Introduction
sub-acute post-stroke spastic hemiparesis, elbow flexor spasticity, Stroke, stroke, UL motor deficits, long-term sensorimotor disability
STROKE, STROKE
Stroke is a leading cause of long-term sensorimotor disability, including persistent deficits in upper limb (UL) functionCurrent rehabilitation therapies do not enhance UL recovery beyond the effects of biological factors that drive brain plasticity towards adaptive re-mapping and re-wiring, mainly in the early sub-acute periodTonic stretch-reflex thresholds (TSRTs) in healthy and stroke participants. (Personalized impairment-based UL training, tuned to the spatial structure of the individual’s UL motor deficits, was combined with technologies shown to improve UL sensorimotor recovery by maximizing motor learning. Practice of reaching tasks was done in a Virtual Reality (VR) environment, while receiving excitatory anodal-tDCS (a-tDCS) over sensorimotor areas of the affected hemisphere. VR offers motivating practice environments incorporating activities important for neurological rehabilitation, such as goal‐oriented tasks, repetition, and feedbackWe originally hypothesized that, in patients with sub-acute post-stroke spastic hemiparesis, repetitive reaching practice restricted to elbow extension ranges that did not evoke elbow flexor spasticity (personalized training) combined with excitatory a-tDCS, would improve the range of spasticity-free active elbow extension (i.e., increase the resting TSRT angle) and UL sensorimotor outcomes more than training with a-tDCS or personalized training alone. We also hypothesized that an increase in the resting TSRT angle would be related to improved kinematics of a standardized reaching task and clinical outcomes.However, since there were no differences in the main effects of treatment range with or without a-tDCS (see Results, Table Descriptive data: Mean (SD) values for pre-test scores for demographic and initial clinical scores of all treatment conditions according to the three original groups and to the groups analyzed according to training range.FMA, Fugl-Meyer Assessment; MAS, Modified Ashworth Scale; L, Left; MOCA, Montreal Cognitive Assessment; NA, Not Applicable; R, Right; TSRT, Tonic Stretch Reflex Threshold; WMFT-FAS, Wolf Motor Function Test-Functional Activity Score.*Difference between Group 1 and Group 2 ANOVA post-hoc deviation F2,1 = 8.496, 