fast arm motor skill training

Conditions: Cerebrovascular Stroke

Summary: every year, almost 800,000 people experience a stroke in the united states, which lead to upper-limb impairments, making recovery of motor function a priority in stroke rehabilitation. 1) the primary objective of this study is to determine whether fast arm movement training on a tracking task ("speed-training"), in chronic stroke survivors with mild to moderate paresis, will generalize to improve arm function better than dose-equivalent accuracy training on the same task. 2) study the effect of intensive arm training on the recovery of anticipatory feedforward control. 3) determine the involvement of cerebellar-cortical circuits in the recovery of arm movements due to speed training.

about 65% of stroke survivors experience long-term limitations in upper extremity (ue) functions. in particular, limitations in arm reaching movements are prominent and correlate strongly with patients' impairment levels. because activities of daily living often involve the ues, retraining reach and grasp skills is critical for return to a full quality-of-life. yet, the training parameters required for effective rehabilitation of ue function are not known. recent evidence suggests that high-speed movements during training are effective at improving arm movements in individuals with chronic stroke. hence, fast movements generating large errors, would promote the restoration of the feedforward controllers and therefore improves arm movements and ue functions in individuals with chronic stroke. because the cerebellum is involved in learning feedforward controllers from motor errors, the improvements would be proportional to the integrity of the cerebellar-cortical networks. a double-blind quasi-randomized controlled study will be carried out in chronic post-stroke survivors. participants will be assigned to either the speed-bias training group or a dose equivalent accuracy-bias training group (control) and will receive 4 days of training over a 1week period by a trained occupational or physical therapist. behavioral, emg, and mri data will be acquired within two weeks before, 3 days post, and one month after intervention.

Eligibility criteria:
inclusion criteria: * at least 6 months following an ischemic supratentorial stroke * at least 21 years of age * exhibit residual capability to move the paretic ue (upper extremity fugl- meyer motor score \>20/66) * able to follow a 2-step command (8th item on the mmse test) * able to perform an unassisted arm reach movement of 25 cm ahead of the body within 5 seconds with trunk restraint * exhibit no greater than mild/moderate spasticity as assessed with a modified ashworth score \< 3 exclusion criteria: * any neurologic diagnoses other than stroke * peripheral movement restrictions, such as neuropathy * orthopedic disorders affecting the paretic ue * severe pain or sensory/proprioceptive impairment in the more affected ue * visual neglect (more than 4% of lines left uncrossed on albert's test). * had a stroke directly affecting the cerebellum * any contra-indications to mri scanning * mostly resolved impairments with an upper extremity fugl- meyer motor score \>58/66

Keywords: stroke physical therapy neurorehabilitation motor function neuroplasticity neuroimaging mri tdi hemiparesis occupational therapy patient focused motor learning motor control skill acquisition skill training motor recovery task-oriented training task-specific training arm function upper extremity arm therapy physical rehabilitation arm rehabilitation