Stroke is the leading cause of motor disability. Unfortunately, even one year post, nearly 80% of stroke patients still have residual motor disabilities. Although research efforts toward facilitating current stroke rehabilitation interventions have yielded beneficial protocols, many are less than optimal and frequently deficient in attaining progress toward motor recovery. A primary reason underlying the minimal amount of motor recovery is the continued lack of a theoretical basis for many popular stroke interventions. One sound theory, bimanual coordination theory, provides a strong basis for explaining motor improvements in chronic hemiparesis. Indeed, bilateral movement training coupled with active neuromuscular stimulation has produced motor gains in extending the wrist and fingers during chronic stroke. The proposed project will investigate intensity levels (frequency) of coupled protocols, bilateral movement training augmented with active stimulation, as a behavioral intervention in stroke patients who are in the subacute phase of recovery (3 - 6 months post). Thirty-three subacute stroke patients will be randomly assigned to one of three intensity level groups: (a) zero control (no coupled protocols), (b) low (2 days/week for 2 weeks), and (c) high (4 days/week for 2 weeks). In addition, motor recovery of subjects will be tracked for 60 days after treatment to evaluate a cumulative effect on motor gains across time. Functional motor capabilities will be assessed 4 times (pretest, mid treatment, posttest 1, and posttest 2) by six primary outcome measures: (a) Fugl-Meyer Upper Extremity Motor Test, (b) Box and Block Test, (c) Wolf Motor Function Test, (d) fractionated reaction time, (e) sustained muscle contraction, and (f) Stroke Impact Scale. This proposal will provide dose-response evidence on intensity levels of coupled protocols and determine the motor recovery benefits of bilateral movement training coupled with active neuromuscular stimulation. Completing this project will comprehensively progress understanding of viable and effective mechanisms that improve motor function, thereby permitting continued advancement of a theoretically framed, empirically driven research program that will inform treatment protocols for recovery of motor disabilities in subacute stroke. ? ? ? ?
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