Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial

Published:August 14, 2019DOI:



      To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke.


      A single-blind, randomized controlled trial.


      Four hospitals.


      Outpatients with chronic stroke and mild to moderate motor impairment (N=44).


      UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks.

      Main Outcome Measures

      Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment.


      The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01).


      BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.


      List of abbreviations:

      ADL (activities of daily living), ANCOVA (analysis of covariance), BAT (bilateral arm training), BHT (bilateral hybrid therapy), BRT (bilateral robot-assisted therapy), FAS (functional ability scale), FMA (Fugl-Meyer Assessment), FMA-UE (upper extremity subscale of the Fugl-Meyer Assessment), IADL (instrumental activities of daily living), mCIT (modified constraint-induced therapy), NEADL (Nottingham Extended Activities of Daily Living scale), QOL (quality of life), RT (robot-assisted therapy), SIS (Stroke Impact Scale version 3.0), UE (upper extremity), UHT (unilateral hybrid therapy), URT (unilateral robot-assisted therapy), WMFT (Wolf Motor Function Test), WFMT-FAS (functional ability scores of Wolf Motor Function Test), WMFT-time (average time scores of Wolf Motor Function Test)
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