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Randomized Controlled Trial
. 2020;38(1):11-22.
doi: 10.3233/RNN-190943.

Bilateral motor priming for post stroke upper extremity hemiparesis: A randomized pilot study

Mary Ellen Stoykov  1   2 , Erin King  3 , Fabian J David  4 , Amanda Vatinno  5 , Louis Fogg  6 , Daniel M Corcos  3   4
Affiliations
Randomized Controlled Trial

Bilateral motor priming for post stroke upper extremity hemiparesis: A randomized pilot study

Mary Ellen Stoykov et al. Restor Neurol Neurosci. 2020.

Abstract

Background: Bilateral priming, device assisted bilateral symmetrical wrist flexion/extension, is a noninvasive neuromodulation technique that can be used in the clinic.

Objective: We examined the additive effect of bilateral motor priming and task specific training in individuals with severe upper limb hemiparesis.

Methods: This is a parallel assignment, single-masked, randomized exploratory pilot study with three timepoints (pre-/post-intervention and follow up). Participants received either bilateral motor priming or health care education followed by task specific training. Sixteen participants who were at least 6 months post-stroke and had a Fugl Meyer Upper Extremity (FMUE) score between 23 and 38 were randomized. Our primary and secondary measures were Chedoke Arm & Hand Activity Index 9 (CAHAI-9) and the FMUE respectively. We determined changes in interhemispheric inhibition using transcranial magnetic stimulation. We hypothesized that improvement in the priming group would persist at follow up.

Results: There was no between-group difference in the CAHAI. The improvement in the FMUE was significantly greater in the experimental group at follow up (t = 2.241, p = 0.045).

Conclusions: Both groups improved in the CAHAI. There was a significant between-group difference in the secondary outcome measure (FMUE) where the bilateral priming group had an average increase of 10 points from pre-intervention to follow up.

Trial registration: ClinicalTrials.gov NCT02277028.

Keywords: Stroke; bilateral; hemiparesis; interhemispheric inhibition; priming; task specific training; upper extremity.

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Figures

Fig. 1.
Fig. 1.
Participant Flow through the Study.
Fig. 2.
Fig. 2.
Picture of Exsurgo Rehabilitation Primer (Auckland, NZ).
Fig. 3.
Fig. 3.
Group means and standard errors for the Chedoke Arm Hand Activity Index, Version 9 (CAHAI 9) scores at each time point for healthcare education (HCE) with task specific training and bilateral motor priming (BMP) with task specific training (TST). *=p < 0.05 within group significance for BMP group.
Fig. 4.
Fig. 4.
Group means and standard errors for the Fugl Myer Upper Extremity Test of Function (FMUE) scores and at each time point for healthcare education (HCE) plus task specific training (TST) or bilateral motor priming (BMP) plus task specific training (TST). **p < 0.05 between group significance.
Fig. 5.
Fig. 5.
Median transcallosal inhibition persistence (TCI) change scores (Post-Pre) and interquartile ranges for the healthcare education (HCE) and bilateral motor priming (BMP) paired with task specific training (TST). **p < 0.05 between group significance.
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