Introduction
hand motor and sensory impairments, finger individuation, chronic stroke, stroke, Dextrain, motor deficit, finger movements
STROKE, SECONDARY, CORTEX
Despite spontaneous recovery with conventional rehabilitation, over half of stroke survivors may retain a disabling motor deficit in the chronic phase, mainly affecting the upper limb [A recent study reported that training of finger individuation in chronic stroke patients is feasible and can improve finger individuation and lead to lasting improvements in hand function [We have developed dedicated technology to simultaneously measure dexterity components and rehabilitate selective finger movement control [The present study aimed to evaluate the “proof-of-concept” benefit of training using the Dextrain Manipulandum for the rehabilitation of hand and fingers in stroke subjects. We hypothesized that training of specific finger dexterity components (e.g., force control and independence of finger movements) coupled with real-time visual feedback and performance scores, enhancing motivation, would lead to greater gains in dexterous hand use compared to dose-matched conventional therapy. A secondary aim was to investigate whether Dextrain therapy leads to greater improvements in hand motor and sensory impairments, quantified dexterity components and activity limitations, as compared to conventional therapy. Finally, to decipher the neurophysiological mechanisms underlying dexterity recovery we explored how motor cortex excitability and short intracortical inhibition (SICI), measured with TMS, changed with therapy and how this change correlated with dexterity improvements.