Stroke is the leading cause of adult-onset disability in the United States, and 75% of those presenting with upper extremity (UE) deficits continue to have decreased UE function, despite rehabilitation. Despite demonstrated efficacy that functional task practice promotes improved UE function post-stroke, most subjects continue to have substantial disability, reporting less paretic hand use than pre-stroke and having lower scores on motor tests. Auditory rhythm entrainment of functional task practice may enhance therapy efficacy by facilitating the adoption of more normal movement patterns. Thus, it is critical to public health that more effective approaches to facilitate UE motor recovery are developed. This study would further the mission of the NCMRR/NICHD to enhance independence of persons with disability and optimal well-being of all people through rehabilitation."""""""" ? ? The primary aim of this pilot study is to gather preliminary data on the impact of auditory rhythm entrainment of functional task practice (FTARC) on improvement in UE function compared to functional task practice alone (FTP) in subjects with moderate hemiparesis from chronic stroke. The primary hypothesis is that after FTARC, subjects will demonstrate greater gains in UE function compared to persons in the FTP group. Secondary aims are to understand (1) the relative impact of FTARC on retention of motor skills 6 months after therapy and (2) to understand how changes in more underlying elemental components of UE movement (kinetic parameters and multi-joint synergies) relate to this improvement in outcome. The secondary hypotheses are that the subjects with FTARC will demonstrate movement composition that is closer to that of neurologically intact individuals and greater retention of functional gains compared to subjects with FTP. ? ? This study will use a prospective, parallel group design in which subjects, after baseline testing, will be adaptively randomized by UE motor severity into either the FTARC or the FTP group. Therapy will be 4 hours of task practice per weekday for 2 weeks. Subjects will wear a mitt on their non-paretic hand for 90% of waking hours. Subjects will then complete post-intervention and 6-month follow up testing. ? ? It is critical to public health that more effective approaches to facilitate arm and hand motor recovery after stroke are developed. Functional task practice with auditory rhythm cues for the arm and hand may enhance therapy efficacy by facilitating the adoption of more normal movement patterns. ? ? ?
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| Sethi, Amit; Patterson, Tara; McGuirk, Theresa et al. (2013) Temporal structure of variability decreases in upper extremity movements post stroke. Clin Biomech (Bristol, Avon) 28:134-9 |
| Sethi, Amit; Davis, Sandra; McGuirk, Theresa et al. (2013) Effect of intense functional task training upon temporal structure of variability of upper extremity post stroke. J Hand Ther 26:132-7; quiz 138 |
| Patterson, Tara S; Bishop, M D; McGuirk, T E et al. (2011) Reliability of upper extremity kinematics while performing different tasks in individuals with stroke. J Mot Behav 43:121-30 |
