This Article Full Text Full Text (PDF) All Versions of this Article: 37/5/1237    most recent 01.STR.0000217417.89347.63v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cirstea, C.M. Articles by Levin, M.F. Search for Related Content PubMed PubMed Citation Articles by Cirstea, C.M. Articles by Levin, M.F. Related Collections Rehabilitation, Stroke

(Stroke. 2006;37:1237.)
© 2006 American Heart Association, Inc.

Original Contributions

Feedback and Cognition in Arm Motor Skill Reacquisition After Stroke

From the Department of Physiology (C.M.C.), Faculty of Medicine, University of Montreal, Quebec, Canada; Cognitive Neuroscience Unit (A.P.), Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Research Centre (M.F.L.), Rehabilitation Institute of Montreal, School of Rehabilitation, University of Montreal, Quebec, Canada.

Correspondence to Mindy F. Levin, PhD, Director, Physical Therapy Program, McGill University, 3654 Promenade Sir-William-Osler, Montreal, PQ, H3G 1Y5. E-mail mindy.levin{at}mcgill.ca

Background and Purpose— A debated subject in stroke rehabilitation relates to the best type of training approach for motor recovery. First, we analyzed the effects of repetitive movement practice in 2 feedback conditions (knowledge of results [KR]; knowledge of performance, [KP]) on reacquisition of reaching. Second, we evaluated the impact of cognitive impairment on motor relearning ability.

Methods— A randomized controlled clinical trial was conducted in Montreal-area rehabilitation centers between 1998 and 2003 with 37 patients with chronic hemiparesis. Patients were randomly assigned to 3 groups: (1) KR (n=14) practiced a reaching task involving 75 repetitions per day, 5 days per week for 2 weeks, with 20% KR about movement precision; (2) KP (n=14) trained on the same task and schedule as KR but with faded KP about joint motions; and (3) control (C; n=9) practiced a nonreaching task. Physical (motor impairment, function) and kinematic (movement time, precision, segmentation, variability) variables were assessed before and after (immediately, 1 month) practice. Cognitive functions (memory, attention, mental flexibility, planning) were also evaluated.

Results— Kinematic gains in KR (precision) and KP (time, variability) exceeded those in C and depended on memory and mental flexibility deficits. In KP, more severely impaired patients made the most clinical gains (>2xC), which were related to memory and planning abilities.

Conclusions— Use of KP during repetitive movement practice resulted in better motor outcomes. Stroke severity together with cognitive impairments are important factors for choosing motor rehabilitation interventions after stroke.

Key Words: randomized controlled trials • rehabilitation • stroke • cognition

This article has been cited by other articles:

				D. Broetz, S. R Soekadar, and N. Birbaumer On "A four-week, task-specific neuroprosthesis program..." Dunning K, et al. Phys Ther. 2008;88:397-405. Physical Therapy, August 1, 2008; 88(8): 970 - 970. [Full Text] [PDF]

				M.C. Cirstea and M.F. Levin Improvement of Arm Movement Patterns and Endpoint Control Depends on Type of Feedback During Practice in Stroke Survivors Neurorehabil Neural Repair, October 1, 2007; 21(5): 398 - 411. [Abstract] [PDF]

				Exercise to Stimulate Recovery of Motor Function After Stroke Journal Watch Neurology, September 5, 2006; 2006(905): 2 - 2. [Full Text]