This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The purpose of this project is twofold: 1) determine whether home-based Joint Movement Tracking Training is effective in promoting improved hand function and brain reorganization in subjects with chronic stroke, and 2) determine whether the mechanism of any such improvements is learning-dependent vs. use-dependent. Recent work from our laboratory has shown that repetitive efforts by subjects with chronic stroke using their paretic hand at a finger movement tracking task produced significant improvements in hand function and brain reorganization. The training technique requires patients to learn how to create precision movemnts of the index finger to track target waveforms on a computer screen. This project will examine whether home-based tracking treatment using a laptop computer and tele-communication technology can be as effective as our earlier work with clinic-based treatment. Equally important, this project will examine whether it is the motor learning or the repetitive movement taht serves as the mechanism of improvement. Two groups of subjects with chronic stroke will be randomly assigned to receive either the tracking treatment or movement treatment in their own home, periodically guided by a remote therapist. The tracking group will receive a pretest, one month of tracking treatment, a posttest, and three months later a retention test. The movement group will receive a pretest, one month of movemtn treatment involving only simple finger movements with no motor learning, a posttest, then cross over to receive one month of tracking, and finally crossover test. Change in behavior will be evaluated with functional tests. Brain reorganization will be evaluated with functional magnetic resonance imaging (fMRI) using a 3 Tesla magnet at the Center for Magnetic Resonance Research (CMRR). This study has the potential of revealing a new form of cost-effective treatment for stroke and also uncovering whether recovery from stroke is learning - dependent or use-dependent.
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