The Effect of Proximal and Distal Training on Stroke Recovery:~Specific Aim 1. Test whether task specific wrist robotic training improves motor performance among persons with chronic impairment after stroke.~Specific Aim 2. Test whether the order in which robot therapy is delivered influences outcomes (shoulder-and-elbow before wrist vs. wrist before shoulder-and-elbow).~Specific Aim 3. Test whether there is generalization across different joints (shoulder & elbow vs wrist).~Specific Aim 4: Test whether there is any interference between training across different joints among persons with chronic impairment after stroke.~Briefly we will invite persons with chronic impairment due to stroke to participate in a study that will train them first on wrist for 6 weeks and then on the shoulder-and-elbow for an additional 6 weeks or vice-versa. A third group will train in alternate days for 12 weeks on the shoulder-and-elbow or the wrist, while a fourth group will be trained on the shoulder, elbow, and wrist on the same day. Outcomes will be measured using standard instruments as well as robot-based measures. We expect that results from this study will provide an objective basis for maximizing this kind of therapy.
We will test on persons with chronic impairment due to stroke:~whether the order in which robot therapy is delivered influences outcomes (shoulder-and-elbow before wrist vs. wrist before shoulder-and-elbow).~whether we should train the shoulder, elbow, and wrist at the same time or on different days.