Abstract
BackgroundRecovering useful hand function after stroke is a major scientific challenge for patients with limited motor recovery. We hypothesized that sequential training beginning with proximal bilateral followed by unilateral task oriented training is superior to time-matched unilateral training alone. Proximal bilateral training could optimally prepare the motor system to respond to the more challenging task-oriented training.MethodsParticipants: Twenty-six participants with moderate severity hemiparesis Intervention: Participants received either 6-weeks of bilateral proximal training followed sequentially by 6-weeks unilateral task-oriented training (COMBO) or 12-weeks of unilateral task-oriented training alone (SAEBO). A subset of 8 COMB0 and 9 SAEBO participants underwent three functional magnetic resonance imaging (fMRI) scans of hand and elbow movement every 6 weeks. Main Outcome Measures: Fugl-Meyer Upper extremity scale, Modified Wolf Motor Function Test, University of Maryland Arm Questionnaire for Stroke, Motor cortex activation (fMRI).ResultsThe COMBO group demonstrated significantly greater gains between baseline and 12-weeks over all outcome measures (p = .018 based on a MANOVA test) and specifically in the Modified Wolf Motor Function test (time). Both groups demonstrated within-group gains on the Fugl-Meyer Upper Extremity test (impairment) and University of Maryland Arm Questionnaire for Stroke (functional use). fMRI subset analyses showed motor cortex (primary and premotor) activation during hand movement was significantly increased by sequential combination training but not by task-oriented training alone.ConclusionsSequentially combining a proximal bilateral before a unilateral task-oriented training may be an effective way to facilitate gains in arm and hand function in those with moderate to severe paresis post-stroke compared to unilateral task oriented training alone.
Highlights
Recovering useful hand function after stroke is a major scientific challenge for patients with limited motor recovery
Progress in improving hand function has been demonstrated in participants with substantial residual function using task-oriented constraint-induced therapy (CIT), such results do not occur in participants with more severe limb impairment [1,2,3,4,5,6]
We proposed that sequencing proximal bilateral and unilateral task-oriented arm training strategies would provide an improvement over a single approach and reach a wider severity range of participants
Summary
Recovering useful hand function after stroke is a major scientific challenge for patients with limited motor recovery. The recovery of useful hand function after stroke is a major clinical challenge for individuals with moderate to severe paresis. Studies targeting more severe populations show promising results but are limited to proximal training approaches and do not result in improvements in paretic (P) hand function [7,8,9,10,11]. Innovative training strategies targeting active rehabilitation of hand and arm function for those with moderate to severe hemiparesis are needed. We proposed that sequencing proximal bilateral and unilateral task-oriented arm training strategies would provide an improvement over a single approach and reach a wider severity range of participants
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
