Remediation of the Non-Paretic Arm in Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Stroke survivors with severe contralesional paresis often have substantial control and
      coordination deficits in the non-paretic arm. Because this arm must serve as the primary
      controller, these deficits can be functionally devastating. The investigators now hypothesize
      that the combination of severe paresis (Upper Extremity Fugl-Meyer Score ≤35) and persistent
      motor deficits in the non-paretic arm limits functional independence in chronic stroke
      survivors. The investigators predict that remediation, focused on the non-paretic arm should
      improve functional independence. The investigators propose a randomized study design with two
      tracts, two periods and four assessments. The investigators envision this study as the first
      step in establishing the basis for a rehabilitation approach that focuses on remediation of
      BOTH arms, which constitutes a substantial change from current remediation protocols focused
      only on the contralesional arm.
    

Detailed description: 
      The investigators previously elaborated hemisphere specific motor deficits in the non-paretic
      arm of chronic stroke survivors with unilateral hemisphere damage. The investigators showed
      that these deficits are associated with substantial limitations in performance of activities
      of daily living (ADL), an effect exacerbated by contralesional paresis due to forced reliance
      on the non-paretic arm. The investigators now hypothesize that the combination low moderate
      to severe paresis (Fugl-Meyer Score < 35) and persistent motor deficits in the non-paretic
      arm limits functional independence in chronic stroke survivors. The investigators predict
      that intense remediation focused on improving the speed, coordination, and accuracy of the
      non-paretic arm should improve functional independence, as well as improving paretic arm
      function due to increased participation in daily activities. Unfortunately, the usual
      standard of care in rehabilitation for survivors with low-moderate to severe paresis tends to
      focus on task training in essential ADL activities, rather than on intensive remediation.
      Previous research has shown that non-paretic arm deficits depend on the hemisphere that is
      damaged by stroke, such that left hemisphere damage (LHD) impairs trajectory features,
      including speed and smoothness, while right hemisphere damage (RHD) impairs the ability to
      bring the arm to rest at an accurate and stable position. The investigators have designed a
      training program to address both of these motor components and to improve the speed and
      dexterity of the non-paretic arm. The investigators propose a randomized study design with
      two tracts, two periods and four assessments. Participants will first complete 2 baseline
      assessments, spaced 3 weeks apart. Following completion of the second assessment,
      participants will be randomly assigned to one of two tracks: Track 1 will receive three weeks
      of arm training, followed by 3 weeks of a comparison condition. Participants assigned to
      track 2 will receive three weeks of the comparison condition, followed by 3 weeks of arm
      training. Then, all participants will complete an end-of-period assessment, and a follow-up
      assessment for retention, 3 weeks after completion of the two periods. Pilot results indicate
      that non-paretic arm training produces substantial improvements in motor performance and
      functional independence as well as reducing paretic arm impairment. This is an essential
      first-step in developing a rehabilitation protocol focused on remediating both arms of
      severely impaired stroke survivors.
    

Intervention name(s): Track 1; Track 2
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Training of non-paretic arm followed by sham condition; Same procedures as track 1, but completed in opposite order, starting with sham condition followed by the non-paretic arm training
Other intervention name(s): remediation of non-paretic arm followed by sham training; sham condition followed by remediation of non-paretic arm
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: stroke; hemiparesis; lesion hemisphere; ipsilesional deficits; contralesional deficits; rehabilitation; remediation; paretic arm