SAGE Journals Online
Advertisement
Sign In to gain access to subscriptions and/or personal tools.

 

Advanced Search

Journal Navigation

Journal Home

Subscriptions

Archive

Contact Us

Table of Contents

Advertisement

Sign In to gain access to subscriptions and/or personal tools.
Neurorehabilitation and Neural Repair
This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Cirstea, M.C.
Right arrow Articles by Levin, M.F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cirstea, M.C.
Right arrow Articles by Levin, M.F.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Improvement of Arm Movement Patterns and Endpoint Control Depends on Type of Feedback During Practice in Stroke Survivors

M.C. Cirstea, MD, PhD

Department of Physiology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada

M.F. Levin, PhD

School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada, mindy.levin{at}mcgill.ca, Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec

Background. A major challenge in stroke rehabilitation is restoration of arm motor function. Therapy-induced improvements in arm function may occur via restoration of premorbid movement patterns (recovery) or development of compensatory movement strategies. However, it is unclear whether the learning benefits of practice might be enhanced by incorporating different forms of feedback, focusing on movement outcomes or on specific arm movement patterns. Objective. To determine if manipulation of attentional focus by providing either knowledge of results (KR) feedback, focusing on movement outcomes, or knowledge of performance (KP) feedback, focusing on arm movement patterns during repetitive practice of a pointing movement, may lead to arm motor recovery. Methods. Twenty-eight chronic stroke survivors were randomly assigned to 2 groups that practiced 10 sessions of 75 pointing movements. During practice, groups received either 20% KR about movement precision or faded (26.6% average) KP about arm joint movements. A nondisabled control group (n = 5) practiced the same task with KR. Results. Motor patterns recovered only in KP, as evidenced by immediate and long-term increases in joint range, better interjoint coordination in early movement phases, and generalization of gains. Improvements in clinical impairment and function were related to decreases in compensation (trunk rotation) and recovery of interjoint coordination in mid-movement phases. Conclusions. In stroke survivors, when the learners' attention was directed to the movements themselves (KP), motor improvements reflect recovery compared to when attention was directed toward movement outcomes (KR).

Key Words: Stroke • Arm paresis • Motor recovery • Compensation • Knowledge of results • Knowledge of performance.

References

  • Carod-Artal J., Egido JA, Gonzalez JL, Varela de Seijas E. Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit. Stroke. 2000;31:2995-3000.[Abstract/Free Full Text]
  • Clarke P., Marshall V., Black SE, Colantonio A. Well-being after stroke in Canadian seniors: findings from the Canadian Study of Health and Aging. Stroke. 2002;33:1016-1021.[Abstract/Free Full Text]
  • Teasell RW, Kalra L. What's new in stroke rehabilitation. Stroke. 2004;35:383-385.[Free Full Text]
  • Aichner F., Adelwèohrer C., Haring HP Rehabilitation approaches to stroke. J Neural Transm Suppl. 2002;63:59-73.[Medline] [Order article via Infotrieve]
  • Dauphinee WD, Kwakkel G. The impact of rehabilitation on stroke outcome: what's the evidence? In: Barnes M, Dobkin B, Bogousslavsky J, eds. Recovery After Stroke. Cambridge, UK: Cambridge University Press; 2005.
  • Kwakkel G., Kollen B., Wagenaar RC Therapy impact on functional recovery in stroke rehabilitation: a critical review of the literature. Phys Ther. 1999;85:377-391.
  • Nudo RJ Recovery after damage to motor cortical areas. Curr Opin Neurobiol. 1999;9:740-747.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Cirstea MC, Levin MF Compensatory strategies for reaching in stroke. Brain. 2000;123(pt 5):940-953.[Abstract/Free Full Text]
  • Roby-Brami A., Fuchs T., Mokhtari M., Bussel B. Reaching and grasping strategies in hemiparetic patients. Motor Control. 1997;1:72-91.
  • Ustinova KI, Goussev VM, Balasubramaniam R., Levin MF Disruption of coordination between arm, trunk, and center of pressure displacement in patients with hemiparesis. Motor Control. 2004;8:139-159.[Web of Science][Medline] [Order article via Infotrieve]
  • Michaelsen SM, Jacobs S., Roby-Brami A., Levin MF Compensation for distal impairments of grasping in adults with hemiparesis. Exp Brain Res. 2004;157:162-173.[Web of Science][Medline] [Order article via Infotrieve]
  • Michaelsen SM, Dannenbaum R., Levin MF Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial. Stroke. 2006;37:186-192.[Abstract/Free Full Text]
  • Cirstea MC, Ptito A., Levin MF Arm reaching improvements with short-term practice depend on the severity of the motor deficit in stroke. Exp Brain Res. 2003;152:476-488.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Ada L., Canning C., Dwyer T. Effect of muscle length on strength and dexterity after stroke. Clin Rehabil. 2000;14:55-61.[Abstract/Free Full Text]
  • Michaelsen SM, Levin MF Short-term effects of practice with trunk restraint on reaching movements in patients with chronic stroke: a controlled trial. Stroke. 2004;35:1914-1919.[Abstract/Free Full Text]
  • Ada L., Canning C., Carr J., et al. Task specific training of reaching and manipulation. In: Bennett KMB, Castiello U, eds. Insights Into the Reach to Grasp Movement. Amsterdam: North Holland; 1994:239-265.
  • Levin MF Should stereotypic movement synergies seen in hemiparetic patients be considered adaptive? Behav Brain Sci. 1997;19:79-80.
  • Allred RP, Maldonado MA, Hsu JE, Jones TA Training the "lessaffected" forelimb after unilateral cortical infarcts interferes with functional recovery of the impaired forelimb in rats. Restor Neurol Neurosci. 2005;23:297-302.[Medline] [Order article via Infotrieve]
  • Cirstea CM, Ptito A., Levin MF Feedback and cognition in arm motor skill reacquisition after stroke. Stroke. 2006;37:1237-1242.[Abstract/Free Full Text]
  • Taub E., Miller NE, Novack TA, et al. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil. 1993;74:347-354.[Web of Science][Medline] [Order article via Infotrieve]
  • Metz GA, Whishaw IQ Skilled reaching an action pattern: stability in rat (Rattus norvegicus) grasping movements as a function of changing food pellet size. Behav Brain Res. 2000;116: 111-122.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Cirstea MC, Mitnitski AB, Feldman AG, Levin MF Interjoint coordination dynamics during reaching in stroke. Exp Brain Res. 2003;151:289-300.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Levin MF, Michaelsen SM, Cirstea CM, Roby-Brami A. Use of the trunk for reaching targets placed within and beyond the reach in adult hemiparesis. Exp Brain Res. 2002;143:171-180.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Butefisch C., Hummelsheim H., Denzler P., Mauritz KH Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand. J Neurol Sci. 1995;130:59-68.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Dean CM, Shepherd RB Task-related training improves performance of seated reaching tasks after stroke: a randomized controlled trial. Stroke. 1997;28:722-728.[Abstract/Free Full Text]
  • Kunkel A., Kopp B., Muller G., et al. Constraint-induced movement therapy for motor recovery in chronic stroke patients. Arch Phys Med Rehabil. 1999;80:624-628.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Whitall J., McCombe Waller S., Silver KH, Macko RF Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke. 2000;31:2390-2395.[Abstract/Free Full Text]
  • Christina R. Motor learning: future lines of research. In: Safrit JM, Eckert HM, eds. The Cutting Edge in Physical Education and Exercise Science Research. Champaign, Ill: Human Kinetics; 1987:26-41.
  • Schmidt RA Motor Control and Learning: A Behavioral Emphasis. 2nd edition, Champaign, Ill: Human Kinetics, 1988.
  • Winstein CJ, Schmidt R. Sensorimotor feedback. In: Holding D, ed. Human skills. Chichester, UK: John Wiley; 1989:17-47.
  • Winstein CJ, Pohl PS, Lewthwaite R. Effects of physical guidance and knowledge of results on motor learning: support for the guidance hypothesis. Res Q Exerc Sport. 1994;65:316-323.[Web of Science][Medline] [Order article via Infotrieve]
  • Winstein CJ Knowledge of results and motor learning: implications for physical therapy. Phys Ther. 1991;71:140-149.[Abstract/Free Full Text]
  • Boyd LA, Winstein CJ Providing explicit information disrupts implicit motor learning after basal ganglia stroke. Learn Mem. 2004;11:388-396.[Abstract/Free Full Text]
  • Doyon J., Penhune V., Ungerleider LG Distinct contribution of the cortico-striatal and cortico-cerebellar systems to motor skill learning. Neuropsychologia. 2003;41:252-262.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Boyd LA, Winstein CJ Impact of explicit information on implicit motor-sequence learning following middle cerebral artery stroke. Phys Ther. 2003;83:976-989.[Abstract/Free Full Text]
  • Winstein CJ, Merians AS, Sullivan KJ Motor learning after unilateral brain damage. Neuropsychologia. 1999;37:975-987.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Cirstea CM, Ptito A., Forget R., Levin MF Arm motor improvments in stroke patients may depend on the type of training. Neurosci Meeting. 2000. Available at: http://abstracts.sfn.org/.
  • Duncan PW, Goldstein LB, Matchar D., et al. Measurement of motor recovery after stroke: outcome assessment and sample size requirements. Stroke. 1992;23:1084-1089.[Abstract/Free Full Text]
  • Woldag H., Hummelsheim H. Evidence-based physiotherapeutic concepts for improving arm and hand function in stroke patients: a review. J Neurol. 2002;249:518-528.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Dancause N., Ptito A., Levin MF Error correction strategies for motor behavior after unilateral brain damage: short-term motor learning processes. Neuropsychologia. 2002;40:1313-1323.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Weeks DL, Aubert MP, Feldman AG, Levin MF One-trial adaptation of movement to changes in load. J Neurophysiol. 1996;75:60-74.[Abstract/Free Full Text]
  • Gowland C., Stratford P., Ward M., et al. Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke. 1993;24:58-63.[Abstract/Free Full Text]
  • Fugl-Meyer AR, Jaasko L., Leyman I., et al. The post-stroke hemiplegic patient: 1. A method for evaluation of physical performance. Scand J Rehabil Med. 1975;7:13-31.[Medline] [Order article via Infotrieve]
  • Levin MF, Hui-Chan CW Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. Electroencephalogr Clin Neurophysiol. 1992;85:131-142.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Desrosiers J., Hebert R., Bravo G., Dutil E. Upper extremity performance test for the elderly (TEMPA): normative data and correlates with sensorimotor parameters. Test d'Evaluation des Membres Superieurs de Personnes Agees. Arch Phys Med Rehabil. 1995;76:1125-1129.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Bernstein N. The Co-ordination and Regulation of Movement. Oxford, UK: Pergamon; 1967.
  • Lee T., Swinnen SP, Serrien D. Cognitive effort and motor learning. Quest. 1994;46:328-344.[Web of Science]
  • McNevin NH, Shea CH, Wulf G. Increasing the distance of an external focus of attention enhances learning. Psychol Res. 2003;67:22-29.[Web of Science][Medline] [Order article via Infotrieve]
  • Totsika V., Wulf G. The influence of external and internal foci of attention on transfer to novel situations and skills. Res Q Exerc Sport. 2003;74:220-225.[Medline] [Order article via Infotrieve]
  • Wulf G., McNevin NH, Fuchs T., et al. Attentional focus in complex skill learning. Res Q Exerc Sport. 2000;71:229-239.[Medline] [Order article via Infotrieve]
  • Wulf G., Prinz W. Directing attention to movement effects enhances learning: a review. Psycho Bull Rev. 2001;8:648-660.
  • Todorov E., Shadmehr R., Bizzi E. Augmented feedback presented in a virtual environment accelerates learning of a difficult motor task. J Mot Behav. 1997;29:147-158.[Web of Science][Medline] [Order article via Infotrieve]
  • Wulf G., Shea CH Principles derived from the study of simple skills do not generalize to complex skill learning. Psycho Bull Rev. 2002;9:185-211.
  • Prinz W. A common coding approach to perception and action. In: Neumann O, Prinz W, eds. Relationships Between Perception and Action. Berlin: Springer-Verlag; 1990:167-201.
  • Latash M. There is no motor redundancy in human movements: there is motor abundance. Motor Control. 2000;4:259-260.[Web of Science][Medline] [Order article via Infotrieve]
  • Prinz W. Perception and action planning. Eur J Cogn Psychol. 1997;9:129-154.[CrossRef]
  • Feldman AG, Levin MF The origin and use of positional frames of reference in motor control. Behav Brain Sci. 1995;18:723-744.[Web of Science]
  • Levin MF, Feldman AG The role of stretch reflex threshold regulation in normal and impaired motor control. Brain Res. 1994;657:23-30.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Carr J., Shepherd R. Movement Science: Foundations for Physical Therapy Rehabilitation. Rockville, Md: Aspen; 1987.
  • Merians AS, Poizner H., Boian R., et al. Sensorimotor training in a virtual reality environment: does it improve functional recovery poststroke? Neurorehabil Neural Repair. 2006;20:252-267.[Abstract/Free Full Text]
  • Subramanian S., Knaut LA, Beaudoin C., et al. Virtual reality environments for rehabilitation of the upper limb after stroke. J Neuroeng Rehab. In press.
  • Stanney K. Handbook of Virtual Environments: Design, Implementation and Applications. London: Lawrence Erlbaum; 2002.
  • Schmidt RA, Young DE Methodology for motor learning: a paradigm for kinematic feedback. J Mot Behav. 1991;23:13-24.[Medline] [Order article via Infotrieve]
  • Wulf G., Schmidt RA, Deubel H. Reduced feedback frequency enhances generalized motor program learning but not parameterization learning. J Exp Psychol Learn Mem Cogn. 1993;19: 1134-1150.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Schmidt RA, Young DE, Swinnen S., Shapiro DC Summary knowledge of results for skill acquisition: support for the guidance hypothesis. J Exp Psychol Learn Mem Cogn. 1989;15:352-359.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Salmoni AW, Schmidt RA, Walter CB Knowledge of results and motor learning: a review and critical reappraisal. Psychol Bull. 1984;95:355-386.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Schmidt RA Frequent augmented feedback can degrade learning: evidence and interpretations. In: Requin J, Stelmach GE, eds. Tutorials in Motor Neuroscience. Dordrecht, the Netherlands: Kluwer; 1991:59-75.
  • Lai Q., Shea G. Generalized motor program (GMP) learning: effects of reduced frequency of knowledge of results and practice variability. J Mot Behav. 1998;30:51-59.[Web of Science]
  • Wulf G., Schmidt RA Feedback-induced variability and the learning of generalized motor programs. J Mot Behav. 1994;26: 348-361.[Web of Science][Medline] [Order article via Infotrieve]
  • Thielman GT, Dean CM, Gentile AM Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. Arch Phys Med Rehabil. 2004;85:1613-1618.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Duncan PW, Lai SM, Keighley J. Defining post-stroke recovery: implications for design and interpretation of drug trials. Neuropharmacology. 2000;39:835-841.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Kwakkel G., Kollen BJ, Lindeman E. Understanding the pattern of functional recovery after stroke: facts and theories. Restor Neurol Neurosci. 2004;22:281-299.[Web of Science][Medline] [Order article via Infotrieve]
  • Platz T. Impairment-oriented training (IOT): scientific concept and evidence-based treatment strategies. Restor Neurol Neurosci. 2004;22:301-315.[Medline] [Order article via Infotrieve]
  • Platz T., van Kaick S., Moller L., et al. Impairment-oriented training and adaptive motor cortex reorganisation after stroke: a fTMS study. J Neurol. 2005;252:1363-1371.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

This version was published on October 1, 2007

Neurorehabilitation and Neural Repair, Vol. 21, No. 5, 398-411 (2007)
DOI: 10.1177/1545968306298414
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Neurorehabil Neural RepairHome page
M. E. Stoykov, G. N. Lewis, and D. M. Corcos
Comparison of Bilateral and Unilateral Training for Upper Extremity Hemiparesis in Stroke
Neurorehabil Neural Repair, November 1, 2009; 23(9): 945 - 953.
[Abstract] [PDF]

Home page
 Neurorehabil Neural RepairHome page
M. L. Woodbury, D. R. Howland, T. E. McGuirk, S. B. Davis, C. R. Senesac, S. Kautz, and L. G. Richards
Effects of Trunk Restraint Combined With Intensive Task Practice on Poststroke Upper Extremity Reach and Function: A Pilot Study
Neurorehabil Neural Repair, January 1, 2009; 23(1): 78 - 91.
[Abstract] [PDF]

Home page
 J. Neurophysiol.Home page
I. Eisner-Janowicz, S. Barbay, E. Hoover, A. M. Stowe, S. B. Frost, E. J. Plautz, and R. J. Nudo
Early and Late Changes in the Distal Forelimb Representation of the Supplementary Motor Area After Injury to Frontal Motor Areas in the Squirrel Monkey
J Neurophysiol, September 1, 2008; 100(3): 1498 - 1512.
[Abstract] [Full Text] [PDF]

Home page
 ptjournalHome page
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]

Home page
 BrainHome page
C. D. Takahashi, L. Der-Yeghiaian, V. Le, R. R. Motiwala, and S. C. Cramer
Robot-based hand motor therapy after stroke
Brain, February 1, 2008; 131(2): 425 - 437.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Cirstea, M.C.
Right arrow Articles by Levin, M.F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cirstea, M.C.
Right arrow Articles by Levin, M.F.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Advertisement