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Published on: October 11, 2024
Bilateral and unilateral arm training improve motor function through differing neuroplastic mechanisms: a
Jill Whitall1, Sandy McCombe Waller, John D Sorkin
1Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA. jwhitall@som.umaryland.edu
Bilateral arm training with rhythmic auditory cueing (BATRAC) and dose-matched therapeutic exercises (DMTEs) both improve upper-extremity function in stroke survivors. While comparable in motor gains, BATRAC showed greater brain activation changes, suggesting different rehabilitation mechanisms.
Area of Science:
- Neurorehabilitation
- Motor recovery after stroke
- Cortical plasticity
Background:
- Stroke survivors often experience upper-extremity (UE) paresis, impacting daily function.
- Understanding mechanisms of UE motor recovery is crucial for effective rehabilitation.
Purpose of the Study:
- To compare the efficacy of bilateral arm training with rhythmic auditory cueing (BATRAC) against dose-matched therapeutic exercises (DMTEs) for UE function in chronic stroke survivors.
- To investigate the effects of these interventions on cortical reorganization using functional magnetic resonance imaging (fMRI).
Main Methods:
- A randomized controlled trial involving 111 adults with chronic UE paresis.
- Interventions included 6 weeks of BATRAC or DMTE, 3 times per week.
- UE function was assessed using Fugl-Meyer UE Test (FM) and modified Wolf Motor Function Test (WT) at multiple time points.
- fMRI was used to evaluate brain activity changes related to UE movement pre- and post-training.
Main Results:
- Both BATRAC and DMTE led to significant and durable improvements in UE function (FM and WT scores), with comparable outcomes between groups.
- Patient satisfaction was higher following BATRAC compared to DMTE.
- BATRAC induced greater increases in brain activation in specific motor-related cortical areas, including the ipsilesional precentral gyrus and contralesional superior frontal gyrus.
- Increased activation in the contralesional superior frontal gyrus correlated with improvements in motor function (WMFT).
Conclusions:
- Neither BATRAC nor DMTE demonstrated superiority in improving motor function for chronic UE hemiparesis.
- Both rehabilitation approaches provide lasting motor benefits.
- The distinct patterns of brain activation changes suggest that BATRAC and DMTE may operate through different neuroplastic mechanisms despite similar functional outcomes.
