title: Exploring the impact of visual and movement based priming on a motor intervention in the acute phase post-stroke in persons with severe hemiparesis of the upper extremity.
abstract: Explore the potential benefits of using priming methods prior to an active hand task in the acute phase post-stroke in persons with severe upper extremity hemiparesis.
  
  
  
  Five individuals were trained using priming techniques including virtual reality (VR) based visual mirror feedback and contralaterally controlled passive movement strategies prior to training with an active pinch force modulation task. Clinical, kinetic, and neurophysiological measurements were taken pre and post the training period. Clinical measures were taken at six months post training.
  
  
  
  The two priming simulations and active training were well tolerated early after stroke. Priming effects were suggested by increased maximal pinch force immediately after visual and movement based priming. Despite having no clinically observable movement distally, the subjects were able to volitionally coordinate isometric force and muscle activity (EMG) in a pinch tracing task. The Root Mean Square Error (RMSE) of force during the pinch trace task gradually decreased over the training period suggesting learning may have occurred. Changes in motor cortical neurophysiology were seen in the unaffected hemisphere using Transcranial Magnetic Stimulation (TMS) mapping. Significant improvements in motor recovery as measured by the Action Research Arm Test (ARAT) and the Upper Extremity Fugl Meyer Assessment (UEFMA) were demonstrated at six months post training by three of the five subjects.
  
  
  
  This study suggests that an early hand-based intervention using visual and movement based priming activities and a scaled motor task allows participation by persons without the motor control required for traditionally presented rehabilitation and testing. Implications for Rehabilitation Rehabilitation of individuals with severely paretic upper extremities after stroke is challenging due to limited movement capacity and few options for therapeutic training. Long-term functional recovery of the arm after stroke depends on early return of active hand control, establishing a need for acute training methods focused distally. This study demonstrates the feasibility of an early hand-based intervention using virtual reality based priming and scaled motor activities which can allow for participation by persons without the motor control required for traditionally presented rehabilitation and testing.
authors.affiliation: a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.
authors.forename: Jigna
authors.initials: J
authors.lastname: Patel
authors.affiliation: a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.
authors.forename: Qinyin
authors.initials: Q
authors.lastname: Qiu
authors.affiliation: a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Yarossi
authors.affiliation: a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.
authors.forename: Alma
authors.initials: A
authors.lastname: Merians
authors.affiliation: b Acute Rehabilitation Unit , Saint Joseph's Wayne Hospital , Wayne , NJ , USA.
authors.forename: Supriya
authors.initials: S
authors.lastname: Massood
authors.affiliation: c Department of Physical Therapy, Movement, and Rehabilitation Science , Bouve College of Health Sciences, Northeastern University , Boston , MA , USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Tunik
authors.affiliation: d Department of Biomedical Engineering , New Jersey Institute of Technology , Newark , NJ , USA.
authors.forename: Sergei
authors.initials: S
authors.lastname: Adamovich
authors.affiliation: a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.
authors.forename: Gerard
authors.initials: G
authors.lastname: Fluet
mesh_terms: D000368:Aged; D005260:Female; D006225:Hand / Q000503:physiopathology*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009068:Movement; D010291:Paresis / Q000534:rehabilitation*; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods*; D063367:Virtual Reality Exposure Therapy
keywords: Acute phase; cerebral vascular accident; cortical priming; flaccid upper extremity; virtual reality-augmented rehabilitation