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PHYS THER
Vol. 88, No. 8, August 2008, p. 970
DOI: 10.2522/ptj.2008.88.8.970.1
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Letters and Responses

On "A four-week, task-specific neuroprosthesis program..." Dunning K, et al. Phys Ther. 2008;88:397–405.


We regard this report1 as very valuable as it describes the use of a task-specific neuroprosthesis program in a patient characterized as severely impaired without any active residual finger and hand movements. Those patients without residual finger and hand movements usually are not included in studies dealing with rehabilitation after stroke because of their negative prognosis. Fortunately, Dunning et al present a therapeutic approach that was successful for a patient with such impairment.

There is one point we would like to raise to better understand the severity of the patient's impairment. Although it was stated that the patient was incapable of any active wrist or finger movement, before the intervention he was able to transfer 12 blocks in the Box and Block Test2 from one side of a wall to the other side in a time frame of 60 seconds. On the Action Research Arm Test, he scored 5 points for grasping. We believe that a minimum of active finger movement is essential to grasp, transfer, and release. Therefore, the definition of "no residual movement" needs some clarification.

Preintervention testing was performed 2 weeks before intervention. But directly after baseline testing, the patient took the neuroprosthesis home for 1 week, probably starting the intervention. It, therefore, is unclear at which time after preintervention the task-specific training began.

The apparatus stimulated finger and wrist extension or finger and wrist flexion. The natural pattern during grasping is wrist extension with finger flexion and wrist flexion with finger extension. Is there any adaptive skillful movement available after this?

Please describe the physical therapy with more detail. If the patient was not able to move his fingers actively, how was feedback about the correct planning of a movement possible? Feedback and reward are main aspects of motor learning.3–6 How did the therapist help the patient perform the complex tasks? The stimulator gave an interrupted pulse with contraction and relaxation intervals at 7 seconds "on" and 7 seconds "off." How could the patient train the listed tasks in that rhythm? Did the apparatus have any feedback system, such as electromyography?

The clarification of the above questions could help other clinicians follow the intervention programs and eventually assist other patients with severe impairments after stroke.

Doris Broetz, Surjo R Soekadar and Niels Birbaumer

D Broetz is Physical Therapist, Institute of Medical Psychology and Behavioral Neurobiology, MEG Center, University of Tuebingen, Germany.


  Footnotes
 
This letter was posted as a Rapid Response on March 6, 2008, at www.ptjournal.org.

References

  1. Dunning K, Berberich A, Albers B, et al. A four-week, task-specific neuroprosthesis program for a person with no active wrist or finger movement because of chronic stroke. Phys Ther. 2008;88:397–405.[Abstract/Free Full Text]
  2. Mathiowetz V, Volland G, Kashman N, Weber K. Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther. 1985;39:386–391.[Web of Science][Medline]
  3. Cirstea CM, Ptito A, Levin MF. Feedback and cognition in arm motor skill reacquisition after stroke. Stroke. 2006;37:1237–1242.[Abstract/Free Full Text]
  4. Cirstea MC, Levin MF. Improvement of arm movement patterns and endpoint control depends on type of feedback during practice in stroke survivors. Neurorehabil Neural Repair. 2007;21:398–411.[Abstract/Free Full Text]
  5. Bray S, Shimojo S, O'Doherty JP. Direct instrumental conditioning of neural activity using functional magnetic resonance imaging-derived reward feedback. J Neurosci. 2007;27:7498–7507.[Abstract/Free Full Text]
  6. Marco-Pallarés J, Müller SV, Münte TF. Learning by doing: an fMRI study of feedback-related brain activations. Neuroreport. 2007;18:1423–1426.[Medline]

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This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Broetz, D.
Right arrow Articles by Birbaumer, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Broetz, D.
Right arrow Articles by Birbaumer, N.
Related Collections
Right arrow Adaptive/Assistive Devices
Right arrow Electrotherapy
Right arrow Stroke (Neurology)
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

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