Targeted Engagement of the Action Selection Network during Task-Oriented Arm Training after Stroke

Abstract

Action selection (AS), or selection of an action from a set of alternatives, is an important movement preparation process that engages a frontal-parietal network. The addition of AS demands to arm training after stroke could be used to engage this motor planning process and the neural network that supports it. The purpose of this case series is to describe the feasibility and outcomes associated with task-oriented arm training aimed at engaging the AS behavioral process and the related neural network in three individuals with chronic stroke. Three participants with mild to moderate motor deficits completed 13 to 15 sessions of task-oriented arm training that included AS cues for each movement repetition; cues dictated movement direction, height, or distance. Before and after training, individuals completed an AS brain-behavior probe during functional MRI. AS behavioral performance improved after training (increased accuracy, decreased reaction time) in all participants while brain activation in the AS network (dorsal premotor, parietal, dorsolateral prefrontal cortices) decreased in two participants. Gains in motor function were also found in all three participants, especially on patient-reported measures of perceived difficulty and confidence to complete upper extremity functional tasks. It was feasible to target the AS behavioral process and the related neural network through the addition of AS demands to functional, task-oriented arm training in three individuals with mild to moderate motor dysfunction poststroke.

Effect of behavioural practice targeted at the motor action selection network after stroke

“…Overall, the results of the current study suggest that behavioural practice can improve action selection performance with a corresponding reduction in brain activation to successfully complete this motor preparation process. Systematic changes in task practice conditions with predictable behavioural and neural effects may be useful in designing novel rehabilitation interventions after stroke (Stewart et al, 2020).…”

Task oriented training for Stroke Rehabilitation: A mini review

“…TOT may be helpful depending on the dosage of training (number of movement repetitions), although the ideal training programme's dosage is yet uncertain. 10 TOT can also induce neuroplasticity changes which are important aspect of learning new tasks and most of the rehabilitation strategies involve repeating task activities for better outcomes. Repeating the tasks results in stimulating motor cortex and associated areas of the brain results in better outcomes.…”

“…Individuals' post-stroke behavioural performance of goaldirected activities can change in response to changes in task conditions or practice instructions. 10 Repeating a single task (for example pouring water from glass-an example of TOT) will help patient learn that specific task while the goal was to achieve pronation and supination at the wrist by providing Action Selection method with multiple tasks options to do pronationsupination. If we change the task of pronation-supination to door handle opening activity that might challenge the patient's capabilities.…”

Neural substrates of Motor Learning Strategies in Stroke

“…TOT & neural dependence: Repetitive arm training leads to implicit and explicit learning in the motor cortex. There is bilateral activation of cerebral cortices followed by brain stem and cerebellar networks [37]. Studies on practice scheduling in motor learning area have been developed based on the assumption that random practice facilitates the transfer and retention of motor skills by adding parameters (e.g.…”