Abstract
Functional impairment of the upper limb (UL) after stroke is a great problem. Finding methods that can improve UL function after stroke is a major concern to all medical service providers. This study was intended to compare the effect of upper limb task specific training (TST) on brain excitability of the affected hemisphere and motor function improvements in patients with left and right stroke. Forty male patients with mild impairment of UL functions were divided into two equal groups; G1 consisted of patients with left hemisphere affection (right side stroke) while G2 consisted of patients with right hemisphere affection (left side stroke). All patients received TST for the affected UL for one hour, three sessions per week for six consecutive weeks. Evaluation was performed twice, pre-, and post-treatment. Outcome measures used were Wolf Motor Function Test (WMFT) and Box and Block Test (BBT) as measures of UL motor function and Quantitative Electroencephalogram (QEEG) of motor and sensory areas of the affected hemisphere as a measure of brain reorganization post-stroke. Both groups showed improvement in motor function of the affected UL measured by WMFT and BBT with reported significant difference between them. G1 showed greater improvement in motor function of the affected UL post-treatment compared to G2. Additionally, there was a significant increase in peak frequency of motor and sensory areas with higher and significant excitability in G1 only. These findings imply that brain reorganization in the left hemisphere responded more to TST compared to the right hemisphere. Based on findings of the current study, we can recommend adding TST to the physical therapy program in stroke patients with left hemisphere lesions.
Highlights
Stroke is considered one of the main causes of disability in adults
Patients were included in the study if age ranged from 47–64, diagnosed with first ever ischemic/hemorrhagic stroke resulting in hemiparesis; confirmed by Magnetic Resonance Imaging (MRI) and the treating neurologist, stroke duration ranged from 6–24 months, medically stable, scored >24 on the Mini-Mental State Examination (MMSE); joints of the affected upper limb (UL) scored grade 1 on the Modified Ashworth Scale (MAS); mild impairment on Fugl Meyer Scale-Upper Extremity (FMA-UE), and if the affected UL scored 2 for tactile sensation and stereognosis 3 for kinesthetic sense on the Nottingham Sensory Assessment (NSA) scale
We found that task-specific training (TST) produced significant improvements in the functional ability of the affected UL, which were similar in patients with left hemisphere lesion and right hemisphere lesion, and confirmed by post-treatment scores of Wolf Motor Function Test (WMFT) and Box and Block Test (BBT)
Summary
Function is a direct result of stroke. Common UL impairments after stroke include paresis, abnormal muscle tone, and/or changes in somatosensation. These impairments are caused by direct damage to the primary motor and somatosensory cortex, secondary sensorimotor cortical areas, subcortical structures, and/or the corticospinal tract [2]. Due to the residual disability caused by stroke, there is an increased incidence of mortality. Patients with stroke experience loss of motor control. An important principle of motor relearning is specificity of practice or in other words task-specific training (TST) [5]. Movements performed consist of motor tasks that focus on an improvement in performance through goal-oriented practice and repetition [7] with the aim of acquiring functional skills. It is well recognized that any movement is the result of interaction between the subject, the task, and the environment, where the task takes place [8,9]
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