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1.1 1 xml info:srw/schema/1/mods-v3.2 Levin M F author Berman S author Weiss N author Parmet Y author Banina M C author Frenkel-Toledo S author Soroker N author Solomon J M author Liebermann D G author 2023 English Post-stroke motor recovery processes remain unknown. Timescales and patterns of upper-limb (UL) recovery suggest a major impact of biological factors, with modest contributions from rehabilitation. We assessed a novel impairment-based training motivated by motor control theory where reaching occurs within the spasticity-free elbow range. Patients with subacute stroke (</= 6 month; n = 46) and elbow flexor spasticity were randomly allocated to a 10-day UL training protocol, either personalized by restricting reaching to the spasticity-free elbow range defined by the tonic stretch reflex threshold (TSRT) or non-personalized (non-restricted) and with/without anodal transcranial direct current stimulation. Outcomes assessed before, after, and 1 month post-intervention were elbow flexor TSRT angle and reach-to-grasp arm kinematics (primary) and stretch reflex velocity sensitivity, clinical impairment, and activity (secondary). Results were analyzed for 3 groups as well as those of the effects of impairment-based training. Clinical measures improved in both groups. Spasticity-free range training resulted in faster and smoother reaches, smaller (i.e., better) arm-plane path length, and closer-to-normal shoulder/elbow movement patterns. Non-personalized training improved clinical scores without improving arm kinematics, suggesting that clinical measures do not account for movement quality. Impairment-based training within a spasticity-free elbow range is promising since it may improve clinical scores together with arm movement quality.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique Identifier: NCT02725853; Initial registration date: 01/04/2016. Humans Elbow *Transcranial Direct Current Stimulation Muscle Spasticity/therapy/complications Upper Extremity *Elbow Joint *Stroke/complications *Stroke Rehabilitation/methods PMID:38129527; PMCID:PMC10739929 exported from refbase (https://refbase.nfshost.com/show.php?record=121), last updated on Tue, 26 Dec 2023 14:20:06 +0000 text http://www.ncbi.nlm.nih.gov/pubmed/38129527 http://www.ncbi.nlm.nih.gov/pubmed/38129527 10.1038/s41598-023-49974-6 38129527 Levin_etal2023 22934 2045-2322 1