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

Jacqui H. Morris, Frederike van Wijck

Research output: Contribution to journalArticle

Abstract

Objectives
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.

Design
Single-blind randomized controlled trial with outcome assessment at baseline, postintervention (6wk), and follow-up (18wk).

Setting
Inpatient acute and rehabilitation hospitals.

Participants
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).

Interventions
Supervised BT or control training for 20 minutes on weekdays over a 6-week period using a standardized program.

Main Outcome Measures
Upper limb activity limitation: Action Research Arm Test; and dexterity: Nine-Hole Peg Test (9HPT).

Results
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.

Conclusions
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.
Original languageEnglish
Pages (from-to)1129-1137
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Volume93
Issue number7
Early online date13 Mar 2012
DOIs
Publication statusPublished - Jul 2012

Keywords

  • rehabilitation
  • stroke patients
  • upper extremity

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