Maximum Pinch Research Articles

Hand Grip and Pinch Strength in a Healthy Children Norms for 6 to 18 Years in Al-Kharj City, Kingdom of Saudi Arabia

Background: Measuring and comparing grip and pinch strengths with their normative data is a valid method to detect intensity of the numerous damages of hand. The aim of the study was to establish the normative data of grip strength and three types of pinch strengths (Key, Tip and Palmar) in healthy Saudi’s children. Method: In this cross-sectional study, of grip strength and three types of pinch strengths (Tip, Key and Palmar) were recorded for 82 healthy children (41 boys and 41 girls) heathy children aged 7-18 years. The Camry Electronic Hand Dynamometer and Hydraulic Pinch Gauge were used to measure grip strength and pinch strength, respectively. Result: Normative data of grip and pinch strengths were provided. Grip and pinch strengths of both genders were close to each other’s and increasing consistently with increasing age. The maximum grip strength and pinch strength was obtained in the group of 14-18 years among both genders. In addition: Study results showed that there was a significant association between weight and all the hand grip strength and pinch strength (p < 0.05) in boys whereas BMI considered as an effective parameter on grip strength and tip pinch strength in girls. Conclusions: Findings from the present study provide reference values for hand grip strength and pinch strength for healthy children from 6- which will be useful to guide rehabilitation outcomes in routine clinical practice.18 years of age which will be useful to guide rehabilitation outcomes in routine clinical practice.

Explicit and implicit motor simulations are impaired in individuals with aphantasia.

Individuals with aphantasia report having difficulties or an inability to generate visual images of objects or events. So far, there is no evidence showing that this condition also impacts the motor system and the generation of motor simulations. We probed the neurophysiological marker of aphantasia during explicit and implicit forms of motor simulation, i.e. motor imagery and action observation, respectively. We tested a group of individuals without any reported imagery deficits (phantasics) as well as a group of individuals self-reporting the inability to mentally simulate images or movements (aphantasics). We instructed the participants to explicitly imagine a maximal pinch movement in the visual and kinaesthetic modalities and to observe a video showing a pinch movement. By means of transcranial magnetic stimulation, we triggered motor-evoked potentials in the target right index finger. As expected, the amplitude of motor-evoked potentials, a marker of corticospinal excitability, increased for phantasics during kinaesthetic motor imagery and action observation relative to rest but not during visual motor imagery. Interestingly, the amplitude of motor-evoked potentials did not increase in any of the conditions for the group of aphantasics. This result provides neurophysiological evidence that individuals living with aphantasia have a real deficit in activating the motor system during motor simulations.

Maximum trunk tip force assessment related to trunk position and prehensile 'fingers' implication in African savannah elephants.

African elephants have a wide range of abilities using their trunk. As a muscular hydrostat, and thanks to the two finger-like processes at its tip, this proboscis can both precisely grasp and exert considerable force by wrapping. Yet few studies have attempted to quantify its distal grasping force. Thus, using a device equipped with force sensors and an automatic reward system, the trunk tip pinch force has been quantified in five captive female African savanna elephants. Results showed that the maximum pinch force of the trunk was 86.4 N, which may suggest that this part of the trunk is mainly dedicated to precision grasping. We also highlighted for the first time a difference in force between the two fingers of the trunk, with the dorsal finger predominantly stronger than the ventral finger. Finally, we showed that the position of the trunk, particularly the torsion, influences its force and distribution between the two trunk fingers. All these results are discussed in the light of the trunk's anatomy, and open up new avenues for evolutionary reflection and soft robot grippers.

Size, but not sex, predicts pinch force and exoskeleton mechanical properties in crayfish of the genus Faxonius

AbstractStudies of animal weaponry and defensive structures rarely take into consideration their underlying mechanical properties. We measured the compressive strength and thickness of the exoskeleton of the claw (chela) in two North American crayfish species, Faxonius virilis and F. limosus. We performed similar measures on the carapace, a body region not directly involved in agonistic contests. Males of both species generated significantly stronger maximum pinch forces than females. However, these differences can be attributed to differences in claw size between the sexes. The thickness (ultrastructure) of the claw exoskeleton was a significant predictor of its compressive strength and likely explained the difference in compressive strength we observed between the two species. Neither claw thickness nor claw compressive strength was correlated with maximum pinch force. Additionally, we found that crayfish body size was a strong predictor of carapace compressive strength and thickness, whereas sex was not. The claw had greater compressive strength and thickness than the corresponding values for the carapace. Our study shows that the mechanical properties of the crayfish exoskeleton are largely a function of size and highlights the need to integrate mechanical properties into studies of animal morphology and performance.

Metacarpophalangeal joint angle of the thumb during maximal pinch strength: a study of healthy volunteers.

Mean metacarpophalangeal joint angles of the thumb during maximal pinch were 9° greater in men than in women. More flexion was not associated with more force during key pinch, but a moderate association was found for palmar pinch, especially in men.

In-vivo kinematics of the trapeziometacarpal joint in dynamic pinch motion using four-dimensional computed tomography imaging.

CT imaging precisely and quantitatively analyzes the kinematics of the carpal bones to evaluate the etiology of related osteoarthritis. Previous studies have investigated the kinematics of the trapeziometacarpal joint using static CT scans of various postures including the pinch position. This study analyzed the in-vivo kinematics of the trapeziometacarpal joint during dynamic pinch motion in young healthy volunteers using four-dimensional CT. Twelve healthy young volunteers participated in this study. Each participant held the pinch meter between their thumb and index finger and pinched it with maximum force for a period of 6s. This series of movement was recorded using a four-dimensional CT. The surface data of the trapezium and first metacarpal of all frames were reconstructed, and bone movement at the trapeziometacarpal joint was calculated using sequential three-dimensional registration. The instantaneous pinch force of each frame was measured using a pointer on a pinch meter that was reconstructed from the CT data. The first metacarpal was abducted (15.9 ± 8.3°) and flexed (12.2 ± 7.1°) relative to the trapezium, and significantly translated to the volar (0.8 ± 0.6mm) and ulnar directions (0.9 ± 0.8mm) with maximum pinch force. This movement consistently increased with the pinch force. This study successfully employed 4D-CT to precisely demonstrate changes in rotation and translation at the trapeziometacarpal joint during pinch motion for various instantaneous forces.

A Musculoskeletal Model of the Hand and Wrist Capable of Simulating Functional Tasks.

The purpose of this work was to develop an open-source musculoskeletal model of the hand and wrist and to evaluate its performance during simulations of functional tasks. The current model was developed by adapting and expanding upon existing models. An optimal control theory framework that combines forward-dynamics simulations with a simulated-annealing optimization was used to simulate maximum grip and pinch force. Active and passive hand opening were simulated to evaluate coordinated kinematic hand movements. The model's maximum grip force production matched experimental measures of grip force, force distribution amongst the digits, and displayed sensitivity to wrist flexion. Simulated lateral pinch strength replicated in vivo palmar pinch strength data. Additionally, predicted activations for 7 of 8 muscles fell within variability of EMG data during palmar pinch. The active and passive hand opening simulations predicted reasonable activations and demonstrated passive motion mimicking tenodesis, respectively. This work advances simulation capabilities of hand and wrist models and provides a foundation for future work to build upon. This is the first open-source musculoskeletal model of the hand and wrist to be implemented during both functional kinetic and kinematic tasks. We provide a novel simulation framework to predict maximal grip and pinch force which can be used to evaluate how potential surgical and rehabilitation interventions influence these functional outcomes while requiring minimal experimental data.

THE EFFECTS OF A HAND-BASED HOME-TRAINING PROGRAM ON FINE FORCE PERCEPTION IN OLDER ADULTS

Abstract The ability to use and manipulate the hands is essential for completing daily activities such as dressing, food preparation, and medication adherence, but declines with age. Assessments of hand function typically include measures of maximum strength despite our recent findings that fine force control may be more indicative of function than strength. The purpose of this study was to determine the effectiveness of a hand-based intervention on improving various aspects of hand function in older adults. Eleven older adults (mean age: 77±6.8y, 7 females) completed a 6-week home-based training program consisting of a series of sensorimotor tasks. Hand assessments included tactile sensation, dexterity, maximum grip and pinch strength, and fine force control using a pinch force matching paradigm. In the fine force task, participants were given a reference force (25% MVC) and were instructed to match the force without visual feedback using either the same (ipsilateral) or opposite (contralateral) hand as the reference force. After the training program, older adults displayed a 35% reduction (p < 0.01) in matching error during the contralateral fine force control task. Additionally, both tactile sensation and dexterity showed improvements in the dominant hand (p < 0.05). No differences were observed in maximum pinch or grip strength. We observed improvements in fine force control, tactile sensibility, and dexterity, all of which contribute to hand function needed for daily activities, as a result of the home-based intervention. These results underscore the importance of measuring different aspects of hand function and the need for additional hand-based interventions in the aging population.

The Effect of Kinesio Tape and Exercise on Maximum Key Pinch Endurance on Assembly Workers

Background: Work-related musculoskeletal pain is generally caused by poor physical conditions and repetitive movement. The aim of this research is to investigate the effect of 8 weeks of kinesio tape and exercise on maximum key pinch endurance and pain reduction regarding the assembly workers.
 Method: This clinical trial study was conducted on 40 female workers employed in the assembly part of an electrical company. The subjects were categorized into three groups: exercise-taping, exercise and control, and performing an 8-week rehabilitation plan twice a week. To assess the upper limb disability and key pinch endurance before and after the intervention, authors used DASH questionnaire and pinch gauge, respectively. Data were evaluated with SPSS 20 and one-way ANOVA, Chi-Square and paired t-test tests. In this study, pinch gauge was used to measure pinch strength. Studies show that pinch gauge has high calibration accuracy and precision.
 Results: The results of this study demonstrated a decrease in upper limb disability in the two groups of exercise and taping-exercise compared to the control group. Chi-square test indicated a statistically significant difference between the history of hand pain in the three groups. Moreover, paired t-test showed that the two hand's key pinch endurance was significantly increased in the two intervention groups compared to the control group.
 Conclusion: Using a kinesio tape can be effective in reducing pain and physical damage in hands. Therefore, at least 2 or 3 exercise sessions can be done per week during working hours.

Fine adaptive precision grip control without maximum pinch strength changes after upper limb neurodynamic mobilization

Before and immediately after passive upper limb neurodynamic mobilizations targeting the median nerve, grip (G_F) and load (L_F) forces applied by the thumb, index and major fingers (three-jaw chuck pinch) were collected using a manipulandum during three different grip precision tasks: grip-lift-hold-replace (GLHR), vertical oscillations (OSC), and vertical oscillations with up and down collisions (OSC/COLL/u, OSC/COLL/d). Several parameters were collected or computed from G_F and L_F. Maximum pinch strength and fingertips pressure sensation threshold were also examined. After the mobilizations, L_F max changes from 3.2 ± 0.4 to 3.4 ± 0.4 N (p = 0.014), dG_F from 89.0 ± 66.6 to 102.2 ± 59.6 N~text{s}^{-1} (p = 0.009), and dL_F from 43.6 ± 17.0 to 56.0 ± 17.9 N~text{s}^{-1} (p<0.001) during GLHR. L_F SD changes from 0.9 ± 0.3 to 1.0 ± 0.2 N (p = 0.004) during OSC. L_F peak changes from 17.4 ± 8.3 to 15.1 ± 7.5 N (p<0.001), G_F from 12.4 ± 6.7 to 11.3 ± 6.8 N (p = 0.033), and L_F from 2.9 ± 0.4 to 3.00 ± 0.4 N (p = 0.018) during OSC/COLL/u. G_F peak changes from 13.5 ± 7.4 to 12.3 ± 7.7 N (p = 0.030) and L_F from 14.5 ± 6.0 to 13.6 ± 5.5 N (p = 0.018) during OSC/COLL/d. Sensation thresholds at index and thumb were reduced (p = 0.001, p = 0.008). Precision grip adaptations observed after the mobilizations could be partly explained by changes in cutaneous median-nerve pressure afferents from the thumb and index fingertips.

Anthropometric scaling of musculoskeletal models of the hand captures age-dependent differences in lateral pinch force

Musculoskeletal models and computer simulations enable non-invasive study of muscle function and contact forces. Hand models are useful for understanding the complexities of hand strength, precision movement, and the dexterity required during daily activities. Yet, generic models fail to accurately represent the entire scope of the population, while subject-specific models are labor-intensive to create. The objective of this study was to assess the efficacy of scaled generic models to represent the broad spectrum of strength profiles across the lifespan. We examined one hundred lateral pinch simulations using a generic model of the wrist and thumb anthropometrically scaled to represent the full range of heights reported for four ages across childhood, puberty, older adolescence, and adulthood. We evaluated maximum lateral pinch force produced, muscle control strategies, and the effect of linearly scaling the maximum isometric force. Our simulations demonstrated three main concepts. First, anthropometric scaling could capture age-dependent differences in pinch strength. Second, a generic muscle control strategy is not representative of all populations. Lastly, simulations do not employ optimal fiber length to complete a lateral pinch task. These results demonstrate the potential of anthropometrically-scaled models to study hand strength across the lifespan, while also highlighting that muscle control strategies may adapt as we age. The results also provide insight to the force–length relationship of thumb muscles during lateral pinch. We conclude that anthropometric scaling can accurately represent age characteristics of the population, but subject-specific models are still necessary to represent individuals.

Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom

More than half of patients who recover from COVID-19 experience fatigue. We studied fatigue using neuropsychological and neurophysiological investigations in post-COVID-19 patients and healthy subjects. Neuropsychological assessment included: Fatigue Severity Scale (FSS), Fatigue Rating Scale, Beck Depression Inventory, Apathy Evaluation Scale, cognitive tests, and computerized tasks. Neurophysiological examination was assessed before (PRE) and 2 min after (POST) a 1-min fatiguing isometric pinching task and included: maximum compound muscle action potential (CMAP) amplitude in first dorsal interosseous muscle (FDI) following ulnar nerve stimulation, resting motor threshold, motor evoked potential (MEP) amplitude and silent period (SP) duration in right FDI following transcranial magnetic stimulation of the left motor cortex. Maximum pinch strength was measured. Perceived exertion was assessed with the Borg-Category-Ratio scale.Patients manifested fatigue, apathy, executive deficits, impaired cognitive control, and reduction in global cognition. Perceived exertion was higher in patients. CMAP and MEP were smaller in patients both PRE and POST. CMAP did not change in either group from PRE to POST, while MEP amplitudes declined in controls POST. SP duration did not differ between groups PRE, increased in controls but decreased in patients POST. Patients' change of SP duration from PRE to POST was negatively correlated to FSS.Abnormal SP shortening and lack of MEP depression concur with a reduction in post-exhaustion corticomotor inhibition, suggesting a possible GABAB-ergic dysfunction. This impairment might be related to the neuropsychological alterations.COVID-19-associated inflammation might lead to GABAergic impairment, possibly representing the basis of fatigue and explaining apathy and executive deficits.

Composite Grip Strength as a Marker of Outcome in Patients Surgically Treated for Degenerative Cervical Myelopathy.

Study DesignRetrospective case series.PurposeThis study aimed to examine the efficacy of composite grip strength as a marker of surgical outcome in patients with moderate to severe degenerative cervical myelopathy.Overview of LiteratureDegenerative cervical myelopathy causes loss of dexterity, muscle strength, and sensations in the hand. The impact of surgical management on improvement in composite grip strength has received scant attention.MethodsThis retrospective study was performed on degenerative cervical myelopathy patients with a complete composite grip strength assessment between January 2013 to January 2019. The Biometrics E-link hand kit was used for the assessment. The following parameters were measured: maximum grip strength, sustained grip strength, three-jaw pinch, maximum key pinch, and sustained key pinch. The pre- and postoperative functional status was assessed using the Nurick grade and the modified Japanese Orthopaedic Association (mJOA) score.ResultsA total of 40 patients were included in the study. The mean patient age was 51.9 years. The mean preoperative Nurick grade was 3.5 and the mJOA score was 10.9. The anterior approach was used in 25 patients, and the posterior approach was used in 15 patients. Four patients developed complications. Degenerative cervical myelopathy resulted in decreased handgrip and pinch strength as compared to normative Indian data. There was a significant improvement in the postoperative composite grip strength for all five parameters. There was no differential improvement between the anterior and posterior surgical groups. The improvement in the composite grip strength correlated with the improvement in functional scores.ConclusionsComposite grip strength analysis is an objective method for assessing the impact of degenerative cervical myelopathy on grip strength and monitoring the postoperative improvement. Decompressive surgery resulted in global improvement in all the parameters of composite grip strength.

Numerical experiments on D-T gas filled PF1000 device with pressure variation

Numerical studies have been conducted using the Lee model code to compute the neutron yield of the PF1000 plasma focus device as a function of operating gas pressure (). The result is compared with the available experimental data. The operating gas Deuterium (D) is substituted with Deuterium-Tritium (D-T) (1:1) gas mixture in the numerical studies and then the is investigated with the function of Associated plasma dynamic properties such as axial velocity radial shock front speed piston speed and maximum pinch temperature are studied and correlations of the parameters with the pressure variation are established. Relevant plasma focus properties such as peak discharge current pinch current ion density and energy input into the pinch EINP are discussed as functions of pressure thus provide correlation of with other relevant plasma focus properties over the operating gas pressure range. The neutron yield performance of the D-T gas mixture is compared to that of the D gas and the optimum gas pressure for the highest neutron yield is identified.

Anatomy of Flank Adipose: The Y Configuration and Hip Extension and Their Effects on the Perception of Gender.

Anatomy of Flank Adipose: The Y Configuration and Hip Extension and Their Effects on the Perception of Gender.

Experimental Study of the Effect of External Inductance on Pinch Characteristics and Neon Soft X-Ray Yield in Filippov-Type Plasma Focus Device

So far, the detailed experimental effect of the inductance on the X-ray yield in the Filippov-type plasma focus devices has not been documented in literature. In this paper, a 90 kJ Filippov-type plasma focus device is used to investigate the effect of three different external inductances (20, 40, and 60 nH) on the pinch current and neon soft X-ray (SXR) yield experimentally. The obtained results for the three inductances show that the 60 nH inductance produces maximum pinch current for high voltages (12–13 kV). The results also show that with using 60 nH external inductance, a larger fraction of maximum current is transferred into the plasma column. Experimental results show that the ratio of pinch to maximum currents for 60 nH is larger than for the two other external inductances. The effect of external inductance on the neon soft X-ray emission at constant pressure (0.25 Torr) and different voltages (10–13 kV) is investigated with a five-channel diode X‑ray spectrometer. Of the three external inductances, the average neon SXR yield has a maximum value at 11 kV for 40 and 60 nH, and 12 kV for 20 nH. The maximum neon SXR yield energy is 24.87 ± 2.52 J for the external inductance 20 nH at 12 kV and it is 23.62 ± 3.10 J for the external inductance 40 nH at 11 kV and 5.23 ± 1.15 J for external inductance 60 nH at 11 kV. Experimental results show that with increasing of external inductance, the maximum neon SXR decreases.

Robot-assisted arm training for treating adult patients with distal radius fracture: a proof-of-concept pilot study.

Fracture of the distal radius is a common wrist injury. As to its management after orthopedic (conservative or surgical) treatment, there is weak evidence for conventional rehabilitation interventions. Despite the increasing interest for robot-assisted arm therapy as to neurological disabilities and its growing diffusion in rehabilitation facilities, no previous study investigated the feasibility of robotic training on arm orthopedic impairment. To evaluate the feasibility in terms of efficacy of robot-assisted arm training on upper limb impairment in patients with fracture of the distal radius. Proof-of-concept, pilot, randomized controlled trial. University hospital. Twenty adult outpatients with distal radius fracture due to wrist injury. All participants underwent ten, 1-hour (40 minutes of arm training + 20 minutes of conventional occupational therapy) training sessions, five days a week for two consecutive weeks. They were randomly assigned to two groups: patients allocated to the Robotic Arm Training group received arm training by means of a robotic device and patients allocated to the Conventional Arm Training group performed arm training following a conventional rehabilitation program. All patients were evaluated before, immediately after treatment and at four weeks of follow-up. The following outcomes were considered at the affected arm: forearm pronation/supination and wrist extension/flexion passive and active range of motion; maximal pinch and grip strength; the Patient-Rated Wrist and Hand Evaluation. No difference was found between groups as to the primary (wrist active and passive range of motion) and secondary (pinch and grip strength; Patient-Rated Wrist and Hand Evaluation Score) outcomes at all time points. Within-group comparisons showed similar improvements at all time points as to all outcomes considered in both groups. Our preliminary findings support the hypothesis that robot-assisted arm training might be a feasible tool for treating upper limb impairment in adult patients with distal radius fracture treated conservatively or surgically. The treatment of arm impairment consequent to distal radius fractures by means of robot-assisted arm training may allow therapists to focus on functional rehabilitation during occupational (individual) therapy and supervise (more than one) patients simultaneously during robotic training sessions.

Fluctuations in Human Corticospinal Activity Prior to Grasp.

Neuronal firing rate variability prior to movement onset contributes to trial-to-trial variability in primate behavior. However, in humans, whether similar mechanisms contribute to trial-to-trial behavioral variability remains unknown. We investigated the time-course of trial-to-trial variability in corticospinal excitability (CSE) using transcranial magnetic stimulation (TMS) during a self-paced reach-to-grasp task. We hypothesized that CSE variability will be modulated prior to the initiation of reach and that such a modulation would explain trial-to-trial behavioral variability. Able-bodied individuals were visually cued to plan their grip force before exertion of either 30% or 5% of their maximum pinch force capacity on an object. TMS was delivered at six time points (0.5, 0.75, 1, 1.1, 1.2, and 1.3 s) following a visual cue that instructed the force level. We first modeled the relation between CSE magnitude and its variability at rest (n = 12) to study the component of CSE variability pertaining to the task but not related to changes in CSE magnitude (n = 12). We found an increase in CSE variability from 1.2 to 1.3 s following the visual cue at 30% but not at 5% of force. This effect was temporally dissociated from the decrease in CSE magnitude that was observed from 0.5 to 0.75 s following the cue. Importantly, the increase in CSE variability explained at least ∼40% of inter-individual differences in trial-to-trial variability in time to peak force rate. These results were found to be repeatable across studies and robust to different analysis methods. Our findings suggest that the neural mechanisms underlying modulation in CSE variability and CSE magnitude are distinct. Notably, the extent of modulation in variability in corticospinal system prior to grasp within individuals may explain their trial-to-trial behavioral variability.

Home rehabilitation supported by a wearable soft-robotic device for improving hand function in older adults: A pilot randomized controlled trial.

BackgroundNew developments, based on the concept of wearable soft-robotic devices, make it possible to support impaired hand function during the performance of daily activities and intensive task-specific training. The wearable soft-robotic ironHand glove is such a system that supports grip strength during the performance of daily activities and hand training exercises at home.DesignThis pilot randomized controlled clinical study explored the effect of prolonged use of the assistive ironHand glove during daily activities at home, in comparison to its use as a trainings tool at home, on functional performance of the hand.MethodsIn total, 91 older adults with self-perceived decline of hand function participated in this study. They were randomly assigned to a 4-weeks intervention of either assistive or therapeutic ironHand use, or control group (received no additional exercise or treatment). All participants performed a maximal pinch grip test, Box and Blocks test (BBT), Jebsen-Taylor Hand Function Test (JTHFT) at baseline and after 4-weeks of intervention. Only participants of the assistive and therapeutic group completed the System Usability Scale (SUS) after the intervention period.ResultsParticipants of the assistive and therapeutic group reported high scores on the SUS (mean = 73, SEM = 2). The therapeutic group showed improvements in unsupported handgrip strength (mean Δ = 3) and pinch strength (mean Δ = 0.5) after 4 weeks of ironHand use (p≤0.039). Scores on the BBT and JTHFT improved not only after 4 weeks of ironHand use (assistive and therapeutic), but also in the control group. Only handgrip strength improved more in the therapeutic group compared to the assistive and control group. No significant correlations were found between changes in performance and assistive or therapeutic ironHand use (p≥0.062).ConclusionThis study showed that support of the wearable soft-robotic ironHand system either as assistive device or as training tool may be a promising way to counter functional hand function decline associated with ageing.

Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study

BackgroundThere is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200–300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group.MethodsSeven subjects received 8–1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated.ResultsThe VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group.ConclusionsAn additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.