title: Sensorimotor training and neural reorganization after stroke:  a case series.
abstract: OBJECTIVE
  Impaired hand function decreases quality of life after stroke. The purpose of this study was to pilot a novel 2-week upper extremity sensorimotor training program. This case series describes the training program and highlights outcome measures used for documenting behavioral change and neural reorganization.
  
  
  METHODS
  Behavioral/performance changes were identified via sensorimotor evaluation. Activity-induced neural reorganization was examined using sensory functional magnetic resonance imaging, diffusion tensor tractography, and brain volume measurement. Participant 1 was a 75-year-old right-handed man 1 year post-right hemisphere stroke, with severe sensory impairment across domains in his left hand; he reported limited left-hand/arm use. Participant 2 was a 63-year-old right-handed woman who had experienced a left hemisphere stroke 9 months earlier, resulting in mild sensory impairment across domains in her right hand, as well as mild motor deficit.
  
  
  METHODS
  Participants were trained 4 hours per day, 5 days per week for 2 weeks. Training tasks required sensory discrimination of temperature, weights, textures, shapes, and objects in the context of active exploration with the involved hand. Random multimodal feedback was used.
  
  
  RESULTS
  Both participants had improved scores on the Wolf Motor Function Test after training. Participant 1 had no measurable change in sensory function, while participant 2 improved in touch perception, proprioception, and haptic performance. Sensory functional magnetic resonance imaging suggested neural reorganization in both participants; participant 1 had a small increase in brain volume, while superior thalamic radiation white matter connectivity was unchanged in either participant.
  
  
  CONCLUSIONS
  Participating in sensorimotor training focused on sensory discrimination during manual manipulation was feasible for both participants. Future research to determine efficacy and identify optimal measures of sensory function and neural reorganization is recommended.
  
  
  BACKGROUND
  (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A38) for more insights from the authors.
authors: School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210, USA. Borstad.2@osu.edu
authors: Alexandra L
authors: AL
authors: Borstad
authors: Travis
authors: T
authors: Bird
authors: Seongjin
authors: S
authors: Choi
authors: Lindsay
authors: L
authors: Goodman
authors: Petra
authors: P
authors: Schmalbrock
authors: Deborah S
authors: DS
authors: Nichols-Larsen
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D004192:Discrimination, Psychological / Q000502:physiology*; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000534:rehabilitation; D009473:Neuronal Plasticity / Q000502:physiology; D009483:Neuropsychological Tests; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D011597:Psychomotor Performance / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology / Q000534:rehabilitation; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D055698:Touch Perception / Q000502:physiology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
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