Action Selection and Arm Rehabilitation After Stroke
Action Selection and Arm Rehabilitation After Stroke
After stroke, individuals often have persistent difficulty using the arm and hand in everyday
 functional tasks that reduces quality of life. Currently available rehabilitation techniques
 are not adequate and new protocols are needed that are based on an understanding of how brain
 regions work together to produce skilled movement. This research project aims to improve our
 understanding of how the brain controls movement after stroke and determine whether a period
 of motor practice that targets specific brain regions through the addition of action
 selection demands leads to improved arm function. We hypothesize that arm motor function and
 the ability to efficiently activate the action selection motor circuit during movement will
 improve after training.
Rehabilitation of arm impairment after stroke includes the repetitive practice of functional
 tasks. In healthy adults, planning plays a vital role in the control of skilled movement,
 however, the behavioral and neural correlates of planning have largely been unexplored in
 individuals recovering from stroke. Action selection is an important motor planning process
 that engages dorsal premotor cortex (PMd) in controls. While PMd activation is a commonly
 reported neural correlate of motor recovery after stroke, the role of PMd in action selection
 and motor training are not known. Therefore, the purpose of this study is to determine the
 effect of training that includes action selection demands on the behavioral and neural
 correlates of movement after stroke. Thirty-eight individuals in the chronic phase of stroke
 will be recruited. After completion of clinical measures of impairment and function, all
 participants with stroke will complete a motor action selection task and functional MRI
 followed by arm training. Arm training will consist of three weeks (15 sessions) of arm motor
 training (1.5 hours per session) that includes action selection demands on movement.
 Follow-up clinical testing will occur at the end of treatment and three weeks later.
Inclusion Criteria:

 -  At least 18 years old

 -  Had stroke at least 6 months ago

 -  Right-hand dominant prior to stroke

 -  Some continued arm and hand weakness

 -  Some ability to move the arm and hand that is weaker from the stroke

 Exclusion Criteria:

 -  Acute medical issues that would interfere with participation

 -  Another neurologic diagnosis that may impact movement (e.g. Parkinson's Disease)

 -  Cannot undergo MRI scanning

 -  Severe apraxia or hemispatial neglect

 -  Pain in the arm that interferes with movement

 -  Difficulty maintaining attention or following directions