Kate Hayward, PhD, PT
Studies have previously demonstrated the efficacy of environmental enrichment and task-specific training to promote post-stroke recovery. The premise is that enrichment creates a neuroplastic milieu that is permissive for recovery, and task-specific training capitalizes on this environment to induce neuroplastic changes and promote motor recovery. Despite the efficacy of this synergistic approach, the respective contribution of each of these components had not been directly compared until this paper by Jeffers and Corbett (1).
This study demonstrated that the combination of environmental enrichment plus task-specific reach training (environment+reach) resulted in significant improvements in reaching (single-pellet retrieval) at both 4- and 9- weeks post-stroke compared to reach training alone or enrichment alone. Further, the enrichment+reach group was the only group that did not differ significantly from the sham group (no stroke) at 4- and 9-weeks post stroke. This indicates significant functional recovery had occurred; all groups were significantly impaired compared to sham at initial post-stroke assessment.
Initial impairment alone (single-pellet retrieval) did not predict recovery in single-pellet retrieval (terminal – initial) as proportional recovery research would suggest. Rather, a combined model that included volume of surviving cortical tissue and rehabilitation approach was found to predict change in single-pellet retrieval. This is consistent with Jeffers and Corbett’s past research using the Montoya staircase (2,3); demonstrating generalizability of their model across reaching tasks.
The synergistic interaction of enrichment+reach, taken with the contribution of rehabilitation approach to predicting recovery, provides important information for the field of clinical stroke recovery research. There are promising clinical studies that have used environmental enrichment principles in acute and subacute rehabilitation (4,5). Yet, the clinical application of a synergic approach (environment+reach) to increase rehabilitation intensity is yet to be explored.
- Jeffers MS, Corbett D. Synergistic effects of enriched environment and task-specific reach training on poststroke recovery of motor function. 2018;49:1496-1503.
- Jeffers MS, Corbett D. Does Stroke Rehabilitation Really Matter? Part A. Neurorehabil Neural Repair. 2018;32:3-6.
- Jeffers MS, Karthikeyan S, Gomez-Smith M, Gasinzigwa S, Achenbach J, Feiten A, et al. Does Stroke Rehabilitation Really Matter? Part Neurorehabil Neural Repair. 2018;32:73-83.
- Rosbergen IC, Grimley RS, Hayward KS, Walker KC, Rowley D, Campbell AM, et al. Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before-after pilot study. Clin Rehabil. 2017;31:1516-28.
- Janssen H, Ada L, Bernhardt J, McElduff P, Pollack M, Nilsson M, et An enriched environment increases activity in stroke patients undergoing rehabilitation in a mixed rehabilitation unit: a pilot non-randomized controlled trial. Disabil Rehabil. 2014;36:255-62.