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

Morris JH, Van Wijck F. Responses of the less affected arm to bilateral upper limb task training in early rehabilitation after stroke: a randomized controlled trial. Arch Phys Med Rehabil 2012;93:1129-37.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.