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Drivers and Consequences of Movement Anxiety after Stroke

Award Number: K23HD120657
ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 09/01/2026
PERIOD OF PERFORMANCE END DATE: 08/31/2031

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Drivers and Consequences of Movement Anxiety after Stroke - PROJECT SUMMARY After stroke, many individuals underuse their paretic upper extremity (UE) despite sufficient motor capacity, limiting functional recovery. One potential cause of UE underuse is movement anxiety—the fear that movement may worsen pain, cause injury, or trigger recurrence of a medical event. Previous studies have found that 48– 83% of stroke patients experience movement anxiety, but have mainly focused on walking and balance. Movement anxiety relating to UE use is less well understood, and no rehabilitation interventions currently target this issue. This gap in knowledge leaves a potentially modifiable barrier to recovery unaddressed. In this study, we will close this gap by prospectively tracking UE movement anxiety in subacute stroke patients during inpatient rehabilitation. We will measure movement anxiety using the Tampa Scale of Kinesiophobia and will characterize patient and rehabilitation factors using clinical scales and the electronic health record. We will also use wrist-worn accelerometers to measure a 24-hour epoch of spontaneous UE use. In Aim 1, we will identify patient factors that predict higher levels of movement anxiety. We hypothesize that UE pain will be the primary contributor to movement anxiety, with pain catastrophizing a secondary contributor. In Aim 2, we will identify patient and rehabilitation factors that influence change in movement anxiety during the inpatient rehabilitation course. We hypothesize that reductions in UE pain and pain catastrophizing will relate to reductions in movement anxiety. In Aim 3, we will determine the relationship between movement anxiety and UE use. We hypothesize that higher movement anxiety predicts lower UE use and vice versa. The proposed research is significant because it would identify at-risk patients, guide the development of targeted interventions, and justify the need to address movement anxiety in rehabilitation. The proposed research is innovative because it examines a surprisingly understudied psychological challenge using gold-standard and quantitative methods. By identifying movement anxiety as a modifiable contributor to UE underuse, this study lays the groundwork for early screening and targeted interventions to enhance rehabilitation engagement and recovery. To accomplish the proposed work, Dr. Shi has assembled a mentoring and advisory team of seasoned investigators and clinicians who will oversee her conceptual, technical, and professional development. In addition to her hands- on research experience, Dr. Shi will undertake tutorials, coursework, and shadowing to build her knowledge in clinical research execution, translating psychological insights into rehabilitation, motion data capture and processing, and advanced statistical analyses. This enhanced skillset will enable Dr. Shi to integrate psychological insights into stroke rehabilitation, opening new therapeutic avenues to advance the field of neurorehabilitation.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $179,495 )
2026	2026	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Child Health and Human Development Extramural Research	000	1	8/31/2026	NEW	$179,495
														Subtotal = $179,495

Grand Total All Awards = $179,495

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Drivers and Consequences of Movement Anxiety after Stroke

Award Number: K23HD120657

ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 09/01/2026

PERIOD OF PERFORMANCE END DATE: 08/31/2031

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