Responses of the less affected arm to bilateral upper limb task training in early rehabilitation after stroke: a randomized controlled trial.

To investigate effects of bilateral training (BT) on ipsilesional arm dexterity and activity limitation; to explore clinical and demographic factors that influence training effects; and to explore relationships between contralesional and ipsilesional recovery. Single-blind randomized controlled trial with outcome assessment at baseline, postintervention (6 wk), and follow-up (18 wk). Inpatient acute and rehabilitation hospitals. Participants were randomized to a BT group in which training involved the ipsilesional and contralesional arms (n=56) or control training involving the contralesional arm only (n=50). Supervised BT or control training for 20 minutes on weekdays over a 6-week period using a standardized program. Upper limb activity limitation: Action Research Arm Test; and dexterity: Nine-Hole Peg Test (9HPT). Lower baseline scores were found for the ipsilesional arm on both measures compared with published normative values. The BT group demonstrated significantly greater change in dexterity (P=.03) during the intervention phase at 0 to 6 weeks (.06±.07pegs/s) compared with the control group (.02±.02pegs/s). The effect was lost for overall recovery at 0 to 18 weeks (P=.93). Younger participants (age≤68y) performed the 9HPT faster at baseline than older participants (P=.04) and demonstrated greater overall recovery with BT than older participants (P=.04). There was no significant correlation between ipsilesional and contralesional recovery. The study suggests that BT may lead to clinically small improvements in ipsilesional performance of fine, rapid dexterity tasks. Younger participants responded better to BT. There was no relationship between contralesional and ipsilesional recovery, suggesting that different causes and recovery mechanisms may exist.

Morris JH ，Van Wijck F 《-》

A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial.

Morris JH ，van Wijck F ，Joice S ，Ogston SA ，Cole I ，MacWalter RS ... -  《-》

Motor recovery of the ipsilesional upper limb in subacute stroke.

To investigate the time-related changes in motor performance of the ipsilesional upper limb in subacute poststroke patients by using clinical and kinematic assessments. Observational, longitudinal, prospective, monocentric study. Physical medicine and rehabilitation department. Stroke patients (n=19; mean age, 62.9y) were included less than 30 days after a first unilateral ischemic/hemorrhagic stroke. The control group was composed of age-matched, healthy volunteers (n=9; mean age, 63.1y). Clinical and kinematic assessments were conducted once a week during 6 weeks and 3 months after inclusion. Clinical measures consisted of Fugl-Meyer Assessment, Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and Barthel Index. We used a 3-dimensional motion recording system during a reach-to-grasp task to analyze movement smoothness, movement time, and peak velocity of the hand. Healthy controls performed both clinical (BBT and 9HPT) and kinematic evaluation within a single session. BBT and 9HPT. Recovery of ipsilesional upper arm capacities increased over time and leveled off after a 6-week period of rehabilitation, corresponding to 9 weeks poststroke. At study discharge, patients demonstrated similar ipsilesional clinical scores to controls but exhibited less smooth reaching movements. We found no effect of the hemispheric side of the lesion on ipsilesional motor deficits. Our findings provide evidence that ipsilesional motor capacities remain impaired at least 3 months after stroke, even if clinical tests fail to detect the impairment. Focusing on this lasting ipsilesional impairment through a more detailed kinematic analysis could be of interest to understand the specific neural network underlying ipsilesional upper-limb impairment.

Metrot J ，Froger J ，Hauret I ，Mottet D ，van Dokkum L ，Laffont I ... -  《-》

Robotic-assisted rehabilitation of the upper limb after acute stroke.

Masiero S ，Celia A ，Rosati G ，Armani M ... -  《ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION》

Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial.

To investigate the effectiveness of mirror therapy (MT) combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb after stroke. Randomized, controlled, assessor-blinded study. Inpatient stroke rehabilitation center of a tertiary care teaching hospital. Patients with first-time ischemic or hemorrhagic stroke (N=20), confined to the territory of the middle cerebral artery, occurring <6 months before the commencement of the study. The MT and control group participants underwent a patient-specific multidisciplinary rehabilitation program including conventional occupational therapy, physical therapy, and speech therapy for 5 d/wk, 6 h/d, over 3 weeks. The participants in the MT group received 1 hour of MT in addition to the conventional stroke rehabilitation. The Upper Extremity Fugl-Meyer Assessment for motor recovery, Brunnstrom stages of motor recovery for the arm and hand, Box and Block Test for gross manual hand dexterity, and modified Ashworth scale to assess the spasticity. After 3 weeks of MT, mean change scores were significantly greater in the MT group than in the control group for the Fugl-Meyer Assessment (P=.008), Brunnstrom stages of motor recovery for the arm (P=.003) and hand (P=.003), and the Box and Block Test (P=.022). No significant difference was found between the groups for modified Ashworth scale (P=.647). MT when combined with bilateral arm training and graded activities was effective in improving motor performance of the paretic upper limb after stroke compared with conventional therapy without MT.

Samuelkamaleshkumar S ，Reethajanetsureka S ，Pauljebaraj P ，Benshamir B ，Padankatti SM ，David JA ... -  《-》