TEAM SCIENCE – PROJECT SUMMARY The ultimate purpose of the COBRE in Stroke Recovery is to improve the recovery of those who have suffered a stroke such that long-term quality of life is improved. Our primary focus is on developing and testing mechanism-based interventions to rehabilitate individuals with post-acute or chronic impairments and disabilities. We seek to accomplish this through the following Overall specific aims: 1) Expand our critical mass of funded investigators; 2) Strengthen innovative scientific cores that advance stroke recovery research; and 3) Advance the ongoing development of an independent, sustainable, multidisciplinary thematic research program. Our COBRE has been developing the skills and infrastructure to address the unique healthcare needs of the state of South Carolina (SC). Specifically, SC is in the “buckle” of the stroke belt, having one of the highest incidences of stroke and age-adjusted stroke mortality in the nation.1 Further, it has the 14th largest rural population2 in the nation, and all 46 SC counties qualify in whole or in part as Health Resources & Services Administration (HRSA)-designated Medically Underserved Communities. Thus, there is an overarching need to develop tele-interventions to serve rural communities with limited access to stroke rehabilitation care. Our COBRE has focused on developing innovative tools, methods, and interventions to address the burden of post- stroke disability. Additionally, through innovative approaches in psychosocial functioning and novel device development, our team is invested in ensuring that rehabilitation gains that occur in the clinic translate into lasting gains in an individual’s lived environment. Our interdisciplinary Team Science project brings together engineers, occupational therapists, neuropsychologists, cognitive psychologists, neuroscientists, and data scientists. The research question to be addressed by this COBRE Team Science Supplement is “Can an interdisciplinary team science research approach successfully improve upper extremity (UE) stroke recovery, especially for rural populations, by translating innovative interventions to the home setting?” Specifically, our interdisciplinary team science research project comprises three innovative, synergistic co-projects that use tele-interventions for UE stroke rehabilitation and test three different ways to improve rehabilitation outcomes in the home. 1) The Seo Co-Project aims to improve the adherence to and performance of home-based UE stroke recovery interventions. The project will objectively track and measure the quantity and quality of rehabilitation exercise and use a sensor- based stepped-care behavioral intervention that monitors adherence, administers ecological momentary assessments to obtain a reason for non-adherence, and provides relevant resources. 2) The Aghamoosa Co- Project aims to address the multisystem functional deficits that result from stroke and may pose barriers to UE recovery. The project will address cognitive deficits at the outset of a behavioral activation participation-based telerehabilitation program to substantially improve stroke survivors’ ability to benefit from the intervention by facilitating their learning, planning, organization, and goal management skills and ultimately increasing real-world arm use. 3) The Badran Co-Project aims to use neuromodulation to increase the neuroplasticity underlying UE recovery. The project will test the feasibility of translating a COBRE junior investigator project-developed intervention (transcutaneous auricular nerve stimulation, taVNS) to a home tele-intervention. It proposes lab- based testing of the feasibility of their stimulation-triggering sensors and at-home testing of the safety, feasibility, and acceptability of self-administered auricular neurostimulation during telerehabilitation of post-stroke UE motor deficits in the home setting. Our COBRE has been a leader in developing neuromodulation tools for increasing neuroplasticity in order to improve rehabilitation gains.3-5 However, few innovative tools have been translated into the home environment. Together, the co-projects synergistically advance UE stroke rehabilitation tele- interventions and ultimately can be integrated to maximize the effectiveness of UE interventions and improve the quality of life for rural South Carolina stroke survivors. The team science approach is crucial for successfully developing an interdisciplinary approach that will allow our investigators to improve stroke recovery by translating innovative interventions to the home setting and assuring that they better translate into functional gains in the real world for stroke survivors. Some of the immediate synergies that would result are the use of the movement quality and quantity tracking capabilities developed in the Seo Co-Project being applied to future telerehabilitation interventions such as those in the other Co-Projects. Similarly, the cognitive priming developed by the Aghamoosa Co-Project and the neuroplasticity priming developed in the Badran Co-Project both can be used to augment future telerehabilitation interventions. Our vision is to continue to develop innovative tele-interventions that can be integrated or preferentially selected to maximize the effectiveness of UE interventions through personalization to the deficits of each individual. In conclusion, our COBRE is uniquely poised to address serious health deficits faced by SC and other IDeA states through a team science effort to develop novel tele-interventions designed to produce lasting functional improvements in the home setting – especially those in rural communities and for those without reliable access to rehabilitation care.

TEAM SCIENCE – PROJECT NARRATIVE The ultimate purpose of the COBRE in Stroke Recovery is to improve the recovery of those who have suffered a stroke such that long-term quality of life is improved. Our COBRE is uniquely poised to address serious health deficits faced by SC and other IDeA states through a team science effort to develop novel tele-interventions designed to produce lasting functional improvements in the home setting – especially those in rural communities and for those without reliable access to rehabilitation care.