Strategies for Recovery of Dexterity Post Stroke

The purpose of this study is to develop, refine and test the 'alternate hand training
strategy' to facilitate adaptation, repetition and relearning to restore hand function after
stroke. The three aims are: to restore adaptation (Aim 1), facilitate grasp efficiency and
normal directional biases during repetition (Aim 2), and enhance the rate of learning to
improve hand function and quality of life post stroke (Aim 3).

Hypotheses: We hypothesize that alternate hand training will increase the rate of learning
and lead to greater improvement in hand function. The results will inform dosing of therapy
for optimal relearning.

Inclusion Criteria:

- Ability to read/write in English

- Age > 18 yrs

- Radiologically verified stroke > 4 months old (3T structural MRI)

- Moderate arm motor impairment (Fugl-Meyer Scale < 60/66)

- Ability to reach, grasp and lift the test objects with the affected side as assessed
by the PI

- Willingness to complete all clinical assessments and MRI, and comply with training
protocols

- Ability to give informed consent and HIPPA certificationsPlease list all exclusion
criteria for study:

Exclusion Criteria:

- Sensorimotor impairments in the unaffected hand

- Severe visual or sensory impairment, including neglect on the affected side

- Significant cognitive dysfunction (score < 24 on Folstein's Mini Mental Status
Examination)

- Severe or unstable spasticity on treatment with Botulinum toxin or intrathecal
baclofen

- Depression (Geriatric Depression Scale score <11)

- Major disability (modified Rankin Scale > 4)

- Previous neurological illness, complicated medical condition, or significant injury to
either upper extremity