Short-Duration and Intensive Training Improves Long-Term Reaching Performance in Individuals With Chronic Stroke

Abstract

Previous studies have shown that multiple sessions of reach training lead to long-term improvements in movement time and smoothness in individuals post-stroke. Yet, such long-term training regimens are often difficult to implement in actual clinical settings. Here, we evaluated the long-term and generalization effects of short-duration and intensive reach training in 16 individuals with chronic stroke and mild to moderate impairments. Participants performed two sessions of unassisted intensive reach training, with 600 movements per session, and with display of performance-based feedback after each movement. The participants’ trunks were restrained with a belt to avoid compensatory movements. Training resulted in significant and durable (1-month) improvements in movement time (20.4% on average) and movement smoothness (22.7% on average). The largest improvements occurred in individuals with the largest initial motor impairments. In addition, training induced generalization to non-trained targets, which persisted in 1-day and in 1-month retention tests. Finally, there was a significant improvement in the Box and Block test from baseline to 1-month retention test (23% on average). Thus, short-duration and intensive reach training can lead to generalized and durable benefits in individuals with chronic stroke and mild to moderate impairments.

The Efficiency, Efficacy, and Retention of Motor Training in Chronic Stroke

“…Finally, as noted the 0 hour group shows significant increase in the MAL during and post-training. In addition to the MAL, each assessment consisted of arm reaching tests comprised with approximately 200 movements with the more affected arm 11 , in addition to the WMFT test (in which subjects perform goal-directed arm and hand movements).…”

“…Whereas some studies have shown decay of the gains post-training, as least for subgroups of patients 13 , others have shown that the gains can be maintained after training 11,14 , yet others have shown that the gains can even further increase following training, possibly through "self-training" if arm use is sufficient 13,[15][16][17] Here, we analyzed the changes in the Quality of Movement sub-scale of the Motor Activity Log (henceforth, the MAL) in the DOSE trial 9 , in which participants with chronic stroke were randomized into four dose groups. The total doses (0, 15, 30 and 60 hours) were equally distributed over the three bouts of training, as shown in Figure 1B.…”

“…While both our recent Dose Optimization for Stroke Evaluation (DOSE) trial and meta-analyses 7,8 suggest that higher doses lead to greater gains 9 , a recent phase II clinical trial showed no effect of dose on arm function 10 . Second, although studies of motor training after stroke show that most gains in movement performance are achieved in the initial sessions 11,12 , the changes of efficiency of training with both additional doses and additional bouts of training on clinical outcomes are unknown. Third, retention following motor training in stroke survivors appears highly variable and the reasons for such variability are unclear.…”

The effects of music‐supported therapy on motor, cognitive, and psychosocial functions in chronic stroke

“…Thus, a foremost question is how much of improvement any short‐term intervention could achieve in the late chronic state. Recent reports offer some encouraging findings of motor improvement observed after just one of two training sessions . However, such an explicit improvement is specific for the trained movement, and hard to generalize to other daily actions.…”

“…Recent reports offer some encouraging findings of motor improvement observed after just one of two training sessions. 38,39 However, such an explicit improvement is specific for the trained movement, and hard to generalize to other daily actions. The standard assessment tasks used here were not the focus of repetitive training in either therapy program.…”