Abstract WMP89: Bilateral Priming Followed by Task Specific Training Can Improve Moderate to Severe Post-Stroke Upper Extremity Hemiparesis

Abstract

INTRODUCTION: Priming techniques to facilitate improved motor performance have been examined in stroke rehabilitation research. Reported techniques include transcranial electric (TES) or magnetic (TMS) stimulation, both of which are costly and approved only for research purposes. Here, we examine a motor priming technique which is cost-effective and clinically feasible. This priming technique consists of continuous, symmetrical, rhythmic, wrist flexion and extension. A novel device, the “rocker,” is used which has a mechanical linkage promoting symmetry of both arms. Previous studies examining bilateral priming plus task specific training (TST) found the combination to be more effective than TST alone. However, there have been no studies that: 1) compare bilateral priming to a unilateral version of the same, and 2) examine priming in severely impaired stroke survivors. Hypothesis: The objective of this pilot study was to test our hypothesis that bilateral priming combined with task specific training (TST) would be effective in stroke survivors with severe upper limb impairment. Methods: We collected pilot data in 6 individuals with severe upper extremity hemparesis receiving either bilateral priming or unilateral priming followed by TST. The entire intervention was approximately 4 weeks with a total of 30 hours of priming plus training. Participants were tested at pre-/post-intervention, and at 4-week follow-up. Behavioral Measures included a bilateral motor function measure (Chedoke Arm and Hand Activity Index, CAHAI) and a unilateral measure (Fugl-Meyer Test of Upper Extremity Function, FMUE). Transcallosal inhibition (TCI) persistence was measured using TMS. Results: At post intervention, the bilateral priming group demonstrated a 9 point increase (improvement) as compared to the unilateral one (3.67 point increase) in the CAHAI. The FMUE change scores were 6.0 and 3.66 for the bilateral and unilateral priming groups respectively. Gains persisted at 4-week follow-up. Transcallosal inhibition was more normalized in the bilateral priming group at discharge. Conclusion: In conclusion, we found preliminary evidence to support our hypothesis that bilateral priming plus TST is effective for individuals with severe hemiparesis.