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The Motor Control Consequences of Physical Therapist Support for Individuals with Chronic Stroke

Schwab, Sarah
http://orcid.org/0000-0002-3835-5718
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1660815682371343

Abstract Details

2022, PhD, University of Cincinnati, Arts and Sciences: Psychology.
After stroke, physical therapists must determine when an individual requires assistance (e.g., physical support) to complete a task and when an individual can execute a motor skill with less assistance. The decision about the amount of support to provide is often based on deviations of movement patterns from expected “norms.” In standing postural control, for instance, a therapist may provide steadying support with the intent to minimize postural fluctuations, even when support is not required to maintain standing balance. When therapists view deviations from norms as “incorrect” in individuals with stroke, they make an assumption that neurotypical individuals exemplify idealized movement patterns and that any variation from that comparator represents an error in performance. “Variability as error” is a pervasive clinical assumption, but it contrasts with the complexity science perspective that motor variability is not just randomness. Variability in motor performance is now understood as an expression of flexibility, allowing an individual to select a motor strategy to fit a given context. The purpose of this study was to determine the effect of physical therapist postural assistance during the practice of an upper-limb task on task performance and underlying motor control patterns in individuals with stroke. It was hypothesized that providing unnecessary assistance (postural stabilization) during practice would result in (a) faster improvements in task performance but (b) reduced immediate retention and more limited transfer; and (c) reduced task-sensitive postural control adjustments at transfer and following practice. Individuals with chronic stroke (n = 23) who were independent in standing balance participated. Participants stood on a force plate while immersed in a virtual scene displaying an anterior target. They aimed to position a virtual laser pointer (via handheld device) in the target. All participants then engaged in a practice period where they positioned the laser in a lateral target. Participants were randomized to either (a) a control group that received no postural support (n = 12), or (b) an experimental group that received postural support to decrease postural fluctuations during practice (n = 11). Participants also engaged in a light finger force production transfer task. Task performance and postural control were concurrently recorded. After practice, both groups of participants demonstrated improvements to upper-limb task performance using the paretic limb. For the target task, individuals in the control group showed task-sensitive changes in postural control and changes to the paretic upper limb. Individuals in the experimental group showed no changes in postural control; they only demonstrated changes in upper-limb strategies. Further, individuals in the control group demonstrated the ability to flexibly shift postural control patterns across different tasks. Physical therapists must be critically aware of what support can and cannot provide and proceed cautiously when making the decision to provide support for the purpose of movement “normalization.” Providing support when it is actually not needed may have unintended impacts to motor control. Future research is required to evaluate long-term impacts of therapist support and determine possible interventions to better facilitate upper limb and postural control integration.
Michael Riley, Ph.D. (Committee Member)
Tehran Davis (Committee Member)
Paula Silva, Ph.D. (Committee Member)
64 p.
Experiments
Stroke; Neurological Rehabilitation; Disability; Motor Control; Postural Control; Upper Extremity

Recommended Citations

Citations

  • Schwab, S. (2022). The Motor Control Consequences of Physical Therapist Support for Individuals with Chronic Stroke [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1660815682371343

    APA Style (7th edition)

  • Schwab, Sarah. The Motor Control Consequences of Physical Therapist Support for Individuals with Chronic Stroke. 2022. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1660815682371343.

    MLA Style (8th edition)

  • Schwab, Sarah. "The Motor Control Consequences of Physical Therapist Support for Individuals with Chronic Stroke." Doctoral dissertation, University of Cincinnati, 2022. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1660815682371343

    Chicago Manual of Style (17th edition)

ucin1660815682371343
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This open access ETD is published by University of Cincinnati and OhioLINK.