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. 2013 Sep;27(7):602-12.
doi: 10.1177/1545968313481279. Epub 2013 Apr 2.

Transfer of Training Between Distinct Motor Tasks After Stroke: Implications for Task-Specific Approaches to Upper-Extremity Neurorehabilitation

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Free PMC article

Transfer of Training Between Distinct Motor Tasks After Stroke: Implications for Task-Specific Approaches to Upper-Extremity Neurorehabilitation

Sydney Y Schaefer et al. Neurorehabil Neural Repair. .
Free PMC article

Abstract

Background: Although task-specific training is emerging as a viable approach for recovering motor function after stroke, there is little evidence for whether the effects of such training transfer to other functional motor tasks not directly practiced in therapy.

Objective: The purpose of the current study was to test whether training on one motor task in individuals with chronic hemiparesis poststroke would transfer to untrained tasks that were either spatiotemporally similar or different.

Methods: In all, 11 participants with chronic mild to moderate hemiparesis following stroke completed 5 days of supervised massed practice of a feeding task with their affected side. Performance on the feeding task, along with 2 other untrained functional upper-extremity motor tasks (sorting, dressing) was assessed before and after training.

Results: Performance of all 3 tasks improved significantly after training exclusively on 1 motor task. The amount of improvement in the untrained tasks was comparable and was not dependent on the degree of similarity to the trained task.

Conclusions: Because the number and type of tasks that can be practiced are often limited within standard stroke rehabilitation, results from this study will be useful for designing task-specific training plans to maximize therapy benefits.

Keywords: motor learning; physical therapy; stroke rehabilitation; task-specific training; transfer; upper extremity.

Figures

Figure 1
Figure 1
Diagram of training schedule across five days. Training sessions were comprised of fifty 30-sec trials of only one motor task. Gray shading indicates sessions (Pre-test and Post-test) in which all motor tasks were completed, under both single and dual task conditions. Order of trials and conditions within each session was randomized.
Figure 2
Figure 2
Motor tasks. Top view of the trained task (`Feeding') and untrained tasks (`Sorting', 'Dressing'). Adapted versions of the feeding task and dressing task are shown beneath each task, respectively, as indicated by arrows.
Figure 3
Figure 3
Spatiotemporal characteristics and training schedule of motor tasks: Feeding (black), sorting (dashed), and dressing (gray). (A) Shoulder and elbow flexion angle and (B) hand path in the horizontal plane (top view; arrows indicate start of trial) during individual 30-second trials for a single participant. Note similarity between feeding and sorting tasks in terms of movement kinematics. 3D position data of the upper extremity segments were collected with an electromagnetic tracking system with four sensors (The Motion Monitor, Innovative Sports Training, Chicago, IL). Sensor locations were: midsternum, upper arm, forearm, and back of hand. Kinematic data were collected at 50 Hz and low-pass filtered at 6 Hz using a second-order Butterworth filter.
Figure 4
Figure 4
Effects of motor training. Mean ± SE motor performance on the (A) feeding task per trial over the course of 250 training trials; (B) feeding task before (pre) and after (post) training; and (C) untrained sorting and dressing tasks before (pre) and after (post) training (***p<.0001; *p<.05).
Figure 5
Figure 5
Preserved training effects under dual task conditions. (A) Mean listening error under dual task conditions ('Listen + Motor'; collapsed across all motor tasks) before (pre) and after (post) motor training. Dashed line indicates mean listening error for `Listening only' condition; gray box indicates SE. (B) Mean motor performance per trial before (pre) and after (post) training for the trained ('Feeding') and the untrained ('Sorting', `Dressing') tasks under dual task conditions ('Listen + Motor'). Error bars indicate SE. Note similarity in trend to Figure 3B (***p<.0001; *p<.05;† p<.1).
Figure 6
Figure 6
Magnitude of improvement due to transfer. (A) Motor performance on all three tasks for a single participant with moderate hemiparesis (ARAT score=26) before (pre) and after (post) training, normalized to unaffected arm performance (100%=normal). (B) Mean improvement in motor performance from pre- to post-test on all three motor tasks as a result of training only on one (Feeding). Amount expressed as percent change relative to the unaffected side of the unaffected side. Error bars indicate SE. (C) Change in ability to fasten buttons from before to after training on the dressing task. Percent of participants based on n=11.

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