Combining d-cycloserine with motor training does not result in improved general motor learning in neurologically intact people or in people with stroke.

Neurological rehabilitation involving motor training has resulted in clinically meaningful improvements in function but is unable to eliminate many of the impairments associated with neurological injury. Thus there is a growing need for interventions that facilitate motor learning during rehabilitation therapy, to optimize recovery. d-Cycloserine (DCS), a partial N-methyl-d-aspartate (NMDA) receptor agonist that enhances neurotransmission throughout the central nervous system (Ressler KJ, Rothbaum BO, Tannenbaum L, Anderson P, Graap K, Zimand E, Hodges L, Davis M. Arch Gen Psychiatry 61: 1136-1144, 2004), has been shown to facilitate declarative and emotional learning. We therefore tested whether combining DCS with motor training facilitates motor learning after stroke in a series of two experiments. Forty-one healthy adults participated in experiment I, and twenty adults with stroke participated in experiment II of this two-session, double-blind study. Session one consisted of baseline assessment, subject randomization, and oral administration of DCS or placebo (250 mg). Subjects then participated in training on a balancing task, a simulated feeding task, and a cognitive task. Subjects returned 1-3 days later for posttest assessment. We found that all subjects had improved performance from pretest to posttest on the balancing task, the simulated feeding task, and the cognitive task. Subjects who were given DCS before motor training, however, did not show enhanced learning on the balancing task, the simulated feeding task, or the associative recognition task compared with subjects given placebo. Moreover, training on the balancing task did not generalize to a similar, untrained balance task. Our findings suggest that DCS does not enhance motor learning or motor skill generalization in neurologically intact adults or in adults with stroke.

Grip type and task goal modify reach-to-grasp performance in post-stroke hemiparesis.

This study investigated whether grip type and/or task goal influenced reaching and grasping performance in poststroke hemiparesis. Sixteen adults with poststroke hemiparesis and twelve healthy adults reached to and grasped a cylindrical object using one of two grip types (3-finger or palmar) to achieve one of two task goals (hold or lift). Performance of the stroke group was characteristic of hemiparetic limb movement during reach-to-grasp, with more curved handpaths and slower velocities compared with the control group. These effects were present regardless of grip type or task goal. Other measures of reaching (reach time and reach velocity at object contact) and grasping (peak thumb-index finger aperture during the reach and peak grip force during the grasp) were differentially affected by grip type, task goal, or both, despite the presence of hemiparesis, providing new evidence that changes in motor patterns after stroke may occur to compensate for stroke-related motor impairment.