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Functional Outcomes Can Vary by Dose: Learning-Based Sensorimotor Training for Patients Stable Poststroke

Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California

Erica A. Pitsch, MPT

Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, pitsch{at}usc.edu

Gary M. Abrams, MD

Department of Neurology, University of California, San Francisco, California

Objective. This study aimed to determine whether the dose of learning-based sensorimotor training (LBSMT) significantly enhances gains in upper limb function in patients stable post stroke. Methods. A total of 45 subjects stable poststroke participated in a 6-8-week LBSMT program of varied dosage: group I (n = 18; 1x/week, 1.5 hours/visit); group II (n = 19, 3x/week, 0.75 hours/visit); and group III (n = 8; 4x/week, 3 hours/visit). All subjects reinforced their training with home-based practice. The primary outcome measures were functional independence, strength, sensory discrimination, and fine motor skills. Results. Across all individual subjects, significant gains were measured on the 4 dependent variables (improvement ranging from 9.0% to 38.9%; P < .001). Group III made greater gains than groups I and II on functional independence, sensory discrimination, and fine motor skills, with a significant linear trend by dose for functional independence (P < .001). Only 2-3 subjects in groups I and II, respectively, would need to be treated at the high dosage of group III for one more subject to achieve >50% gain in functional independence. Conclusions. Learning-based sensorimotor training based on the principles of neuroplasticity was associated with improved function in patients stable poststroke. The gains were dose specific with the greatest change measured in subjects participating in the high-intensity treatment group.

Key Words: Stroke • Neuroplasticity • Sensory training • Sensorimotor training.

Neurorehabilitation and Neural Repair, Vol. 22, No. 5, 494-504 (2008)
DOI: 10.1177/1545968308317431


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