Task Oriented Training Activities Post Stroke Will Produce Measurable Alterations in Brain Plasticity Concurrent with Skill Improvement

ABSTRACT

Background

Task-oriented training with upper extremity (UE) skilled movements has been established as a method to regain function post stroke. Although improved UE function has been shown after this type of therapy, there is minimal evidence that brain plasticity is associated with this training. The accelerated skill acquisition program (ASAP) is an example of an approach for promoting UE function using targeting movements.

Objective

To investigate the effects of a single 2-hour session of ASAP in individuals with stroke on measures of brain plasticity as represented by corticospinal excitability (CE) and determine associations with reach-to-grasp (RTG) performance.

Methods

Eighteen post-acute stroke patients were randomized to two groups. Experimental group (n = 9) underwent ASAP for 2 hours, while the control group (n = 9) received dose equivalent usual and customary care. Both groups were evaluated for CE and RTG performance prior to the session and then four times after training: immediately, 1 day, 6 days, and 12 days.

Results

Significant alterations in CE were found in the peak-to-peak of Motor Evoked Potential amplitude of elbow and wrist extensor muscles in the lesioned hemisphere. The experimental group also demonstrated improved execution (shortened total movement time, TMT), feed-forward mechanism (deceleration time, DT) and planning (lengthened relative time to maximum hand aperture, RTApmax) compared to the control group

Conclusion

Alterations in brain plasticity occur concurrently with improvements in RTG performance in post-acute stroke patients with mild impairment after a single 2-hour session of task-oriented training and persist for at least 12 days.

KEYWORDS:

• Accelerated skill acquisition program
• Corticomotor excitability
• Stroke
• Transcranial magnetic stimulation

Abbreviations

ASAP accelerated skill acquisition program

CE corticomotor excitability (by TMS)

DT deceleration time

FMA-UE Fugl-Meyer Assessment – Upper Extremity

LTP long term potentiation

MCA middle cerebral artery

MEP motor evoked potential

rMT resting motor threshold

RTG reach-to-grasp

RTApmax relative time to maximum grasp aperture

TApmax time to maximum grasp aperture

TMS transcranial magnetic stimulation

TMT total movement time

TOT task oriented training

TVmax time to maximum transport velocity

UCC usual and customary care

Vmax maximum transport velocity

UE upper extremity