Temporal and spatial control following bilateral versus unilateral training.
S McCombe Waller1, W Liu, J Whitall
1University of Maryland Baltimore, School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD 21201, USA. smccombewaller@som.umaryland.edu
Human Movement Science
|July 22, 2008
Summary
Bilateral Arm Training with Rhythmic Auditory Cueing (BATRAC) improved bilateral arm reaching more than Dose Matched Therapeutic Exercises (DMTE). Task-specific training demonstrated that BATRAC enhanced bilateral movements, while DMTE improved unilateral movements in stroke survivors.
Area of Science:
- Neurorehabilitation
- Motor Control and Learning
- Biomechanics
Background:
- Stroke survivors often experience upper extremity motor deficits.
- Current rehabilitation protocols increasingly incorporate motor control principles like bilateral coordination and task-specificity.
- Standardized tests often report composite scores, potentially masking specific motor control changes.
Purpose of the Study:
- To compare the effects of Bilateral Arm Training with Rhythmic Auditory Cueing (BATRAC) and Dose Matched Therapeutic Exercises (DMTE) on upper extremity motor control in stroke survivors.
- To investigate task-specificity of training protocols by assessing bilateral and unilateral arm reaching.
- To determine if kinematic measures capture motor control changes missed by traditional assessments.
Main Methods:
- A sub-study of a randomized controlled trial comparing BATRAC and DMTE.
- Participants (n=18) received 18 sessions of 20-minute training over 6 weeks.
- Assessment included bilateral and unilateral arm reaching kinematics and standardized tests (Fugl-Meyer Upper Extremity, Wolf Motor Arm Test).
Main Results:
- BATRAC group showed faster bilateral reaching, increased peak acceleration, fewer movement units, and smoother hand paths.
- BATRAC demonstrated greater improvements in movement units and hand path smoothness for bilateral reaching compared to DMTE.
- DMTE group showed faster paretic arm reaching in unilateral tasks, but overall improvements were not significantly greater than BATRAC.
- Task-specific improvements were observed: BATRAC enhanced bilateral reaching, DMTE enhanced unilateral reaching.
Conclusions:
- Reaching analysis reveals task-specificity in upper extremity training for stroke survivors.
- BATRAC is more effective for improving bilateral arm coordination and reaching.
- DMTE shows benefits for unilateral reaching, particularly for the paretic arm.
- Kinematic measures of temporal/spatial control provide functionally relevant insights into motor recovery beyond composite scores.
