Bilateral facilitation of motor control in chronic hemiplegia

The present study addressed the efficacy of concurrently moving both arms, with and without a load added to the uninvolved arm, in facilitating the quality of movement of the involved side in individuals with moderate, chronic hemiplegia. Six hemiplegic cerebrovascular accident (CVA) subjects with left-hemisphere lesions participated in the study. The four males and two females ranged from 46 to 77 years of age and 30-96 months post-CVA. All subjects scored at least 70% on the Fugl-Meyer test of motor function. The task was to perform discrete unilateral and bilateral elbow extensions in the horizontal plane. The movements were 45 degrees in amplitude and were to terminate in a 10 degrees target zone that was indicated by an illustration of a coffee mug. The instructions were to move toward the mug as smoothly as possible in a movement time (MT) determined to be 20% longer than their minimal MT for that distance. The primary dependent variable was the percentage of continuous vs. discontinuous trajectories observed in each condition, based on whether or not a transient hesitation or reversal was observed. Phase of peak velocity was also quantified as a general indication of the symmetry of the velocity profile. Three of the six subjects exhibited a greater percentage of continuous movements of the involved arm in the nonloaded bilateral condition than the unimanual condition. Five subjects benefited when the uninvolved arm was inertially loaded in the bilateral condition when compared with unimanual performance. Only the oldest subject failed to exhibit facilitation. Peak velocity phase tended to normalize toward symmetry in the bilateral conditions. These findings are consistent with prior evidence that the control of the involved arm improves during bimanual performance for some hemiplegic subjects. It further suggests loading the uninvolved arm may benefit some subjects with respect to unimanual performance, with age perhaps playing a role in determining efficacy.