Motor Control Physical Therapist Support Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The purpose of this study is to systematically determine the effect of unnecessary physical
      therapist assistance in individuals after stroke during the practice of an upper limb task on
      an individual's task performance and their underlying motor control patterns when learning
      (or re-learning) motor skills.
    

Detailed description: 
      Independent motor task performance is the most highly prioritized outcome of physical therapy
      for individuals with motor disability. Accordingly, a key priority for physical therapists in
      multiple practice settings is the advancement of functional motor independence. Therapists
      must determine when a patient requires assistance (e.g., verbal cues, physical support) to
      complete a motor task and when a patient is able to execute a motor skill with less
      assistance. If a therapist does not provide enough support, the patient is at risk for
      unsuccessful task performance. As such, therapists often default to providing a higher level
      of assistance.

      An individual following stroke, for instance, may demonstrate an increased magnitude of
      postural sway while completing self-care activities at the sink. A therapist may decide to
      provide physical support for the patient to decrease sway variability, whether or not the
      patient requires this support to maintain performance. The motor control consequences of
      providing this assistance (thus constraining movement variability and providing fewer options
      for adapting movement) when assistance is actually not needed is unknown. The purpose of this
      study is to systematically determine the effect of unnecessary assistance during the practice
      of an upper limb task on functional performance and underlying motor control patterns when
      learning (or re-learning) motor skills in individuals with stroke. The insights gained from
      the current project will have the potential to improve the currently available physical
      therapy interventions for individuals with stroke.

      The effects of unnecessary physical therapist support will be examined in terms of upper limb
      task performance, retention, and transfer, and in terms of the postural control supporting
      task performance. The study is currently planned for individuals with stroke. Participants
      will be required to maintain the position of a virtual laser within a target while standing.
      An experimental group will receive postural support (physical assistance to maintain upright
      posture) during a practice period in order to specifically determine the effect of postural
      support on upper limb task performance and postural sway patterns. Participants will also
      engage in a light finger force production transfer task to ascertain the influence of
      postural support on a different supra-postural task.

      It is hypothesized that providing unnecessary assistance (and thus limiting independence)
      during practice of a novel motor task will result in (a) faster improvements in task
      performance but reduced retention and more limited transfer to another, similar task; and (b)
      reduced task- sensitive postural sway adjustments (measured in terms of both the quantity and
      temporal structure) during practice, at transfer, and at retention, reflecting reduced
      adaptability of postural patterns to task demands.
    

Intervention name(s): Physical therapist support
Intervention type(s): Behavioral
Intervention description(s): Participants will receive physical therapist support to reduce postural sway variability while completing an upper limb precision aiming task in virtual reality.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Basic Science
Keywords: physical therapy; postural control; supra-postural task; stroke; motor control; contextual factors; variability