Abstract
The aim of this study was to compare the effects of bilateral arm training with auditory cueing (BATRAC) versus control intervention on motor performance of the upper extremity (UE) and to explore the central neurophysiological mechanism underlying this effect in moderately impaired chronic stroke patients. This was a randomized-controlled clinical trial. Overall, 76 chronic stroke patients (mean age = 50.2 ± 6.2 years), 6–67 months after the onset of the first stroke were enrolled. They received either BATRAC (with both UE trained simultaneously in symmetric and asymmetric patterns) or control intervention (unilateral therapeutic exercises for the paretic UE). Each session lasted for 1 h, scheduled as three sessions/week (on an alternate day) for 8 successive weeks. Outcome measures included the Fugl-Meyer motor performance test for the UE (FMUE) and percutaneous transcranial magnetic stimulation to elicit motor-evoked potential (MEP) in paretic abductor pollicis brevis muscle. Group comparisons indicated a significantly better improvement in the MEP parameters (transcranial magnetic stimulation threshold, central motor conduction time, and MEP amplitude) in the BATRAC group. The FMUE scores increased in both groups, but there was no significant difference between groups in the FMUE scores. These findings recommend the use of BATRAC in chronic stroke patients not only to improve motor performance but also to induce central neurophysiological effects.
Highlights
Upper extremity (UE) hemiparesis is the most common poststroke disability and its recovery is often limited
Bilateral arm training (BAT) with rhythmic auditory cueing (BATRAC) is based on motor learning principles including repetition, feedback, and goal setting with the aim of overcoming learned nonuse and relative inactivity [10,11]
This study aimed to investigate the efficacy of BATRAC versus a unilateral UE rehabilitation program (UUERP), as a control intervention (CI), on both UE motor performance and motor-evoked potential (MEP) changes in moderately impaired chronic stroke patients
Summary
Upper extremity (UE) hemiparesis is the most common poststroke disability and its recovery is often limited. Bilateral arm training (BAT), which includes a number of different training techniques with the use of both UE to complete a task, has been used in treating stroke survivors at all levels of arm impairment with a positive overall outcome [5]. BATRAC is based on motor learning principles including repetition, feedback, and goal setting with the aim of overcoming learned nonuse and relative inactivity [10,11]. It includes the use of the nonparetic UE as a fundamental component of the training, on the basis of interlimb coupling theory, where the two UE act to form a neurofunctional unit [12]
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