Chronic stroke longitudinal motor improvements: cumulative learning evidence found in the upper extremity

The purpose was to determine the cumulative longitudinal effects of upper extremity distributed practice with variable treatment protocols involving EMG-triggered neuromuscular stimulation and coupled bilateral movements.

Sixteen chronic stroke subjects were randomly selected to complete 5 effective upper extremity treatment protocols over 12 months. The subjects were randomly assigned to 1 of 2 treatment orders. Consistent across the orders and protocols, the participants completed 90 min of training per day for 4 days during separate 2-week rehabilitation periods.

Data for the 5 primary outcome measures were analyzed in separate mixed design ANOVAs (treatment order x test session: 2 x 6). The analyses revealed distinct cumulative treatment evidence later in training in comparison to the baseline motor capabilities: (1) higher number of blocks moved; (2) higher percentage of blocks moved by the impaired hand; (3) faster motor reaction time (peripheral component), and (4) faster total reaction time.

These chronic stroke patients displayed robust cumulative motor improvement effects from the longitudinally distributed practice of active neuromuscular stimulation and coupled bilateral movements.