Clinical and neurophysiologic responses to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: A case study

The need to quickly discharge patients following stroke from acute rehabilitation facilities to the home has resulted in an intense focus on restoring safe and independent, if not normal, motor function. Rehabilitation of hand function in patients with upper limb impairment is often de-prioritized to allow for an emphasis on practicing activities necessary for a safe discharge to the home, such as walking and bed mobility. This case study describes a patient with slow recovering hand motor function (hand sub-section of Fugl-Meyer examination score = 2 on post-stroke day 37) following a stroke. The patient received an intensive eight-session intervention that focused on the recovery of finger extension, finger individuation and pinch-grasp force modulation as well as the recovery of proximal upper extremity movement. Over the eight sessions, the patient demonstrated a dramatic increase in hand function and a corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. Gains in motor control transferred to clinically meaningful hand function measured at the activity level.