Abstract
Objective
To compare the effects of unilateral and bilateral arm training on arm impairment
in severely affected patients with stroke.
Design
Single-blinded, randomized controlled trial.
Setting
Inpatient rehabilitation center.
Participants
First-time subacute patients (N=69) with stroke and a nonfunctional hand. Patients
were stratified according to lesion location post hoc.
Interventions
Repetitive bilateral arm training on an arm cycle followed by synchronized bilateral
repetitive distal hand training or an identical unilateral arm training performed
by the paretic limb only. Both unilateral and bilateral trainings were administered
twice daily over 6 weeks.
Main Outcome Measures
The primary outcome measure was the Fugl-Meyer Assessment (FMA) score for the arm,
and secondary measures were biomechanical parameters measuring isometric force and
rate of force generation. Outcome measures were assessed before, at the end of, and
2 weeks after intervention.
Results
Patients were homogeneous at study onset. All patients improved regarding the FMA
arm score and most biomechanical parameters after intervention. Yet the post hoc analysis
stratifying patients according to lesion location showed that patients with pure subcortical
stroke, but not patients with cortical involvement of stroke, showed a significantly
greater improvement (P=.022) following the bilateral training in FMA arm score (from 6.8±5.7 to 17.8±15.8)
compared with unilateral training (from 6.5±7.8 to 8.7±8.6).
Conclusions
The benefit of bilateral arm training followed by repetitive bilateral hand training
for motor control of the severely paretic upper limb may depend on lesion location.
Further studies with larger sample size are required for the validation of these results.
Keywords
List of abbreviations:
ANOVA (analysis of variance), BT (bilateral training), FMA (Fugl-Meyer Assessment), MI (Motricity Index), RRT (rate of rise of tension), UT (unilateral training)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 04, 2020
Footnotes
Disclosures: none
Clinical Trial Registration No.: DRKS00009294.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
