Article

PURPOSE: Explore the potential benefits of using priming methods prior to an
active hand task in the acute phase post-stroke in persons with severe upper
extremity hemiparesis. METHODS: Five individuals were trained using priming
techniques including virtual reality (VR) based visual mirror feedback and
contralaterally controlled passive movement strategies prior to training with an
active pinch force modulation task. Clinical, kinetic, and neurophysiological
measurements were taken pre and post the training period. Clinical measures were
taken at six months post training. RESULTS: The two priming simulations and
active training were well tolerated early after stroke. Priming effects were
suggested by increased maximal pinch force immediately after visual and movement
based priming. Despite having no clinically observable movement distally, the
subjects were able to volitionally coordinate isometric force and muscle activity
(EMG) in a pinch tracing task. The Root Mean Square Error (RMSE) of force during
the pinch trace task gradually decreased over the training period suggesting
learning may have occurred. Changes in motor cortical neurophysiology were seen
in the unaffected hemisphere using Transcranial Magnetic Stimulation (TMS)
mapping. Significant improvements in motor recovery as measured by the Action
Research Arm Test (ARAT) and the Upper Extremity Fugl Meyer Assessment (UEFMA)
were demonstrated at six months post training by three of the five subjects.
CONCLUSION: This study suggests that an early hand-based intervention using
visual and movement based priming activities and a scaled motor task allows
participation by persons without the motor control required for traditionally
presented rehabilitation and testing. Implications for Rehabilitation
Rehabilitation of individuals with severely paretic upper extremities after
stroke is challenging due to limited movement capacity and few options for
therapeutic training. Long-term functional recovery of the arm after stroke
depends on early return of active hand control, establishing a need for acute
training methods focused distally. This study demonstrates the feasibility of an
early hand-based intervention using virtual reality based priming and scaled
motor activities which can allow for participation by persons without the motor
control required for traditionally presented rehabilitation and testing.

Langue : ANGLAIS