Moderated Poster Australian and New Zealand Stroke Organisation Conference 2025

Adjuvants and upper extremity motor training: A synthesis of preclinical evidence to guide future trial design (123233)

Madeleine J. Smith 1 , Jean-Louis Zhou 2 , Ana Antonic-Baker 1 , Lauren J. Christie 3 4 5 , Andrew N. Clarkson 1 6 , Dale Corbett 7 , Numa Dancause 2 , Kate S. Hayward 8 9 , Matthew Wingfield 10 , Natasha A. Lannin 1 11
  1. Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
  2. Département de Neurosciences, Centre Interdisciplinaire de Recherche sur le Cerveau et l’Apprentissage (CIRCA), Université de Montréal, Montréal, Canada
  3. Allied Health Research Unit, St Vincent’s Health Network Sydney, Darlinghurst, NSW, Australia
  4. School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
  5. Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Darlinghurst, NSW, Australia
  6. REGENBIO Consultants LTD, Dunedin, New Zealand
  7. Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
  8. Departments of Physiotherapy and Medicine, University of Melbourne, Melbourne, Victoria, Australia
  9. Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  10. Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
  11. Alfred Health, Melbourne, Victoria, Australia

Background/Aims: Stroke frequently leads to upper limb impairments. While motor training improves strength, coordination and upper limb use, recovery is often incomplete. Adjuvant treatments combined with motor training may enhance recovery by offering a permissive, neuroplastic milieu. The primary aim of this systematic review is to determine if task-specific forelimb motor training either alone or in combination with other interventions, increases performance in forelimb motor tasks or improves spontaneous recovery of the forelimb after ischaemic stroke.

Methods: Searches were conducted in PubMed, MEDLINE, Embase and Web of Science. Two authors independently conducted both the title/abstract screen and review full-text.

Results: Sixty-one studies were included. Most were conducted in rats (83.6%) predominantly using only males (80.3%). Stroke models included endothelin-1 (49.2%), photothrombosis (37.7%), middle cerebral artery occlusion (11.5%) and electro-cauterisation (1.6%). Motor training interventions included skilled reaching (78.7%), staircase test (6.6%), robotic rehabilitation (4.9%) or other tasks involving pushing or rotation of a lever (9.8%). Adjuvants were evaluated in 42 studies (66.1%) and included pharmacotherapies, enriched environments, cortical or vagus nerve stimulation, aerobic exercise, dietary interventions, and cell therapy. We are currently conducting a meta-analysis to evaluate intervention effectiveness.

Conclusion: Clinically, there is increasing interest in combining novel pharmacological, behavioural, neuro-modulatory or stem cell adjuvants with motor training to enhance recovery. While early trials have begun exploring this concept, clinical translation remains limited. This review will identify the most promising interventions and inform future clinical trial design, supporting the implementation of translational research into clinical practice.