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Moderators and Rehabilitation of Upper Extremity Ipsilesional Motor Deficits in Chronic Unilateral Stroke Survivors
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Moderators and Rehabilitation of Upper Extremity Ipsilesional Motor Deficits in Chronic Unilateral Stroke Survivors
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Dissertation
Moderators and Rehabilitation of Upper Extremity Ipsilesional Motor Deficits in Chronic Unilateral Stroke Survivors
2023
Overview
In stroke survivors with unilateral brain damage due to middle cerebral artery occlusions (MCA), motor impairments are most prominent on the contralesional side of the body and rehabilitation efforts have thus been strongly focused on improving motor function in the contralesional limb. However, substantial research has indicated ipsilesional motor deficits that appear to impair functional independence in those stroke survivors with severe contralesional upper-extremity impairment. These ipsilesional deficits have been shown to be hemisphere dependent, such that different aspects of control are affected by right vs left hemisphere damage. To address the gap between the identification of ipsilesional deficits and intervention of these deficits, this dissertation is comprised of two studies: a pilot study to establish feasibility of a hemisphere specific ipsilesional arm intervention, and a study to determine factors that may moderate the relationship between ipsilesional deficits and functional independence in stroke survivors with severe or moderate-severe contralesional impairment. The purpose of the first study was to determine whether intense remediation of the less impaired, ipsilesional arm in unilateral stroke survivors with chronic, moderate to severe contralesional motor deficits produces ipsilesional arm improvements in motor coordination and functional independence. Based on preliminary data, we predicted remediating the ipsilesional arm in stroke survivors with severe impairments would lead to substantial improvements in motor coordination, movement speed, and these improvements would generalize to affect function. The purpose of the second study was to determine whether apraxia, laterality of hemispheric damage, or severity of contralesional impairment (Upper Extremity Fugl-Meyer < 15= severe; 16-34= severe-moderate) moderated the relationship between ipsilesional deficits (Jebsen-Taylor Hand Function Test and ipsilesional grip strength), and functional independence (Barthel Index). We predicted that in this subgroup of stroke survivors the associations of strength and dexterity of the ipsilesional arm with functional independence (Barthel Index) would not be affected by these three potential moderators. Our findings substantiated this prediction, indicating that both strength and dexterity of the ipsilesional arm be considered as primary targets for evaluation and treatment in physical rehabilitation (PT & OT) interventions intended for stroke survivors with severe contralesional paresis.
