Comparison of finger tracking versus simple movement training via telerehabilitation to alter hand function and cortical reorganization after stroke.
OBJECTIVE
To compare 2 telerehabilitation training strategies, repetitive tracking movements versus repetitive simple movements, to promote brain reorganization and recovery of hand function.


METHODS
Twenty subjects with chronic stroke and 10 degrees of voluntary finger extension were randomly assigned to receive 1800 telerehabilitation trials over 2 weeks of either computerized tracking training (track group) with the affected finger and wrist involving temporospatial processing to achieve accuracy or movement training (move group) with no attention to accuracy. Following movement training, the move group crossed over to receive an additional 2 weeks of tracking training. Behavioral changes were measured with the Box and Block test, Jebsen Taylor test, and finger range of motion, along with a finger-tracking activation paradigm during fMRI.


RESULTS
The track group showed significant improvement in all 4 behavioral tests; the move group improved in the Box and Block and Jebsen Taylor tests. The improvement for the track group in the Box and Block and Jebsen Taylor tests did not surpass that for the move group. A consistent group pattern of brain reorganization was not evident. The move group, after crossing over, did not show further significant improvements.


CONCLUSIONS
Telerehabilitation may be effective in improving performance in subjects with chronic stroke. Tracking training with reinforcement to enhance learning, however, did not produce a clear advantage over the same amount of practice of random movements. Two weeks of training may be insufficient to demonstrate a behavioral advantage and associated brain reorganization.
Carey
James R
JR
Program in Physical Therapy, University of Minnesota, Minneapolis 55455, USA. carey007@umn.edu
Durfee
William K
WK
Bhatt
Ela
E
Nagpal
Ashima
A
Weinstein
Samantha A
SA
Anderson
Kathleen M
KM
Lewis
Scott M
SM
D000368:Aged; D018592:Cross-Over Studies; D005260:Female; D005385:Fingers / Q000502:physiology; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009473:Neuronal Plasticity / Q000502:physiology*; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D011597:Psychomotor Performance / Q000502:physiology; D013003:Somatosensory Cortex / Q000502:physiology; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D017216:Telemedicine / Q000379:methods*; D013813:Therapy, Computer-Assisted