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Effect of auditory constraints on motor performance depends on stage of recovery post-stroke.

Aluru V, Lu Y, Leung A, Verghese J, Raghavan P - Front Neurol (2014)

Bottom Line: In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation.In minimal paresis, wrist extension did not improve under any condition.The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, New York University School of Medicine , New York, NY , USA.

ABSTRACT
In order to develop evidence-based rehabilitation protocols post-stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post-stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in 20 subjects with chronic hemiparesis. We used a bimanual wrist extension task, performed with a custom-made wrist trainer, to facilitate learning of wrist extension in the paretic hand under four auditory conditions: (1) without auditory cueing; (2) to non-musical happy sounds; (3) to self-selected music; and (4) to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each) were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics, and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups, which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke.

No MeSH data available.


Related in: MedlinePlus

Trendlines of wrist extension performance variables over six repeated trials with the paretic hand under each condition for the three groups: (A) spastic paresis (blue); (B) spastic co-contraction (red); (C) minimal paresis (green). The four conditions are represented by the different patterned lines.
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Figure 5: Trendlines of wrist extension performance variables over six repeated trials with the paretic hand under each condition for the three groups: (A) spastic paresis (blue); (B) spastic co-contraction (red); (C) minimal paresis (green). The four conditions are represented by the different patterned lines.

Mentions: Our second objective was to examine how different types of auditory stimuli interact with bimanual training to facilitate subsequent learning with the paretic limb in the three groups. Subjects performed six cycles of two bimanual trials followed by one unimanual trial with the paretic hand, where each trial consisted of multiple repeats of wrist flexion-extension over 15 s. We were interested in the changes in wrist extension, wrist extensor activation, wrist flexor activation, and co-activation over the six unimanual trials for each of the auditory conditions (represented by the different line patterns, see Figure 5). The mean level of the trend lines provides an indication of the amplitude of overall performance, whereas the slope of the trend lines quantifies the rate of learning on the paretic side. A positive slope suggests sustained improvement whereas a negative slope suggests reduced performance under that constraint. Subjects in the spastic paresis (Figure 5A) and spastic co-contraction (Figure 5B) groups started with low or negative wrist extension, but showed sustained improvements under certain auditory constraints. Subjects in the minimal paresis group (Figure 5C), showed good wrist extension at first, but did not improve much over the repeated trials.


Effect of auditory constraints on motor performance depends on stage of recovery post-stroke.

Aluru V, Lu Y, Leung A, Verghese J, Raghavan P - Front Neurol (2014)

Trendlines of wrist extension performance variables over six repeated trials with the paretic hand under each condition for the three groups: (A) spastic paresis (blue); (B) spastic co-contraction (red); (C) minimal paresis (green). The four conditions are represented by the different patterned lines.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4066443&req=5

Figure 5: Trendlines of wrist extension performance variables over six repeated trials with the paretic hand under each condition for the three groups: (A) spastic paresis (blue); (B) spastic co-contraction (red); (C) minimal paresis (green). The four conditions are represented by the different patterned lines.
Mentions: Our second objective was to examine how different types of auditory stimuli interact with bimanual training to facilitate subsequent learning with the paretic limb in the three groups. Subjects performed six cycles of two bimanual trials followed by one unimanual trial with the paretic hand, where each trial consisted of multiple repeats of wrist flexion-extension over 15 s. We were interested in the changes in wrist extension, wrist extensor activation, wrist flexor activation, and co-activation over the six unimanual trials for each of the auditory conditions (represented by the different line patterns, see Figure 5). The mean level of the trend lines provides an indication of the amplitude of overall performance, whereas the slope of the trend lines quantifies the rate of learning on the paretic side. A positive slope suggests sustained improvement whereas a negative slope suggests reduced performance under that constraint. Subjects in the spastic paresis (Figure 5A) and spastic co-contraction (Figure 5B) groups started with low or negative wrist extension, but showed sustained improvements under certain auditory constraints. Subjects in the minimal paresis group (Figure 5C), showed good wrist extension at first, but did not improve much over the repeated trials.

Bottom Line: In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation.In minimal paresis, wrist extension did not improve under any condition.The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, New York University School of Medicine , New York, NY , USA.

ABSTRACT
In order to develop evidence-based rehabilitation protocols post-stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post-stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in 20 subjects with chronic hemiparesis. We used a bimanual wrist extension task, performed with a custom-made wrist trainer, to facilitate learning of wrist extension in the paretic hand under four auditory conditions: (1) without auditory cueing; (2) to non-musical happy sounds; (3) to self-selected music; and (4) to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each) were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics, and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups, which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke.

No MeSH data available.


Related in: MedlinePlus