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Plastic Processes in Stroke Recovery: Computational and Clinical Evidence| old_uid | 7326 |
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| title | Plastic Processes in Stroke Recovery: Computational and Clinical Evidence |
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| start_date | 2009/09/03 |
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| schedule | 11h30 |
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| online | no |
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| summary | Although spontaneous use of the more affected arm and hand after stroke is an important determinant of participation and quality of life, a number of patients exhibit decreases in use following rehabilitative therapy. We test the hypothesis that there exists a threshold for function of the paretic arm and hand after therapy: if function is above this threshold, spontaneous use will increase in the months following therapy. In contrast, if function is below this threshold, spontaneous use will decrease. We present a computer model that contains a left and a right motor cortex, each controlling the opposite arm, and a single action choice module. The model accounts for the reversal of the loss of cortical representation after rehabilitation and the increase of this loss after stroke with insufficient rehabilitation. The model further predicts that if the dose of therapy is sufficient to bring performance above a certain threshold, then training can be stopped. Below this threshold, rehabilitation is in vain. We then tested this prediction by re-analyzing the data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) phase III randomized control trial, in which participants received Constraint-Induced Movement Therapy (CIMT) for 2 weeks and were tested both one week and 1 year after therapy. Our results demonstrate that arm and hand function measured immediately after therapy predicts, on average, the long-term change of arm use: above a functional threshold, use improves. Below this threshold, use decreases. In conclusion, understanding the non-linear relationship between the function of the limb and decision to use the limb is important for the future development of cost-effective interventions and prevention of rehabilitation in vain. |
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| responsibles | Béranger |
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