Home Based Adaptive Arm Training for Children With Hemiplegia
Phase: NA
Conditions: Hemiplegia
Sponsor: NYU Langone Health

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Clinical Research Protocol 
 
 
 
 
 
 
Home based adaptive arm training for children with 
hemiplegia 
 
Regulatory Sponsor: 
Renat Sukhov, MD 
Rusk Rehabilitation Medicine 
Hospital for Joint Diseases 
301 East 17th Street, 4th Fl. – NY, NY 100003 
(212) 598-7671 
 
Funding Sponsor: 
Kids of NYU 
 
 
Study Product: 
Bimanual Arm Trainer (BAT, Mirrored Motion Works, NC) 
 
 
Protocol Number: 
s15-01326 
 
IDE Number: 
N/A 
 
 
 
ClinicalTrials.gov: 
 
    NCT02751502  
    

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I. 
Introduction 
 
This document is a protocol for a human research study. This study is to be conducted in accordance with 
US government research regulations, and applicable international standards of Good Clinical Practice, 
and institutional research policies and procedures. 
 
I.1 
Background 
Acquired brain injuries (ABI) due to hypoxia, stroke, and trauma are major causes of morbidity in 
children and adolescents. The response of the nervous system to acquired injury is dependent on (a) age 
and type of injury (b) maturity of the brain cellular mechanisms and (c) environmental factors including but 
not limited to child participation in rehabilitation programs. The first two of the above mentioned parameters 
are being actively studied in experimental animal models to further understand age- dependent 
neuroplasticity (Kolb and Gibb 1993; Kolb, Petrie et al. 1996; Kolb and Cioe 2003). The environmental 
influence on functional recovery and outcome patterns in human research subjects especially in the 
younger population with ABI is largely unknown due to a large number of variables and multiple barriers 
related to the frequency of school-based and outpatient-based rehabilitation approaches, insurance 
limitations, and time and transportation associated with parental/caregiver obligations. We propose to 
specifically study functional outcomes with home-based training in pediatric patients with residual upper 
limb hemiplegia in the chronic stages of recovery from ABI. 
 
Availability of redundant motor circuits for recovery in the maturing brain 
Plasticity has been described as a complex set of mechanisms underlying activity- dependent 
reshaping of neuronal, interneuronal and glial connections with synaptogenesis mediated by excitatory and 
inhibitory pathways and neuronal apoptosis (Reeves, Lyeth et al. 1995; Bittigau, Sifringer et al. 1999; 
Anderson, Catroppa et al. 2005). The complex responses to injury allow the brain to functionally reorganize 
to restore some degree of function following ABI. In fact, a superior capacity to reorganize following focal 
neurological lesions has been noted in the developing brain (Kennard 1936; Kennard 1938). 
Electrophysiologic studies reveal that areas of the cortex adjacent to the injury show a heightened 
response to stimulation (Driscoll, Monfils et al. 2007), suggesting that rearrangement of interneuronal and 
synaptic connections in the intact adjacent cortex may lead to improved functional outcome by recruitment 
of these undamaged areas. However, recent technological advances in neuroimaging in early life brain 
injury elucidate the role of the contralesional hemisphere in reorganization following unilateral damage to 
the cortico-spinal tract, i.e. normally transient ipsilateral cortical projections from the contralesional 
hemisphere are strengthened and maintained following brain injury (Staudt 2010). These results suggest 
that a viable approach to re-training the affected upper limb after ABI in children may be to harness the 
redundant motor circuitry from the contralesional side to enhance plasticity of the available circuits in the 
lesioned hemisphere. 
 
Pattern of recovery of isolated movement in upper limb joints 
The enhanced capacity for recovery from pediatric brain injury is thought to stem from a 
neurobiological cascade of neurotransmitter release, changes in the speed of the response to injury and in 
the number of synaptic connections to experience (Goldman 1974; Goldman 1976; Kennard 1942). 
Specifically, pioneering work of surgical ablation in primary motor and premotor cortex of primates revealed 
two key but contradictory results: (1) the “younger” brain has fewer immediate deficits and better long term 
functional outcome and (2) the same animals also developed greater spasticity, uncoordinated fine finger 
movements and abnormalities of ambulation later on in life (Finger 1999). Interestingly, there is no direct 
explanation for the delay in the manifestations of ABI, but the main hypothesis is that early injury perturbs 
the pattern and sequence of normal maturation in some way. Exactly how the pattern of maturation is 
perturbed is not fully understood. 
Twitchell and Brunnstrom observed a sequential recovery of motor function (Twitchell 1951; 
Brunnstrom 1966; Brunnstrom 1970) that has stood the test of time. The Fugl-Meyer scale captures 

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where a patient may be in this sequence and is the most widely-used quantitative measure of motor 
recovery post stroke (van Wijck, Pandyan et al. 2001; Gladstone, Danells et al. 2002). The scores have 
also been shown to correlate with the extent of corticospinal tract damage (Zhu, Lindenberg et al. 2010). 
Recently, it was shown that bimanual-to-unimanual training can potentially progress recovery along this 
sequence, but that patients at different stages of recovery would require different training conditions – 
individuals with spastic paresis, who are earlier in the sequence of recovery may benefit more from 
bimanual-to-unimanual training with rhythmic auditory stimulation, where as those with spastic co- 
contraction, at a later stage in the sequence of recovery may benefit from bimanual-to-unimanual training 
without auditory stimulation (Aluru, Lu et al. 2014). This study provides benchmarks for the different stages 
of motor recovery and the type of training that may be beneficial to progress the individual to the next stage. 
We can now examine the pattern of recovery after ABI in pediatric patients with bimanual-to- unimanual 
training provided with a device as well as conventional non-device training at home. 
 
 
I.2 
Specific Aims 
The specific aims of this proposal are to: 
 
Aim 1: Introduce home-based targeted upper limb training in children with hemiplegia from ABI 
using a bimanual-to-unimanual training approach 
We hypothesize that child-friendly home-based upper limb bimanual-to-unimanual training will lead to 
greater compliance and improved motor outcome on the Fugl Myer Scale compared to a conventional home 
training program. 
 
Aim 2: Improve the understanding of the pattern of recovery of isolated joint movements in the 
pediatric population with hemiplegia following ABI. 
We hypothesize that individuals receiving device-based bimanual-to-unimanual training will show 
improvement in active range of motion across upper limb joints compared with a conventional home training 
program. 
 
This collaborative research will be performed in conjunction with the Motor Recovery Research Lab (Dr. 
Preeti Raghavan). The data obtained from this project will be used as preliminary data towards an NIH 
grant. 
 
II. 
Study Design 
Twenty children between the ages of 5-17 years with acquired brain injury 6 months to 2 years prior 
to enrollment will receive conventional home therapy (home exercise program) for 4 weeks followed by 
device-based home training for 4 weeks. We hope to recruit 10 children between the ages of 5-11 years 
and 10 children between the ages of 12-17 years. All enrolled children will complete the assessments 
below at baseline, after 4 weeks of conventional therapy, and after device training. The total length of 
study enrollment will be 8 weeks for all participants. 
 
This is a pilot feasibility study hence sample size is small and arbitrary. Power analysis from these pilot 
data will be used to determine sample size in future studies. Subjects will be screened to ensure that they 
meet inclusion-exclusion criteria at Visit 1. 

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III. 
Subject Selection And Withdrawal 
 
1. Number of Subjects. 
Twenty (20) pediatric patients aged 5-17 years will be recruited. Subjects will be community 
dwelling individuals and will be voluntarily enrolled after obtaining the informed consent from their 
parent/guardian. 
 
2. Gender of Subjects. There will be no gender bias for enrollment in the study 
 
 
3. Age of Subjects. The age range of subjects is 5 -17 years 
 
4. Racial and Ethnic Origin. There are no exclusions based on gender or ethnic group 
 
5. Inclusion Criteria 
1. Acquired Brain Injury at least 3 months prior to enrollment; 
2. Unilateral hemiparesis 
3. History of compliance with home exercise programs in the past. 
 
6. Exclusion Criteria 
1. Any social or medical problem that precludes compliance with the protocol 
2. Comorbid seizure disorder or other neurological disease 
3. Treatment with botulinum toxin or intrathecal baclofen in the 3 months preceding enrollment 
4. Implanted neuromodulatory or electronic device or other complicating illness 
5. Lack of capacity to consent 
 
7. Vulnerable Subjects 
The patients meeting inclusion criteria will be children. We will only enroll patients with capacity to provide 
informed consent. We will provide information to the subjects in terms that they can fully understand, and 
capacity to consent will be determined by the subject’s verbal understanding of the protocol as determined 
by the PI. We will not exert any overt or covert coercion, and no financial incentive will be offered. The 
consent document that the subject will be asked to sign will be written in the language that the potential 
subject understands and will be approved by the IRB. 
 
IV. 
Study Device 
IV.1 Description 
 
The device is a FDA Class I exempt medical device, and 
is registered with the FDA 
(http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/rl 
.cfm?lid=461627&lpcd=PKS).The device facilitates 
movements of the affected hemiparetic arm by moving 
the unaffected arm at the shoulder and elbow joint. The 
device is interfaced with a video game for motivation and 
feedback. It also facilitates movements of the forearm and 
grasp and release on both the affected and unaffected 
sides (Fig. 1). 
 
Training Protocol: 
 
 
 
 
 
 
 
 
 
Fig.1. Bimanual Arm Trainer 

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The home-based training protocols both with and without the device will be consistent with the 
fundamental principles of neurorehabilitation as outlined by Bobath (Bobath 1978) and with motor 
learning principles (Shepherd and Carr 2006). The main postulates of the Bobath concept are that (1) 
posture and movement are not separate entities, (2) sensory input influences motor output and (3) 
muscle strength is a does not necessarily equal function (Vaughan-Graham, Cott et al. 2014). The 
principles of motor learning are repetitive task-specific practice with feedback (Bosse, Mohr et al. 2015) 
 
Assessments: A pediatric occupational therapist will assess all subjects on the Fugl-Meyer Scale, the 
Assisting Hand Assessment Test, active and passive Range of Motion using video pre-and post-training, 
the Melbourne Assessment 2 and the PedsQL. The Melbourne Assessment 2 is a test of unilateral upper 
limb function and is a validated and reliable tool for evaluating upper limb movement in children with 
neurological conditions. The PedQL is an assessment tool that measures health related quality of live in 
adolescents with acute and chronic health conditions. The therapist will also teach the subjects how to use 
the Bimanual Arm Trainer (in the device training group) and how to perform the home exercise program (in 
the non-device training group). 
Device-based 
bimanual-to-unimanual 
home 
training will be provided with the Bimanual Arm 
Trainer (BAT, Mirrored Motion Works, NC) shown 
above. 
The 
device 
provides 
bimanual-to- 
unimanual training of simultaneous shoulder 
external rotation and elbow extension, and 
independent training of pronation-supination and 
grasp and release of each hand. Range of motion 
and speed are recorded during training and 
feedback and motivation are provided through age-
appropriate gaming modules. The rationale for 
training shoulder external rotation and elbow 
extension is consistent with the Bobath concept 
of achieving postural stability through scapular 
stabilization for control of more distal movements. 
Preliminary data with the BAT showed that training 
in adult stroke patients led to improvement in 
active range of motion in trained movements 
(shoulder external rotation) as well as distal 
untrained movements (forearm pronation 
Fig. 2. Training with a previous version of the 
BAT for 4 weeks in adults with severe chronic 
hemiplegia led to improvement in active range 
of motion in trained (shoulder external rotation) 
and untrained movements (forearm pronation 
and wrist extension). 
and wrist extension) (Fig. 2). Patients in the device group will be asked to train specific movements 
repeatedly with the device for 45 minutes five days a week for 4 weeks and compliance will be monitored 
through training logs and remotely. We have tested a pediatric prototype of the Bimanual Arm Trainer (Fig. 
3). Previous bimanual research has shown that training 5 days a week for 4 weeks can accelerate recovery 
of upper limb motor function (Stinear et al. 2014). 
 
 
Fig.3. Training a child with the Bimanual Arm 
Trainer 
 
 
 
 
 
 
 
Conventional non-device based home training will be 
provided using a home-exercise program provided by an occupational therapist and customized to the 

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patient’s needs using the principles from Bobath and Motor Learning. Patients will also be asked to train 
specific movements repeatedly for 45 minutes five days a week for 4 weeks and compliance will be 
monitored through training logs. 
 
Progression of training: Patients with spastic paresis (Brunnstrom’s stages I and II) will engage in bimanual-
to-unimanual training (Fig. 4) with rhythmic auditory stimulation initially, those with spastic co- contraction 
(Brunnstrom’s stages III and IV) will engage in bimanual-to-unimanual training without rhythmic auditory 
stimulation (Aluru, Lu et al. 2014). At each weekly review of the previous week’s data, 
the therapist will determine the conditions of further 
training. Training will be progressed as per standard 
practice in individuals receiving standard home 
training by a pediatric occupational therapist. 
 
 
Fig. 4. Example of protocol for bimanual-to- 
unimanual training within a training session. The 
left arm (red box) was affected. 
 
 
 
 
 
IV.2 Subject Compliance Monitoring 
The study Occupational Therapist (OT) will monitor compliance with the training protocol with training logs 
provided to the child and parents. The OT will also review the training data and determine adherence to 
the treatment regimen. If subjects are consistently non-compliant and demonstrate less than 80% 
compliance with the training sessions (i.e., miss more than 1 training session per week), they will be 
dropped from the study. 
 
V. 
Study Procedures 
All data will be obtained solely for research purposes. 
 
Visit 1. Subjects will provide informed consent and be screened to ensure that they meet inclusion- 
exclusion criteria. If they meet criteria, they will undergo further assessments using the Fugl-Meyer Scale, 
the Assisting Hand Assessment Test, the Melbourne Assessment 2 and the PedsQL (see attached 
scales). Total testing time will not exceed three hours, and the subjects will be given adequate rest breaks 
to ensure that they do not become fatigued. All subjects will be given a home exercise program and 
exercise logs to record the time spent in training at home. 
 
Visit 2. Subjects will be assessed again 4 weeks after their home therapy program. At this visit they will 
also receive baseline testing and training on the device. After this visit, subjects will receive the device for 
training at home, which will be monitored on a weekly basis remotely by the occupational therapist to ensure 
compliance and to answer any questions. 
 
Visit 3. This will be the post-device treatment assessment visit. 
 
VI. 
Data Analysis & Data Monitoring 
 
Data Analysis 

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Aim 1: Introduce home-based targeted upper limb training in children with hemiplegia from ABI 
using a bimanual-to-unimanual training approach. We will test the hypothesis that child-friendly home- 
based upper limb bimanual-to-unimanual training will lead to greater compliance and improved motor 
outcome on the Fugl-Meyer Scale, the Assisting Hand Assessment Test, active Range of Motion 
assessments, the Melbourne Assessment 2 and the PedsQL, compared to the conventional home training 
program. The groups will be compared using a two-way ANOVA. 
 
Aim 2: Improve the understanding of the pattern of recovery of isolated joint movements in the 
pediatric population with hemiplegia following ABI. We will test the hypothesis that individuals receiving 
device-based bimanual-to-unimanual training will show improvement in active range of motion across upper 
limb joints compared with a conventional home training program. 
 
The results of this study will pave the way for both understanding and meeting the needs of pediatric 
patients with Acquired Brain Injury in a systematic manner. Given the extent of plasticity in children there 
is a great need to rapidly optimize recovery so that physical, emotional and intellectual growth are as 
unhindered as possible. There is currently a dearth of evidence in how this can be accomplished. This 
study will provide pilot data for a larger study to optimize motor outcome pertaining to upper limb recovery 
as rapidly as possible. 
 
 
Data Monitoring 
 
The PI will be overall responsible for data monitoring. 
(1) Types of Data or Events: All accumulated outcome data, enrollment numbers, reportable event data 
(including adverse reactions and unanticipated problems) and the overall compliance with the protocol will 
be monitored. 
(2) Responsibilities and roles for gathering, evaluating and monitoring the data: The PI will be overall 
responsible for monitoring the data collected, including data related to unanticipated problems and adverse 
events. Data accuracy will be verified by the PI on an ongoing basis at monthly reviews of data. The PI will 
verify compliance with the protocol at an ongoing basis and at weekly lab meetings. Independence of 
judgment will be assured by using independent assessors for outcomes. 
(3) Reporting adverse events and unanticipated problems to the monitoring entity: Any adverse events will 
be reported to and compiled by the PI on an ongoing basis. Reportable events will be reported to the IRB 
by the PI within 5 business days. All other SAEs will be reported annually to the IRB. 
(4) Assessments: Data analysis will be performed as the data are collected to look for “unanticipated 
problems involving risks to participants or others” (i.e., as to whether they are unexpected, related and 
harmful). 
(5) Criteria for action: If there are significant related and harmful adverse events at any point in time, the 
study will be stopped. 
(6) Procedures for Communicating – dissemination of safety information: Outcome of data monitoring will 
be communicated to the IRB and research sponsor annually unless there are reportable adverse events or 
criteria for action. 
 
 
VII. 
Data Handling and Record Keeping 
 
Data Storage and Confidentiality: Research data will be stored in the PI’s office at Hospital for Joint 
Diseases. Research data will be labeled by subject codes and stored on a password protected computer 
and/or in a locked file cabinet. The data collection computer will be in a locked fixed location, password 
protected, and on a local network. Both computer and file cabinet are located in the PI’s lab at New York 
University’s Rusk Rehabilitation. Only the PI and her HIPAA certified delegates will have access to the data. 

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Data Stored for Future use: The data collected will be used as pilot data to plan future studies. New 
questions may come up from this study that may be addressed by reanalyzing the collected data. The data 
will be stored for up to 7 years. The data will be labeled, stored, and accessible to the PI and delegates as 
described in the section: Data Storage and Confidentiality. If patients specifically request to withdraw their 
data from the data stored for future use, they must do so in writing, which will be kept on file. Their data will 
be segregated from the rest of the data and not used for future analysis. However it will be stored for 
analysis of the present study and as per rules of publication, for at least 7 years post- publication. 
 
 
VIII. 
Safety and Adverse Events 
 
 
RISK/BENEFIT ASSESSMENT 
 
Risks: The risk of injury from the BAT is minimal as it is a non-powered, non-robotic device and all 
movements are controlled by the patient. However training may lead to muscle soreness in the unaffected 
and affected arms. There is a risk of fatigue in patients with stroke who may have weakness. There is a risk 
of breach of confidentiality since subjects will be answering questionnaires. 
 
Protection against Risks: Fatigue in patients with stroke will be minimized by setting the training duration to 
short periods tolerated by the patient initially and then increasing it gradually, to build endurance. The 
subjects will be told that they can take rest periods as often as needed. The speed of training will be 
controlled by the subject. 
 
Potential Benefits to the Subjects: The subject's participation may provide valuable information that will help 
in the development of effective tele-rehabilitation. This information may help us to improve the way we treat 
future stroke subjects 
 
 
IX. 
Subject Identification, Recruitment, Consent/Assent 
 
1. Method of Subject Identification and Recruitment 
 
Attending Physicians and Physical and Occupational therapists from the outpatient facility at New York 
University’s Rusk Rehabilitation will refer patients with chronic stroke to the PI and study staff by giving 
them the PI’s contact information if they meet study criteria.. Subjects who contact the PI and are 
found eligible for the study will be required to provide informed consent prior to participation in the 
study. The study protocol and informed consent forms will be approved by the IRB at NYU Medical 
Center. Subjects will be informed that they can discontinue the study or its procedures at any time, and 
that further evaluation or treatment will not be withheld. The identification and recruitment of subjects 
will protect the privacy of subjects and be free of undue influence. 
 
2. Process of Consent 
 
Assent will be obtained by the PI or HIPAA-certified delegates, in the PI’s office, which is a private 
area, at the New York University’s Rusk Rehabilitation, Hospital for Joint Diseases prior to participation 
in the study. The assent will be obtained jointly with the parent(s) and the minor.  The assent 
document will be thoroughly discussed at a convenient time, free of time constraints and the subject 
and the parent will be given time to think about their decision. We will get the consent of the parent 
and the assent of the adolescent on the approved age-appropriate consent form. The subject and the 

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parent will be asked to provide a statement of their understanding of the procedures, risks, and a 
general concept of the study. 
 
The parent (s) of the subject will be given a copy of both the consent and assent forms and be 
encouraged to contact the PI if they have further questions about the protocol. When the minor turns 
18, we will get their consent (re-consent them). All subjects will also provide a separate consent for 
videotaping. The permission of only one parent will be required. 
 
The subject (between the ages of 15-17 years old) will be asked to sign the assent form if they agree 
to participate in the study. The parent of the subject will be present at the time the document is signed 
along with the PI or her HIPAA-certified delegate 
 
All subjects will also provide separate consent for videotaping of the clinical assessments. They will 
sign and date the Audio Video consent and will receive a copy of the signed consent. Videotapes of 
session and clinical assessments may be used for instruction and training purposes. 
 
 
3. Subject Capacity. The subjects recruited for this study will be community-dwelling individuals with 
capacity to provide consent and assent. The parents will provide consent for minors (5-17) via a 
separate consent form. 
 
4. Subject /Representative Comprehension. Capacity will be determined by a general 
conversation between the subject/ authorized representative and the PI to assess the subject’s verbal 
understanding of the protocol including the nature and purpose of the study, the procedures involved, 
as well as the risks and benefits of participating versus not participating; appreciation of the 
significance of the disclosed information and the potential risks and benefits for one’s own situation 
and condition; and the ability to engage in a reasoning process about the risks and benefits of 
participating versus alternatives, and; the ability to express a choice about whether or not to 
participate. 
 
5. Subject Withdrawal. Subjects may decide not to participate in the research study at any given time 
without any penalty. Withdrawal can be made by informing the research study staff; including the PI; 
verbally or in writing. Upon withdrawal, subject’s data will be removed from the study research data 
immediately. 
 
6. Debriefing Procedures. No information will be purposely withheld from subjects. 
 
7. Consent Forms. The IRB Standard Consent Forms and Assent form will be used (please see 
attached). 
 
8. Documentation of Consent. The study and the consent form will be thoroughly discussed with 
each subject, section by section. Subjects will be asked to provide a statement of their understanding 
of the procedures, risks, and general concept of the study. The consent document, and documentation 
of the process, will be stored in the PI's office at the Rusk Institute of Rehabilitation Medicine, NYU 
Medical Center, on a password protected computer and/or in a locked filing cabinet. The computer will 
be in a locked, fixed location (no mobile laptop), password protected, and on a local network. 
 
9. Costs to the Subject. Subjects will not incur any costs for participating in the study. 
 
10. Payment for Participation. There will be no compensation for participation in this study. 

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X. 
Conflict of Interest 
 
Conflict of Interest 
Dr. Preeti Raghavan (Co-I) is the inventor of the device and she has disclosed her conflict of interest with 
CIMU. 
 
XI. 
Investigators’ qualifications and experience (CVs attached) 
Renat Sukhov, MD, is the Principal Investigator at Rusk Rehabilitation. He is a specialist in pediatric 
rehabilitation. 
 
Preeti Raghavan, MD is the co-Investigator and Director of the Motor Recovery Research Laboratory at 
Rusk Rehabilitation. She is also the inventor of the BAT device. 
 
Pediatric Occupational Therapist (TBD) will be involved in recruitment and assessment of subjects, 
monitoring of compliance and administration of the training protocols. She will also be involved in the 
analysis and interpretation of data along with the PI and co-PI. 
 
Zena Moore, MS is the Senior Research Coordinator on the project and will be responsible for data 
management and reporting under the supervision of the PI and co-PI. 
 
 
XII. 
References 
Aluru, V., Y. Lu, et al. (2014). "Effect of auditory constraints on motor performance depends on stage of 
recovery post-stroke." Front Neurol 5: 106. 
Anderson, V., C. Catroppa, et al. (2005). "Functional plasticity or vulnerability after early brain injury?" 
Pediatrics 116(6): 1374-1382. 
Bittigau, P., M. Sifringer, et al. (1999). "Apoptotic neurodegeneration following trauma is markedly 
enhanced in the immature brain." Ann Neurol 45(6): 724-735. 
Bobath, B. (1978). Adult Hemiplegia: evaluation and treatment. London, Heinemann. 
Bosse, H. M., J. Mohr, et al. (2015). "The benefit of repetitive skills training and frequency of expert 
feedback in the early acquisition of procedural skills." BMC Med Educ 15: 22. 
Brunnstrom, S. (1966). "Motor testing procedures in hemiplegia: based on sequential recovery stages." 
Phys Ther 46(4): 357-375. 
Brunnstrom, S. (1970). Movement therapy in hemiplegia. A neurophysiological approach. New York, 
Harper & Row. 
Driscoll, I., M. H. Monfils, et al. (2007). "Neurophysiological properties of cells filling the neonatal medial 
prefrontal cortex lesion cavity." Brain Res 1178: 38-43. 
Finger, S. (1999). "Margaret Kennard on sparing and recovery of function: a tribute on the 100th 
anniversary of her birth." J Hist Neurosci 8(3): 269-285. 
Gladstone, D. J., C. J. Danells, et al. (2002). "The fugl-meyer assessment of motor recovery after stroke: 
a critical review of its measurement properties." Neurorehabil Neural Repair 16(3): 232-240. 
Goldman, P. S. (1974). "Functional recovery after lesions of the nervous systems. 3. Developmental 
processes in neural plasticity. Recovery of function after CNS lesions in infant monkeys." Neurosci 
Res Program Bull 12(2): 217-222. 
Goldman, P. S. (1976). "The role of experience in recovery of function following orbital prefrontal lesions 
in infant monkeys." Neuropsychologia 14(4): 401-412. 
Kennard, M. A. (1936). "Age and other Factors in Motor Recovery from Precentral Lesions in Monkeys." 
AM J Physiol 115: 138-146. 
Kennard, M. A. (1938). "Reorganization of motor function in the cerebral cortex of monkeys deprived of 
motor and premotor areas in infancy." J Neurophysiol. 1: 477-496. 

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Kennard, M. A. ( 1942). "Cortical reorganization of motor function: Studies on a series of monkeys of various 
ages from infancy to maturity." Archives of Neurology and Psychiatry 48(227-40). 
Kolb, B. and J. Cioe (2003). "Recovery from early cortical damage in rats. IX. Differential behavioral and 
anatomical effects of temporal cortex lesions at different ages of neural maturation." Behav Brain 
Res 144(1-2): 67-76. 
Kolb, B. and R. Gibb (1993). "Possible anatomical basis of recovery of function after neonatal frontal lesions 
in rats." Behav Neurosci 107(5): 799-811. 
Kolb, B., B. Petrie, et al. (1996). "Recovery from early cortical damage in rats, VII. Comparison of the 
behavioural and anatomical effects of medial prefrontal lesions at different ages of neural 
maturation." Behav Brain Res 79(1-2): 1-14. 
Reeves, T. M., B. G. Lyeth, et al. (1995). "Long-term potentiation deficits and excitability changes following 
traumatic brain injury." Exp Brain Res 106(2): 248-256. 
Shepherd, R. B. and J. H. Carr (2006). "Neurological rehabilitation." Disabil Rehabil 28(13-14): 811-812. 
Staudt, M. (2010). "Brain plasticity following early life brain injury: insights from neuroimaging." Semin 
Perinatol 34(1): 87-92. 
Twitchell, T. E. (1951). "The restoration of motor function following hemiplegia in man." Brain 74(4): 443- 
480. 
van Wijck, F. M., A. D. Pandyan, et al. (2001). "Assessing motor deficits in neurological rehabilitation: 
patterns of instrument usage." Neurorehabil Neural Repair 15(1): 23-30. 
Vaughan-Graham, J., C. Cott, et al. (2014). "The Bobath (NDT) concept in adult neurological rehabilitation: 
what is the state of the knowledge? A scoping review. Part II: intervention studies perspectives." 
Disabil Rehabil: 1-20. 
Zhu, L. L., R. Lindenberg, et al. (2010). "Lesion load of the corticospinal tract predicts motor impairment in 
chronic stroke." Stroke 41(5): 910-915. 
 
XIII. 
Attachments 
 
• Consent Form 
• Audio-Video Consent 
• Assent Form 
• Fugl-Meyer Scale 
• Assisting Hand Assessment Test 
• Melbourne Assessment 2 
• PedsQL