the socioeconomic burden from the stroke survivors' loss of independence and their care (\>HK$15 billion/year), the efficacy of rehabilitation and efficiency of its delivery must be improved. These goals can be achieved by prescribing them with individually tailored rehabilitations predicted to yield maximal functional return. Defining a predictive model for such personalization remains challenging given the immense heterogeneity of stroke. The investigators aim to build an explainable AI system that predicts a subject's recovery potential and the treatment option that may realize this potential based on multi-modal pre-rehab assessments. Data from clinical, neuroimaging, neurophysiological, and multi-omic evaluations will be collected from stroke survivors (N≥400) before they undergo upper limb rehab with usual care, neuromuscular stimulation, robotic training, or acupuncture. Machine learning-extracted data features will be used to train decision-tree and neural-network AI algorithms for robust predictions. As soon as the model is validated, the investigators will deploy it to implement a personalized rehab program in the community. Our model's ability to predict the optimal intervention from a wide spectrum of input modalities distinguishes ours from previous less-than-accurate models. Our interdisciplinary team of 13 PIs with expertise in neurology, PT/OT, acupuncture, electrical/biomed. engineering, robotics, neuroscience, neuroimaging, multi-omics, data science, and clinical trial management will put us in a world-unique position to execute this project successfully and generate opportunities of interdisciplinary education. In the long run, our prediction system will accelerate marketization of new rehab strategies by facilitating their clinical-trial evaluations in more targeted subjects, thereby leading Hong Kong to be a future global hub of innovative rehabilitation.

Conditions

• Acute Stroke Intervention
• Acute Stroke
• Acute Ischemic Stroke

Interventions

OTHER

Acupuncture

Patients will receive 12 weeks of acupuncture with 3 half-hour sessions weekly. Acupoints will include (1) a basic formula of 8 Bo's abdomen acupoints (paretic side, 0.5cm depth vertically) \[66\]; (2) 12 conventional acupoints (bilateral, opposite to paretic side first, 1-4 cm depth vertically) \[67\]; and (3) 3 scalp acupoints (opposite to paretic side, 0.5-cm depth at 15-30 degrees) \[68\]At most 3 additional supplementary acupoints will be included, depending on the clinician's professional judgement. Sterile needles will be used after skin disinfection. Manual rotating manipulation \[69\] will be performed every 10 minutes on the conventional acupoints to achieve De-qi sensation \[70\]. Abdomen and scalp acupoints do not require De-qi. Subjects will be monitored throughout the course of therapy with face-to-face assessments by blinded and trained clinicians after 0, 4, 8, 12 weeks of intervention. Clinical scales will also be recorded at 0 (A0), 8 (A½), and 12 weeks (A1).

OTHER

control group

Subjects in this group will receive the typical post-stroke care offered to stroke survivors of Hong Kong. This care emphasizes restoring function and independence through a comprehensive approach. Physical therapy focuses on improving mobility with exercises and training; occupational therapy helps patients relearn essential daily living skills, facilitating a smooth transition back to everyday life. Speech therapy is integral for addressing communication challenges, and psychological support is provided to help patients manage the emotional impact of stroke. All subjects will receive the above care for 8 weeks (≥3 hourly sessions per week). Clinical scales will be recorded at 0 (A0), 4 (A½), and 8 weeks (A1).

DEVICE

Robotic Training

For this treatment group, CMC (corticomuscular coherence)-EMG-triggered control will assist wrist extension with hand open and wrist flexion with hand close alternately by mechanical pneumatic support \[60\]. During wrist-hand extension, the pneumatic fingers will assist a hand-open motion with constant inflation till the inner pressure reaches 90kPa; during the wrist-hand flexion, the pneumatic fingers will deflate constantly to assist a hand-close motion. To trigger ENMS assistance, two criteria must be met: (1) the average EMGs of target muscles exceed a pre-defined threshold, and (2) a significant CMC peak value with peak frequency in the beta band is captured. Here, the target muscle groups will be the extensor digitorum and extensor carpi ulnaris (ED-ECU) and flexor digitorum and flexor carpi radialis (FD-FCR), and the EMG and CMC will be evaluated during sustained contraction of these muscles over a 3-sec window.

DEVICE

Neuromuscular Electrical Stimulation Group

For this treatment group, constant NMES (70V, 40Hz, 0-300µs square wave bursts \[63\]) will be delivered to the ED-ECU and FD-FCR muscles to assist in wrist-hand extension and flexion, respectively. The pulse width of NMES will be individually adjusted to achieve the maximum muscle contraction with the minimum stimulation intensity. The control strategy of CMC-EMG-triggered NMES will be the same as that used in the robot.

Sponsors & Collaborators

• The Hong Kong Polytechnic University

  collaborator OTHER

• City University of Hong Kong

  collaborator OTHER

• Hong Kong Baptist University

  collaborator OTHER

• The University of Western Australia

  collaborator OTHER

• Chinese University of Hong Kong

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

65 Years

Max Age

80 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-07-01

Primary Completion

2027-12-31

Completion

2028-06-30

Countries

• Hong Kong