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Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm

Sandy McCombe Waller1, Jill Whitall2, Toye Jenkins3

  • 1School of Medicine, Department of Physical Therapy and Rehabilitation Science, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA. smccombewaller@som.umaryland.edu.

BMC Neurology
|December 16, 2014
PubMed
Summary

Sequential bilateral and unilateral training improved arm and hand function post-stroke more than unilateral training alone. This combined approach enhances motor cortex activation, aiding recovery in patients with moderate to severe hemiparesis.

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Area of Science:

  • Neurorehabilitation
  • Motor Recovery
  • Stroke Rehabilitation

Background:

  • Limited motor recovery after stroke presents a significant challenge.
  • Proximal bilateral training may prime the motor system for subsequent unilateral training.

Purpose of the Study:

  • To compare sequential bilateral-unilateral training with unilateral training alone for improving upper extremity function post-stroke.
  • To investigate the effects on motor cortex activation using functional magnetic resonance imaging (fMRI).

Main Methods:

  • Twenty-six participants with moderate hemiparesis were randomized to either combined (COMBO) or sequential-alone (SAEBO) training.
  • The COMBO group received 6 weeks of bilateral proximal training followed by 6 weeks of unilateral task-oriented training.
  • The SAEBO group received 12 weeks of unilateral task-oriented training alone.

Main Results:

  • The COMBO group showed significantly greater improvements across all outcome measures compared to the SAEBO group (p=.018).
  • Significant gains were observed in the Modified Wolf Motor Function Test for the COMBO group.
  • fMRI data indicated increased motor cortex activation in the COMBO group, but not in the SAEBO group.

Conclusions:

  • Sequential combination training (bilateral proximal followed by unilateral task-oriented) is effective for enhancing arm and hand function post-stroke.
  • This approach may be superior to unilateral training alone for patients with moderate to severe paresis.
  • The findings suggest a potential new strategy for stroke rehabilitation to optimize motor recovery.