Treatment of Supplementary Motor Area Syndrome

Supplementary motor area syndrome is characterized by impaired initiation of volitional movement and commonly occurs following dominant or bilateral supplementary motor area (SMA) lesions. Initiation deficit is extremely disruptive to functional performance due to the pervasive nature of the impairment. We present a functional treatment approach, based on a Lurian model of neuropsychological intervention, involving the verbal regulation of movement. Using a single-case experimental design (i.e., extended ABAB), involving planned intermittent treatment withdrawal, we treated the severe initiation deficit of a 53-year-old male with supplementary motor area syndrome, secondary to a dominant SMA lesion. Significant gains were demonstrated in response latency, time to completion of multiple-step upper limb movements, activities of daily living (ADL), and mobility. Despite severely impaired initiation, the patient was able to learn and independently utilize a structured cuing sequence, which significantly increased his capacity to initiate purposeful voluntary movement. Key Words: Supplementary motor area—Movement initiation—Neurologic rehabilitation.