In the previous cycle of this grant, we characterized hemisphere-specific motor control deficits in the non- paretic arm of unilaterally lesioned stroke survivors. Our preliminary data indicate these deficits are substantial and functionally limiting in patients with severe paresis. We have specifically designed an intervention to remediate the hemisphere-specific deficits in the non-paretic arm, using a virtual-reality platform, and then follow this training with manipulation training of a variety of real objects, designed to facilitate generalization and transfer to functional behaviors encountered in the natural environment. We propose a 2-site, two-group randomized intervention with a treatment group, which will receive unilateral training of the non-paretic arm, through our Virtual Reality and Manipulation Training (VRMT) protocol. This intervention protocol is grounded in the premise that targeted remediation of fundamental control deficits exhibited by the non-paretic arm will generalize and transfer beyond practiced tasks to performance of activities of daily living (ADL). This approach contrasts with the more pragmatic approach of task-specific training of essential ADL?s, which is limited in scope, more cumbersome, and ignores known fundamental motor control deficits. Our control group will receive conventional intervention, guided by recently released practice guidelines for upper limb intervention in adult stroke. The impact of the proposed research is that we address persistent functional performance deficits in chronic stroke patients with severe paresis, who?s non- paretic arm impairments are generally ignored in most current rehabilitation protocols.
Our first aim addresses the overall effectiveness of this intervention, relative to our control group: To determine whether non-paretic arm VRMT in chronic stroke survivors with severe paresis will produce durable improvements in non-paretic arm motor performance that will generalize to improve functional activities and functional independence to a greater extent than conventional therapy focused on the paretic arm.
Our second aim focuses on the mechanistic basis of potential training-related improvements in motor performance: To determine whether intervention-induced improvements in non-paretic arm performance are associated with improvements in hemisphere-specific reaching kinematics. Finally, our third aim monitors for potential negative effects of our experimental intervention on paretic arm impairment. We have already integrated the PI?s laboratories (Sainburg-PSU, Winstein-USC) for our pilot research project that has provided excellent support for aims 1 and 3. !
Stroke survivors with severe chronic paresis who are not able to use their paretic hand for manipulations, often have substantial motor control deficits in the non-paretic arm that can substantially limit functional independence. This proposal will test remediation focused on improving functional independence by training control and coordination of the non-paretic arm. It will also test the effects of this intervention on paretic arm motor impairment. If successful, this study will provide rigorous evidence for a therapy that remediates persistent functional performance deficits in chronic stroke patients with severe paresis, who's non-paretic arm impairments are generally ignored in most current rehabilitation protocols. ! ! !
| Mutha, Pratik K; Stapp, Lee H; Sainburg, Robert L et al. (2017) Motor Adaptation Deficits in Ideomotor Apraxia. J Int Neuropsychol Soc 23:139-149 |
| Schaffer, Jacob E; Sainburg, Robert L (2017) Interlimb differences in coordination of unsupported reaching movements. Neuroscience 350:54-64 |
| Patterson, Jacqueline R; Brown, Liana E; Wagstaff, David A et al. (2017) Limb position drift results from misalignment of proprioceptive and visual maps. Neuroscience 346:382-394 |
| Sainburg, Robert L; Liew, Sook-Lei; Frey, Scott H et al. (2017) Promoting Translational Research Among Movement Science, Occupational Science, and Occupational Therapy. J Mot Behav 49:1-7 |
| Jo, H J; Maenza, C; Good, D C et al. (2016) Effects of unilateral stroke on multi-finger synergies and their feed-forward adjustments. Neuroscience 319:194-205 |
| Sainburg, Robert L; Mutha, Pratik K (2016) Error Detection is Critical for Visual-Motor Corrections. Motor Control 20:187-94 |
| Sainburg, Robert L; Schaefer, Sydney Y; Yadav, Vivek (2016) Lateralized motor control processes determine asymmetry of interlimb transfer. Neuroscience 334:26-38 |
| Sainburg, Robert L; Maenza, Candice; Winstein, Carolee et al. (2016) Motor Lateralization Provides a Foundation for Predicting and Treating Non-paretic Arm Motor Deficits in Stroke. Adv Exp Med Biol 957:257-272 |
| Akpinar, Selcuk; Sainburg, Robert L; Kirazci, Sadettin et al. (2015) Motor asymmetry in elite fencers. J Mot Behav 47:302-11 |
| Sainburg, Robert L (2015) Should the Equilibrium Point Hypothesis (EPH) be Considered a Scientific Theory? Motor Control 19:142-8 |
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