Temporal and spatial control following bilateral versus unilateral training 2008

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Human Movement Science 27 (2008) 749–758

Contents lists available at ScienceDirect

Human Movement Science
journal homepage: www.elsevier.com/locate/humov

Temporal and spatial control following bilateral versus
unilateral training
S. McCombe Waller a,*, W. Liu a,b, J. Whitall a

University of Maryland Baltimore, School of Medicine, Department of Physical Therapy and RehabilitationScience,
100 Penn Street, Baltimore, MD 21201, USA
Walsh University, Division of Physical Therapy, North Canton, USA



Article history:
Available online 17 July 2008

PsycINFO classification:
Bilateral and unilateral training
Spatial motor control
Temporal motor control

Principles of motor control and learning such as bilateralcoordination and task-specificity, are increasingly incorporated in the
design of upper extremity rehabilitation protocols for stroke survivors. Yet most studies investigating the efficacy of new protocols
report composite scores of standardized tests, such as the FuglMeyer Upper Extremity test (FM) and the Wolf Motor Arm Test,
rather than determining how the motor control and coordination
of armmovements has changed. Here we present a sub-study of
a larger randomized controlled trial comparing a bilateral and unilateral training protocol where participants were assessed on bilateral and unilateral arm reaching. Eligible participants for the arm
reaching analysis were 9 (FM = 37) and 9 (FM = 34) in Bilateral
Arm Training with Rhythmic Auditory Cueing (BATRAC) and Dose
MatchedTherapeutic Exercises (DMTE), respectively. Participants
undertook 18 sessions of training for 6 weeks with 20 min of active
training per session. For bilateral arm reaching, participants after
BATRAC were faster, with increased peak acceleration, fewer
movement units, and smoother hand paths for each arm. The
BATRAC training group showed greater improvements with training than the DMTE group duringbilateral reaching for parameters
of movement units and smoothness of hand path. For unilateral
arm reaching, participants were faster after DMTE for paretic arm
reaching; however, this group did not improve to a greater extent
than the BATRAC training group. Within group functional gains
were seen after BATRAC on FM, Wolf Motor Arm Test (time and
weight) and after DMTE on FM and Wolf Weight.There was a positive correlation between movement units and the time component

* Corresponding author.
E-mail address: smccombewaller@som.umaryland.edu (S. McCombe Waller).
0167-9457/$ - see front matter Ó 2008 Elsevier B.V. All rights reserved.


S. McCombe Waller et al. / Human Movement Science 27 (2008) 749–758

of the Wolf Motor Arm Test. Thereaching analysis demonstrates
task-specificity in training since BATRAC improves performance
in bilateral reaching and DMTE improves performance in unilateral
reaching. Temporal/spatial control outcomes in studies of poststroke interventions can identify functionally relevant motor control changes that are not captured by traditional standardized tests.
Ó 2008 Elsevier B.V. All rights reserved.1. Introduction
Upper extremity paresis post-stroke is a leading cause of serious long-term disability (AHA, 2007).
With over 4.8 million patients in the US alone with stroke and improved survival rates, recovery of
arm function is a major rehabilitation and health care challenge. Unfortunately, only about 5% of patients currently regain full use of arm and hand function (Gowland, deBruin,Basmajian, Plews, & Nurcea, 1992). New therapeutic strategies are under investigation in an effort to improve functional
outcomes of the arms including bilateral arm training (Gowland et al., 1992; Luft et al., 2004; Lum,
Burgar, Shor, Majmundar, & van der Loos, 2002; McCombe Waller & Whitall, 2005; Whitall, McCombe
Waller, Silver, & Macko, 000), robotics (Aisen, Krebs, Hogan, McDowell, &...