Cerebral infarctions (strokes) are the leading

Effectiveness of Sensory and Motor Rehabilitation of the Upper Limb Following the Principles of Neuroplasticity: Patients Stable Poststroke Nancy Byl,...
Author: Griselda Daniel
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Effectiveness of Sensory and Motor Rehabilitation of the Upper Limb Following the Principles of Neuroplasticity: Patients Stable Poststroke Nancy Byl, Jennifer Roderick, Olfat Mohamed, Monica Hanny, Josh Kotler, Amy Smith, Molly Tang, and Gary Abrams

Based on the principles of neuroplasticity, the purpose of this crossover study was to determine if improvement in upper extremity (UE) function and independence could be achieved in patients 6 months to 7 years poststroke following an outpatient rehabilitation program (supervised 1.5 hours per week for 8 weeks reinforced with home gloving unaffected side and attended, graded, repetitive sensory and motor training activities). Twenty-one subjects (right or left hemiparesis; able to walk 100 feet with or without a cane; partially opened and closed the hand; partially elevated the shoulder and elbow against gravity) were randomly assigned to Group A (sensory training 4 weeks, motor training 4 weeks) or Group B (motor training 4 weeks, sensory training 4 weeks). Greater than 20% (P 100 feet with or without an assistive device), and demonstrate sufficient voluntary control and strength to elevate the arm (at least 60 degrees), bend the elbow (45-60 degrees) against gravity and initiate partial opening and closing of

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the hand. Subjects were excluded if they were diagnosed with a traumatic brain injury, degenerative neuromuscular disease, or serious musculoskeletal injury. Patients were not excluded if they suffered medically stable conditions such as diabetes, heart disease, high blood pressure, or ageexpected degenerative arthritis. All subjects were requested to obtain physician clearance to participate in a therapeutic exercise program. Subjects were recruited from physical therapists in the University of California, San Francisco (UCSF) Faculty Practice, physicians in the UCSF Neurology Clinics, and flyers posted in medical and neurology clinics in the San Francisco Bay Area. The subjects were initially screened for eligibility by telephone. Subjects meeting the initial telephone screen were scheduled for an appointment with the research assistant to confirm eligibility and arrange testing appointments. This study was approved by the Committee on Human Research at UCSF. All subjects were informed of their rights and provided signed consent before data collection.

METHODS All subjects were evaluated at baseline, 4 and 8 weeks of training. The first 10 subjects were followed up and retested 12 weeks after the last supervised treatment session, and the last 8 patients were contacted by telephone 3 months posttreatment. Two teams of research assistants participated in this project. Each research assistant was trained as an evaluator or an interventionist. The principal investigator trained all of the research assistants. All of the evaluators practiced administering the tests until 90% agreement was achieved. The evaluators were blinded to group assignment, and a different evaluator readministered the tests at each assessment period. This controlled for the bias of retesting by the same evaluator. Where possible, parallel test forms (e.g., the same items presented in different order) were administered at the beginning and the end of the study to minimize the bias of patient learning with retesting. The evaluation was based on standardized methods and procedures assessing a broad range of sensory, motor, and functional skills. Detailed testing procedures can be reviewed in published studies.47-60 Table 1 provides a summary of the tests and procedures. The results from the clinical tests were combined to create 6 dependent variables. The integration of correlated subtests (r > 0.35) into specific independent outcome variables controlled for the experiment-wise error by avoiding unnec178

essary repetitive testing on correlated outcome variables.61 The following dependent variables were created: sensory discrimination (kinesthesia, graphesthesia, and stereognosis),47-49 fine motor control (digital reaction time50 and performance time on the Purdue Peg Board51), musculoskeletal performance for the upper and lower limb (strength52-54 and range of motion54), functional independence (Wolf Motor Function Test [WMFT]56-58 and the California Functional Evaluation 4058), and gait speed.59 The 6 dependent variables were independent (correlations