Gerard G Fluet1, Jigna Patel1, Qinyin Qiu1, Matthew Yarossi1, Supriya Massood2, Sergei V Adamovich1,3, Eugene Tunik4, Alma S Merians1. 1. a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA. 2. b St. Joseph's Wayne Hospital , Acute Rehabilitation Unit , Wayne , NJ , USA. 3. c Department of Biomedical Engineering , New Jersey Institute of Technology, University Heights , Newark , NJ , USA. 4. d Department of Physical Therapy, Movement, and Rehabilitation Science, Bouve College of Health Sciences , Northeastern University , Boston , MA , USA.
Abstract
PURPOSE: The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. METHODS: This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. RESULTS: Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. CONCLUSION: This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke.
PURPOSE: The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. METHODS: This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. RESULTS: Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. CONCLUSION: This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke.
Authors: Gerard G Fluet; Alma S Merians; Qinyin Qiu; Ian Lafond; Soha Saleh; Viviana Ruano; Andrea R Delmonico; Sergei V Adamovich Journal: J Neurol Phys Ther Date: 2012-06 Impact factor: 3.649
Authors: Scott Barbay; Erik J Plautz; Kathleen M Friel; Shawn B Frost; Numa Dancause; Ann M Stowe; Randolph J Nudo Journal: Exp Brain Res Date: 2005-11-05 Impact factor: 1.972
Authors: Corwin Boake; Elizabeth A Noser; Tony Ro; Sarah Baraniuk; Mary Gaber; Ruth Johnson; Eva T Salmeron; Thao M Tran; Jenny M Lai; Edward Taub; Lemuel A Moye; James C Grotta; Harvey S Levin Journal: Neurorehabil Neural Repair Date: 2007 Jan-Feb Impact factor: 3.919
Authors: Mónica da Silva Cameirão; Sergi Bermúdez I Badia; Esther Duarte; Paul F M J Verschure Journal: Restor Neurol Neurosci Date: 2011 Impact factor: 2.406
Authors: Catherine E Lang; Joanne M Wagner; Dorothy F Edwards; Shirley A Sahrmann; Alexander W Dromerick Journal: Neurorehabil Neural Repair Date: 2006-12 Impact factor: 3.919