ArmCoach4Stroke

2020

A stroke is a common and disabling disorder that often affects arm activities. After stroke intensive arm therapy is essential for gaining and retaining functional improvements.  However, due to high costs, therapist shortages, patient burden, and adherence issues, intensive arm treatment is underutilized and will become increasingly challenging in the future. Therefore, there is an urgent need for sustainable, technology-supported, and motivating home-based treatment, with therapist supervision only when necessary.

The Focus
The multidisciplinary ArmCoach4Stroke project aims to develop and evaluate an interactive and innovative therapy aid using movement sensors to enhance daily arm use and exercise at home. This system provides personalized feedback to patients and therapists based on objective data, promoting tailored therapy outside clinical settings.

The Research
The ArmCoach4Stroke system consists of two sensor/feedback wrist units, additional exercise sensors, and a tablet application for real-time performance monitoring and therapist-defined exercises. The system is easy to use and patient friendly. Patients receive vibrotactile feedback to encourage arm usage (based on pre-set targets), while exercise exercise performance is quantified in quantity (e.g. numbers of repetitions) and quality metrics (e.g. speed). The summary data from daily activities and exercises are transmitted for remote monitoring, facilitating direct patient-therapist interaction and improving rehabilitation outcomes.

By collaborating with patients, therapists and other (end)users, ArmCoach4Stroke aims to optimize implementation in healthcare, filling a crucial gap in intensive arm therapy for stroke survivors and enhancing their daily function and quality of life. ArmCoach4Stroke makes rehabilitation care more efficient and sustainable for this vulnerable and growing group.

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Funded

Contact person:

Dr. J.B.J. Bussmann

Principal investigators

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ARENA-PRIME

2018
The former CVON-ARENA programme (2012-2017) advanced understanding of cardiac RNA species in heart failure (microRNAs, lncRNAs and circular RNAs).The CVON-ARENA programme (2012-2017) advanced understanding of cardiac RNA species, such as microRNAs, lncRNAs, and circular RNAs, in various forms of heart failure (HF). This subsequent DCVA-ARENA-PRIME programme (2018-2023) targets treatment-resistant HF forms, particularly in younger patients with dilated cardiomyopathy (DCM) or arrhythmogenic cardiomyopathy (ACM). The Focus In preceding decades, conventional therapies have notably enhanced the survival rates of heart failure (HF) patients. However, a subset of individuals, particularly younger patients afflicted with dilated cardiomyopathy (DCM) or arrhythmogenic cardiomyopathy (ACM), still confront disease progression despite these treatments. This underscores the necessity for innovative approaches. The DCVA-ARENA-PRIME initiative aims to address this gap by focusing on the development of novel gene therapies tailored to the specific disease mechanisms underlying DCM, attributed to mutations in the RBM20 and LMNA genes, as well as ACM, and associated with mutations in the DSGL2 and PKP2 genes. The goal is to progress towards first-in-human clinical trials, particularly focusing on LMNA disease, and to establish preclinical proof-of-concept for ACM therapies targeting DSGL2 and PKP2. The Research The DCVA-ARENA-PRIME researchers utilize insights from previous programmes on cardiac gene therapies (e.g., inhibitory RNAs such as allele-specific short hairpin RNAs, antimiRs, etc.) and gene editing technologies (e.g., base- and prime editing) to develop novel treatments for dilated cardiomyopathy (DCM) and arrhythmogenic cardiomyopathy (ACM). This effort is supplemented by advanced research on adeno-associated viral vectors and the integration of heart tissue collections with cutting-edge sequencing technologies (like single-cell sequencing) to further explore disease mechanisms. At the beginning of the DCVA-ARENA-PRIME programme, a (end-) user committee has been established, making sure that (end-)users are  closely involved in the design of the studies and the implementation of the co-created studies and deliverables. This committee meets annually alongside the program's research meetings to provide guidance to investigators on optimizing the program's outcomes for (end-) users. It addresses all feedback, inquiries, and recommendations, whether requested or spontaneous. This committee meets once per year in conjunction with the programme’s research meetings and advises the investigators about the course of the programme and what actions need to be taken in order to maximise the probability that the (end-) users will be able to utilize and/or benefit from the results. This committee addresses any comments, remarks, questions and advice they may have, solicited or otherwise. The members of the DCVA-ARENA-PRIME user committee include cardiomyopathy patients and their relatives, clinicians (e.g. cardiologists), representatives from related research programs (e.g., RegMedXB, H2020-TRAIN-HEART), and industry stakeholders including biotech and pharma company representatives and venture capitalists. Supporting Young Investigators The programme prioritizes attracting and nurturing young talent, providing hands-on training and fellowship awards to facilitate their career development. Over 20 young investigators participate, benefiting from exposure to collaborative research environments. To further support this career development, five fellowship awards of 50.000€ have been granted the past three years to junior postdoctoral researchers in the laboratories of the Hubrecht Institute, University Medical Center Utrecht, Amsterdam UMC (location VUmc and AMC) and Maastricht University.
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IN CONTROL II

The IN-CONTROL II consortium builds upon the success of IN-CONTROL I, which highlighted the pivotal role of the microbiome in low-grade inflammation associated with atherosclerotic cardiovascular diseases (CVD) and related risk factors such as lipid levels and microbiome-derived metabolites. These insights are crucial for addressing the rising rates of CVD-related mortality, particularly in aging and overweight populations. The Focus The objectives of IN-CONTROL II are to: Investigate the mechanisms underlying trained immunity in CVD patients, considering factors like senescence, age, sex, and obesity. Elucidate the interactions between microbiome-derived signals (aromatic amino acids, metabolites, bile acids) and immune senescence in obesity-related cardio-metabolic diseases. Identify novel therapeutic targets and develop pharmacological and microbiome-based therapies to counteract inappropriate induction of trained immunity and inflammation in cardiovascular disease. The Research The consortium aims to shift from association to causality, from population-based cohorts to patient groups with atherosclerotic cardiovascular disease (CVD) and from observation to intervention. In this transition, it will also take advantage of recent developments in the network of the consortium, delineating cellular senescence as a druggable target for the broad spectrum of age-related chronic diseases, including cardiovascular diseases, and identification of components of the bile acid-signaling system for this purpose. Another recent development of the recognition of innate immune memory (‘trained immunity’) as pathophysiological mechanism in atherosclerotic CVD. The consortium will conduct proof-of-principle trials in specific patient cohorts, employing advanced experimental techniques such as systems biology, single cell sequencing, innovative animal models, and metabolic flux quantification (fluxomics). A talent program will facilitate knowledge transfer and skill development for young researchers within the consortium, emphasizing rapid translation of research findings into clinical applications.
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