Reimagining pain assessment after stroke

A UM researcher is examining portable brain-monitoring technology, which could support more individualized rehabilitation and improve the assessment of shoulder pain following stroke. 

Dr. Mirella Veras, assistant professor of physical therapy at the College of Rehabilitation Sciences, is leading the pilot study through the Artificial Intelligence for Rehabilitation Laboratory (AIRE Lab), which she runs out of the rehabilitation hospital at Health Sciences Centre. 

Veras said post-stroke shoulder pain is a common disabling complication that can interfere with a person’s participation in rehabilitation. It can also delay motor recovery, disrupt sleep and reduce quality of life. 

“Pain can create a significant barrier to rehabilitation after stroke,” Veras said. “Our goal is to better understand how the brain responds to pain during movements that are relevant to rehabilitation and, ultimately, to support more individualized approaches to assessment and treatment.” 

The project will use functional near-infrared spectroscopy (fNIRS), a portable and non-invasive neuroimaging technology, to monitor changes in brain activity while participants complete different shoulder-related tasks. The study will be conducted at the AIRE Lab, where her team will operate the equipment and ensure appropriate sensor placement and data quality.  

Veras said an advantage of fNIRS is its portability, which may allow brain activity to be assessed in a wider range of real-world environments, including rehabilitation clinics and other community or clinical settings.  

Veras expects the study to include about 20 participants beginning in September. Her research team – which includes five student researchers – will determine the safety and feasibility of the protocol and explore whether machine-learning approaches can identify patterns that may eventually support more objective and individualized monitoring of pain. 

“This is an early feasibility study, so we are not using the technology to diagnose pain,” Veras said. “We are examining whether it can help us understand pain-related brain responses during rehabilitation activities and guide rehabilitation and the design of larger studies.” 

Student research opportunities 

The project is also providing interdisciplinary research training for undergraduate and graduate students. 

Timothy Igbokwe, an M.Sc. student in rehabilitation sciences, received a $5,000 award from Riverview Health Centre to support his work on the project. He moved to Winnipeg from Nigeria last September to pursue his master’s degree. 

“Dr. Veras and I share an interest in using technology to improve the quality of life of people who have experienced a stroke. Some people experience communication difficulties after a stroke, which can make it challenging to describe their pain,” Igbokwe said.   

“My research is exploring whether fNIRS can provide additional information about brain activity during painful movement and complement existing clinical pain assessments.” 

Bliss Earnest, who is completing a bachelor of arts in psychology, is on a summer research placement with the lab, assisting with the development and standardization of study protocols and creating educational and instructional videos. 

“I'm working on a review article about the use of the technology to measure pain and how that can be used to develop interventions for acute and chronic pain management,” she said. 

“I'm really interested in chronic pain research now and I can connect that to my field of study. Chronic pain is very connected to mental health, and the people who live with chronic pain don’t necessarily have a lot of support for their mental health, so that’s another area I want to explore in the future.” 

 Veras said the students bring “different but complementary skills” to the project. 

“They are gaining hands-on experience with pain assessment, neuroimaging, research methods, knowledge translation and responsible innovation while helping us build a stronger and more reproducible study.”