A TREATMENT FOR EXCESS MOTOR DISABILITY IN THE AGED

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In this laboratory we have developed a new set of techniques that preliminary studies suggest can substantially reduce the incapacitating motor deficit of many elderly stroke patients and lessen their dependence. The techniques involve "constraint-induced" (CI) facilitation of impaired movement and include prolonged motor restriction of the unaffected upper extremity by a sling while at the same time training the affected upper limb. Initial results indicate that old age, per se, is not an important factor in limiting the final level of motor recovery attainable. Limitations of the work previously carried out in this laboratory were the small sample size and a control intervention that was not equal in credibility to the experimental intervention. Aim 1 of the proposed research will be to address these two issues. The sample size will be increased. In addition, the interventions employed in two physical therapy comparison groups have been redesigned so that they will be equal in credibility to that employed with the CI group. Aim 2 of the project is to determine whether aging is a factor in the speed or extent to which the motor impairment of the upper extremity in chronic stroke patients can be reduced by CI techniques. Aim 3 of the study is to ascertain through the use of magnetic resonance imaging whether there is some commonality in the location or extent of the lesions that characterize patients who benefit most from use of CI techniques. The goal of Aim 4 is to assess in a controlled study whether either the intensive or conventional physical therapy we propose to employ is effective in improving the upper extremity motor status of chronic stroke patients. The research team is interdisciplinary and includes three psychologists (with the emphasis of different individuals being in rehabilitation and motor control, statistics and gerontology), a neurologist and two physical therapists. The experimental design will involve 80 subjects randomly assigned to four groups (with blocking based on age). One group will receive movement restriction of the impaired upper extremity for a period of two weeks and training of the unaffected upper extremity. These results will be compared with those of a group of subjects receiving intensive physical therapy, a group of subjects receiving conventional physical therapy and a group of subjects on a waiting list. Each group of 20 will have equal numbers of persons with left - and right - brain strokes. The motor function, amount of limb use and range of motion of these individuals will be assessed before and after intervention and during followup, both in the laboratory and in the life situation.