Early versus delayed VR-based hand training in persons with acute stroke

Introduction: Several large trials of task based rehabilitation examining interventions designed to meet the main tenets of experience-dependent neuroplasticity have failed to identify an approach to rehabilitation that produces improvements in hand function that consistently returns persons with stroke to their pre-stroke levels of activity and participation. Several scholars have identified the heightened levels of neuroplasticity occurring immediately after a stroke as an important opportunity to present rehabilitation interventions that will optimize the functional recovery. The study described in this paper begins to examine whether the heightened plasticity occurring early after stroke, when combined with intense technology based upper extremity training, will have a more positive impact than the spontaneous recovery process on its own, or similar interventions presented later, on the long-term recovery of hand and arm function. We hypothesized that early training would allow subjects to integrate their recovering motor abilities into higher levels of activity level performance and that this early integration would result in higher levles of activity level function normalized for impairment level at retention.