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Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study.
Disabil Rehabil 2017; 39(15):1524-1531DR

Abstract

PURPOSE

The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated.

METHODS

This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation.

RESULTS

Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing.

CONCLUSION

This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke.

Authors+Show Affiliations

a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.b St. Joseph's Wayne Hospital , Acute Rehabilitation Unit , Wayne , NJ , USA.a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA. c Department of Biomedical Engineering , New Jersey Institute of Technology, University Heights , Newark , NJ , USA.d Department of Physical Therapy, Movement, and Rehabilitation Science, Bouve College of Health Sciences , Northeastern University , Boston , MA , USA.a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27669997

Citation

Fluet, Gerard G., et al. "Motor Skill Changes and Neurophysiologic Adaptation to Recovery-oriented Virtual Rehabilitation of Hand Function in a Person With Subacute Stroke: a Case Study." Disability and Rehabilitation, vol. 39, no. 15, 2017, pp. 1524-1531.
Fluet GG, Patel J, Qiu Q, et al. Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study. Disabil Rehabil. 2017;39(15):1524-1531.
Fluet, G. G., Patel, J., Qiu, Q., Yarossi, M., Massood, S., Adamovich, S. V., ... Merians, A. S. (2017). Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study. Disability and Rehabilitation, 39(15), pp. 1524-1531. doi:10.1080/09638288.2016.1226421.
Fluet GG, et al. Motor Skill Changes and Neurophysiologic Adaptation to Recovery-oriented Virtual Rehabilitation of Hand Function in a Person With Subacute Stroke: a Case Study. Disabil Rehabil. 2017;39(15):1524-1531. PubMed PMID: 27669997.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study. AU - Fluet,Gerard G, AU - Patel,Jigna, AU - Qiu,Qinyin, AU - Yarossi,Matthew, AU - Massood,Supriya, AU - Adamovich,Sergei V, AU - Tunik,Eugene, AU - Merians,Alma S, Y1 - 2016/09/27/ PY - 2016/9/28/pubmed PY - 2018/3/9/medline PY - 2016/9/28/entrez KW - Stroke KW - hand KW - rehabilitation KW - robotics KW - upper extremity KW - virtual reality SP - 1524 EP - 1531 JF - Disability and rehabilitation JO - Disabil Rehabil VL - 39 IS - 15 N2 - PURPOSE: The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. METHODS: This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. RESULTS: Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. CONCLUSION: This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke. SN - 1464-5165 UR - https://www.unboundmedicine.com/medline/citation/27669997/Motor_skill_changes_and_neurophysiologic_adaptation_to_recovery_oriented_virtual_rehabilitation_of_hand_function_in_a_person_with_subacute_stroke:_a_case_study_ L2 - http://www.tandfonline.com/doi/abs/10.1080/09638288.2016.1226421 DB - PRIME DP - Unbound Medicine ER -