Shoulder, or Elbow, or Wrist: What Should we Train First After a Stroke?

The Effect of Proximal and Distal Training on Stroke Recovery:

Specific Aim 1. Test whether task specific wrist robotic training improves motor performance
among persons with chronic impairment after stroke.

Specific Aim 2. Test whether the order in which robot therapy is delivered influences
outcomes (shoulder-and-elbow before wrist vs. wrist before shoulder-and-elbow).

Specific Aim 3. Test whether there is generalization across different joints (shoulder &
elbow vs wrist).

Specific Aim 4: Test whether there is any interference between training across different
joints among persons with chronic impairment after stroke.

Briefly we will invite persons with chronic impairment due to stroke to participate in a
study that will train them first on wrist for 6 weeks and then on the shoulder-and-elbow for
an additional 6 weeks or vice-versa. A third group will train in alternate days for 12
weeks on the shoulder-and-elbow or the wrist, while a fourth group will be trained on the
shoulder, elbow, and wrist on the same day. Outcomes will be measured using standard
instruments as well as robot-based measures. We expect that results from this study will
provide an objective basis for maximizing this kind of therapy.

Inclusion Criteria:

Patients will be included in the study if they meet the following criteria:

1. naïve subjects who have never experienced robot-assisted therapy as inpatients or
outpatients;

2. first single focal unilateral lesion with diagnosis verified by brain imaging (MRI or
CT scans) that has occurred at least 6 months prior;

3. cognitive function sufficient to understand the experiments and follow instructions
(Mini-Mental Status Score of 22 and higher or interview for aphasic subjects);

4. average Motor Power score >= 1/5 or <= 3/5 (neither hemiplegic nor fully recovered
motor function in 6 muscles of the shoulder, elbow, and wrist);

5. informed written consent to participate in the study.

Exclusion Criteria:

Patients will be excluded from the study if they have a fixed contraction deformity in the
affected limb.