Exploring the impact of visual and movement based priming on a motor intervention in the acute phase post-stroke in persons with severe hemiparesis of the upper extremity.

No control group or usual-care comparison was included, so spontaneous recovery, usual rehabilitation, and task familiarity could explain the changes. Only five participants were studied, and they were selected from 80 screened people, so the sample is small and highly selected. Participants were within one month of stroke and had severe paresis but no severe spasticity, neglect, proprioceptive loss, unstable vital signs, or inability to follow commands, so results may not apply to more medically or cognitively complex patients. Clinical gains during training were mostly proximal, and one participant could not perform the pinch trace task adequately. The authors acknowledge that improved pinch trace performance could reflect becoming familiar with a new task rather than motor learning. TMS was performed for only four subjects. No brain-stimulation responses were observed from the lesioned hemisphere, so interpretation of cortical changes is limited. The paper describes planned eight one-hour sessions but also reports seven or eight 45-minute sessions, so the actual dose is unclear.

Do not conclude that this priming and pinch training caused recovery. The study had no control group, only five participants, and early spontaneous recovery plus usual inpatient rehabilitation could account for the gains.