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Sensorimotor Training and Neural Reorganization After Stroke: A Case Series

Borstad, Alexandra L. PT, PhD, NCS; Bird, Travis PT, DPT; Choi, Seongjin PhD; Goodman, Lindsay PT, DPT, GCS; Schmalbrock, Petra PhD; Nichols-Larsen, Deborah S. PT, PhD

Journal of Neurologic Physical Therapy: March 2013 - Volume 37 - Issue 1 - p 27–36
doi: 10.1097/NPT.0b013e318283de0d
Case Studies
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Background and Purpose: Impaired hand function decreases quality of life after stroke. The purpose of this study was to pilot a novel 2-week upper extremity sensorimotor training program. This case series describes the training program and highlights outcome measures used for documenting behavioral change and neural reorganization.

Case Description: Behavioral/performance changes were identified via sensorimotor evaluation. Activity-induced neural reorganization was examined using sensory functional magnetic resonance imaging, diffusion tensor tractography, and brain volume measurement. Participant 1 was a 75-year-old right-handed man 1 year post–right hemisphere stroke, with severe sensory impairment across domains in his left hand; he reported limited left-hand/arm use. Participant 2 was a 63-year-old right-handed woman who had experienced a left hemisphere stroke 9 months earlier, resulting in mild sensory impairment across domains in her right hand, as well as mild motor deficit.

Intervention: Participants were trained 4 hours per day, 5 days per week for 2 weeks. Training tasks required sensory discrimination of temperature, weights, textures, shapes, and objects in the context of active exploration with the involved hand. Random multimodal feedback was used.

Outcomes: Both participants had improved scores on the Wolf Motor Function Test after training. Participant 1 had no measurable change in sensory function, while participant 2 improved in touch perception, proprioception, and haptic performance. Sensory functional magnetic resonance imaging suggested neural reorganization in both participants; participant 1 had a small increase in brain volume, while superior thalamic radiation white matter connectivity was unchanged in either participant.

Discussion: Participating in sensorimotor training focused on sensory discrimination during manual manipulation was feasible for both participants. Future research to determine efficacy and identify optimal measures of sensory function and neural reorganization is recommended.

Video Abstract available: (see Video, Supplemental Digital Content 1, for more insights from the authors.

School of Health and Rehabilitation Sciences (A.L.B., D.S.N.L.) and Department of Radiology, College of Medicine (S.C., P.S.), The Ohio State University, and Home Care by Blackstone (L.G.), Columbus, Ohio; and Good Samaritan Hospital, Dayton, Ohio (T.B.).

Correspondence: Alexandra L. Borstad, PT, PhD, NCS, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210 (

A portion of this work was previously presented at the Society for Neuroscience Annual Meeting 2011.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2013 Neurology Section, APTA