BACKGROUND: Recovering useful hand function after @entity64 is a major scientific challenge for @entity1 with limited motor recovery. We hypothesized that sequential training beginning with proximal bilateral followed by unilateral task oriented training is superior to time-matched unilateral training alone. Proximal bilateral training could optimally prepare the motor system to respond to the more challenging task-oriented training. METHODS: @entity1 : Twenty-six @entity1 with moderate severity @entity1269 Intervention: @entity1 received either 6-weeks of bilateral proximal training followed sequentially by 6-weeks unilateral task-oriented training (COMBO) or 12-weeks of unilateral task-oriented training alone (SAEBO). A subset of 8 COMB0 and 9 SAEBO @entity1 underwent three functional magnetic resonance imaging (fMRI) scans of hand and elbow movement every 6  weeks. MAIN OUTCOME MEASURES: Fugl-Meyer Upper extremity scale, Modified Wolf Motor Function Test, University of Maryland Arm Questionnaire for @entity64 , Motor cortex activation (fMRI). RESULTS: The COMBO group demonstrated significantly greater gains between baseline and 12-weeks over all outcome measures (p   =   .018 based on a MANOVA test) and specifically in the Modified Wolf Motor Function test (time). Both groups demonstrated within-group gains on the Fugl-Meyer Upper Extremity test (impairment) and University of Maryland Arm Questionnaire for @entity64 (functional use). fMRI subset analyses showed motor cortex (primary and premotor) activation during hand movement was significantly increased by sequential combination training but not by task-oriented training alone. CONCLUSIONS: Sequentially combining a proximal bilateral before a unilateral task-oriented training may be an effective way to facilitate gains in arm and hand function in those with moderate to severe paresis post- @entity64 compared to unilateral task oriented training alone.

Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with XXXX .

@entity1 :: ('9606', 'Species') :: ['participants', 'patients', 'Participants'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke', 'Stroke'] @entity1269 :: ('MESH:D010291', 'Disease') :: ['hemiparesis']
@entity64 :: (MESH:D020521,Disease) :: ['chronic stroke']
