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Use It and Improve It or Lose It: Interactions between Arm Function and Use in Humans Post-stroke

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  • Yukikazu Hidaka
  • Cheol E Han
  • Steven L Wolf
  • Carolee J Winstein
  • Nicolas Schweighofer

Abstract

“Use it and improve it, or lose it” is one of the axioms of motor therapy after stroke. There is, however, little understanding of the interactions between arm function and use in humans post-stroke. Here, we explored putative non-linear interactions between upper extremity function and use by developing a first-order dynamical model of stroke recovery with longitudinal data from participants receiving constraint induced movement therapy (CIMT) in the EXCITE clinical trial. Using a Bayesian regression framework, we systematically compared this model with competitive models that included, or not, interactions between function and use. Model comparisons showed that the model with the predicted interactions between arm function and use was the best fitting model. Furthermore, by comparing the model parameters before and after CIMT intervention in participants receiving the intervention one year after randomization, we found that therapy increased the parameter that controls the effect of arm function on arm use. Increase in this parameter, which can be thought of as the confidence to use the arm for a given level of function, lead to increase in spontaneous use after therapy compared to before therapy. Author Summary: Although, there is now definitive evidence that intensive task-specific practice is effective for improving upper extremity function and use after stroke, it is unclear how individual patients recover from stroke, and how they respond to therapy. Here, we propose a novel computational model of stroke recovery to study the time-varying dynamics of recovery of individuals at least 3 months post-stroke with mild to moderate impairments. Our model gives support to one of the axiom of neuro-rehabilitation “use it or lose it”. Furthermore, analysis of the model parameters showed that increase in confidence to use the affected arm during therapy may affect the dynamics of recovery. Our long-term goal is to develop and validate a method based on such dynamical models, to allow clinicians and patients to make informed decisions about treatment and potentially determine the critical dose of motor therapy for an individual patient.

Suggested Citation

  • Yukikazu Hidaka & Cheol E Han & Steven L Wolf & Carolee J Winstein & Nicolas Schweighofer, 2012. "Use It and Improve It or Lose It: Interactions between Arm Function and Use in Humans Post-stroke," PLOS Computational Biology, Public Library of Science, vol. 8(2), pages 1-13, February.
    • Handle: RePEc:plo:pcbi00:1002343
    DOI: 10.1371/journal.pcbi.1002343
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    1. Nathaniel D. Daw & John P. O'Doherty & Peter Dayan & Ben Seymour & Raymond J. Dolan, 2006. "Cortical substrates for exploratory decisions in humans," Nature, Nature, vol. 441(7095), pages 876-879, June.
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    1. Yu-Wen Chen & Yi-Chun Li & Chien-Yu Huang & Chia-Jung Lin & Chia-Jui Tien & Wen-Shiang Chen & Chia-Ling Chen & Keh-Chung Lin, 2023. "Predicting Arm Nonuse in Individuals with Good Arm Motor Function after Stroke Rehabilitation: A Machine Learning Study," IJERPH, MDPI, vol. 20(5), pages 1-12, February.

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