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

Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with chronic stroke
Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with chronic stroke
Background
Recovering useful hand function after stroke is a major scientific challenge for patients 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
Participants: Twenty-six participants with moderate severity hemiparesis Intervention: Participants 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 participants 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 Stroke, 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 Stroke (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-stroke compared to unilateral task oriented training alone.
1471-2377
McCombe Waller, Sandy
91ffc714-a088-428d-b92c-9b0d70f286da
Whitall, Jill
9761aefb-be80-4270-bc1f-0e726399376e
Jenkins, Toye
8465b5aa-db4a-4e5a-846e-f483895b988e
Magder, Laurence S.
3dfaadd7-2b5a-453a-ba85-e4a23c434a73
Hanley, Daniel F.
eedff09c-b115-4f05-bd76-012397e1adbd
Goldberg, Andrew
8f0327b9-19b2-4ca7-a8e1-68cc0458c55c
Luft, Andreas R.
7d63411e-0ae7-4b6b-9455-b43ba702238c
McCombe Waller, Sandy
91ffc714-a088-428d-b92c-9b0d70f286da
Whitall, Jill
9761aefb-be80-4270-bc1f-0e726399376e
Jenkins, Toye
8465b5aa-db4a-4e5a-846e-f483895b988e
Magder, Laurence S.
3dfaadd7-2b5a-453a-ba85-e4a23c434a73
Hanley, Daniel F.
eedff09c-b115-4f05-bd76-012397e1adbd
Goldberg, Andrew
8f0327b9-19b2-4ca7-a8e1-68cc0458c55c
Luft, Andreas R.
7d63411e-0ae7-4b6b-9455-b43ba702238c

McCombe Waller, Sandy, Whitall, Jill, Jenkins, Toye, Magder, Laurence S., Hanley, Daniel F., Goldberg, Andrew and Luft, Andreas R. (2014) Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with chronic stroke. BMC Neurology, 14 (236). (doi:10.1186/s12883-014-0236-6).

Record type: Article

Abstract

Background
Recovering useful hand function after stroke is a major scientific challenge for patients 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
Participants: Twenty-six participants with moderate severity hemiparesis Intervention: Participants 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 participants 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 Stroke, 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 Stroke (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-stroke compared to unilateral task oriented training alone.

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Published date: 14 December 2014

Identifiers

Local EPrints ID: 415071
URI: http://eprints.soton.ac.uk/id/eprint/415071
ISSN: 1471-2377
PURE UUID: 2e28cbb6-158e-4b85-9957-94b05cb2bed0

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Date deposited: 25 Oct 2017 16:30
Last modified: 15 Mar 2024 16:34

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Contributors

Author: Sandy McCombe Waller
Author: Jill Whitall
Author: Toye Jenkins
Author: Laurence S. Magder
Author: Daniel F. Hanley
Author: Andrew Goldberg
Author: Andreas R. Luft

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