title: Complex versus simple ankle movement training in stroke using telerehabilitation: a randomized controlled trial.
abstract: BACKGROUND
  Telerehabilitation allows rehabilitative training to continue remotely after discharge from acute care and can include complex tasks known to create rich conditions for neural change.
  
  
  OBJECTIVE
  The purposes of this study were: (1) to explore the feasibility of using telerehabilitation to improve ankle dorsiflexion during the swing phase of gait in people with stroke and (2) to compare complex versus simple movements of the ankle in promoting behavioral change and brain reorganization.
  
  
  METHODS
  This study was a pilot randomized controlled trial.
  
  
  METHODS
  Training was done in the participant's home. Testing was done in separate research labs involving functional magnetic resonance imaging (fMRI) and multi-camera gait analysis.
  
  
  METHODS
  Sixteen participants with chronic stroke and impaired ankle dorsiflexion were assigned randomly to receive 4 weeks of telerehabilitation of the paretic ankle.
  
  
  METHODS
  Participants received either computerized complex movement training (track group) or simple movement training (move group).
  
  
  METHODS
  Behavioral changes were measured with the 10-m walk test and gait analysis using a motion capture system. Brain reorganization was measured with ankle tracking during fMRI.
  
  
  RESULTS
  Dorsiflexion during gait was significantly larger in the track group compared with the move group. For fMRI, although the volume, percent volume, and intensity of cortical activation failed to show significant changes, the frequency count of the number of participants showing an increase versus a decrease in these values from pretest to posttest measurements was significantly different between the 2 groups, with the track group decreasing and the move group increasing.
  
  
  CONCLUSIONS
  Limitations of this study were that no follow-up test was conducted and that a small sample size was used.
  
  
  CONCLUSIONS
  The results suggest that telerehabilitation, emphasizing complex task training with the paretic limb, is feasible and can be effective in promoting further dorsiflexion in people with chronic stroke.
authors.affiliation: Program in Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota 55455, USA.
authors.forename: Huiqiong
authors.initials: H
authors.lastname: Deng
authors.forename: William K
authors.initials: WK
authors.lastname: Durfee
authors.forename: David J
authors.initials: DJ
authors.lastname: Nuckley
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Rheude
authors.forename: Amy E
authors.initials: AE
authors.lastname: Severson
authors.forename: Katie M
authors.initials: KM
authors.lastname: Skluzacek
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Spindler
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Davey
authors.forename: James R
authors.initials: JR
authors.lastname: Carey
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012984:Software; D018709:Statistics, Nonparametric; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*
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