Article

This randomized controlled trial tests the efficacy of
bilateral arm training with rhythmic auditory cueing (BATRAC) versus dose-matched
therapeutic exercises (DMTEs) on upper-extremity (UE) function in stroke
survivors and uses functional magnetic resonance imaging (fMRI) to examine
effects on cortical reorganization. METHODS: A total of 111 adults with chronic
UE paresis were randomized to 6 weeks (3x/week) of BATRAC or DMTE. Primary end
points of UE assessments of Fugl-Meyer UE Test (FM) and modified Wolf Motor
Function Test Time (WT) were performed 6 weeks prior to and at baseline, after
training, and 4 months later. Pretraining and posttraining, fMRI for UE movement
was evaluated in 17 BATRAC and 21 DMTE participants. RESULTS: The improvements in
UE function (BATRAC: FM Delta = 1.1 + 0.5, P = .03; WT Delta = -2.6 + 0.8, P <
.00; DMTE: FM Delta = 1.9 + 0.4, P < .00; WT Delta = -1.6 + 0.7; P = .04) were
comparable between groups and retained after 4 months. Satisfaction was higher
after BATRAC than DMTE (P = .003). BATRAC led to significantly higher increase in
activation in ipsilesional precentral, anterior cingulate and postcentral gyri,
and supplementary motor area and contralesional superior frontal gyrus (P < .05).
Activation change in the latter was correlated with improvement in the WMFT (P =
.01). CONCLUSIONS: BATRAC is not superior to DMTE, but both rehabilitation
programs durably improve motor function for individuals with chronic UE
hemiparesis and with varied deficit severity. Adaptations in brain activation are
greater after BATRAC than DMTE, suggesting that given similar benefits to motor
function, these therapies operate through different mechanisms.
Neuroplasticite

Langue : ANGLAIS