2026-02-02 ペンシルベニア州立大学(Penn State)
<関連情報>
- https://www.psu.edu/news/research/story/targeting-good-arm-after-stroke-leads-better-motor-skills
- https://jamanetwork.com/journals/jamaneurology/fullarticle/2844558
慢性脳卒中における同側上肢の標的治療 ランダム化臨床試験 Targeted Remediation of the Ipsilesional Arm in Chronic Stroke A Randomized Clinical Trial
Candice Maenza, PhD; Carolee J. Winstein, PhD; Terrence E. Murphy, PhD;et al
JAMA Neurology Published:February 2, 2026
DOI:10.1001/jamaneurol.2025.5496
Key Points
Question Does training of the less impaired ipsilesional arm lead to sustained improvements in motor performance in patients with chronic stroke with severe contralesional arm paresis?
Findings In this 2-site randomized clinical trial (n = 53), participants receiving ipsilesional arm training produced significantly greater motor performance improvements, measured by the Jebsen-Taylor Hand Function Test, than best practice contralesional therapy.
Meaning Ipsilesional motor deficits are modifiable even years after stroke, supporting the ipsilesional arm as an important yet underrecognized rehabilitation target for individuals with severe hemiparesis who depend on that limb for daily independence.
Abstract
Importance Ipsilesional upper-limb motor deficits after stroke are functionally important yet largely neglected in rehabilitation. Remediation may improve motor outcomes in individuals with severe contralesional arm hemiparesis.
Objective To determine whether training of the ipsilesional arm improves motor performance in chronic stroke with severe contralesional impairment and significant ipsilesional arm motor deficits.
Design, Setting, and Participants This 2-site, parallel-group randomized clinical trial with blinded outcome assessment was conducted from February 2019 to August 2024, with follow-up through 6 months posttreatment. Data analysis was performed from August 2024 through August 2025. The trial was conducted at outpatient research laboratories at Penn State College of Medicine and the University of Southern California among adults with radiologically confirmed unilateral middle cerebral artery stroke, severe contralesional upper-extremity impairment (Fugl-Meyer score ≤28), and ipsilesional motor deficits. Participants were randomly assigned with equal probability to 2 treatment groups and stratified by sex.
Interventions Participants were randomized to a 5-week, 15-session intervention focused on either the ipsilesional (n = 25) or contralesional (n = 28) upper limb. The ipsilesional group received ipsilesional virtual reality and manipulation training; the contralesional group received dose-matched, best practice contralesional arm therapy.
Main Outcomes and Measures The primary outcomes were ipsilesional motor performance (Jebsen-Taylor Hand Function Test [excluding writing]), functional independence (Barthel Index), contralesional impairment severity (Fugl-Meyer Assessment [Upper Extremity]), and perceived manual ability (ABILHAND-Stroke).
Results Of 100 adults screened, 58 were included, and 53 participants (91%) completed both baseline and immediate posttreatment assessments. Of the 53 participants who completed the study, mean (SD) age was 59 (11) years, and 17 participants (32%) were female. In this modified intent-to-treat analysis, the ipsilesional treatment group showed significant improvement in Jebsen-Taylor Hand Function Test performance (mean difference, -5.87 seconds; 95% CI, -8.89 to -2.85 seconds; P = .003), representing a 12% reduction in time to completion. Relative to its own baseline, this improvement was sustained at the 3-week and 6-month follow-up times within the ipsilesional treatment group only. No significant effects were observed for the remaining outcomes.
Conclusions and Relevance In this parallel-group randomized clinical trial, targeted ipsilesional arm training significantly improved ipsilesional motor performance in patients with chronic stroke with severe paresis. This approach may enhance functional capacity in patients who rely on the ipsilesional arm for daily activities.
Trial Registration ClinicalTrials.gov Identifier: NCT03634397
中等度から重度の上肢麻痺を伴う慢性脳卒中患者における、障害の少ない方の腕の補助訓練は機能的自立を改善する:パイロットスタディ Remedial Training of the Less-Impaired Arm in Chronic Stroke Survivors With Moderate to Severe Upper-Extremity Paresis Improves Functional Independence: A Pilot Study
Candice Maenza,David A. Wagstaff,Rini Varghese,Carolee Winstein,David C. Good,Robert L. Sainburg
Frontiers of Human Neuroscience Published:12 March 2021
DOI:https://doi.org/10.3389/fnhum.2021.645714
The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen–Taylor Hand Function Test (JHFT)], ipsilesional grip strength, contralesional arm impairment level [Fugl–Meyer Assessment (FM)], and functional independence [Functional independence measure (FIM)] (N = 13). Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study.
