Electrical stimulation of wrist extensors in poststroke hemiplegia. EMG feedback treatment of upper limb in hemiplegic stroke patients: a pilot study. Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation. Does the Application of Constraint-Induced Movement Therapy During Acute Rehabilitation Reduce Arm Impairment After Ischemic Stroke? Rhythmic facilitation of gait training in hemiparetic stroke rehabilitation Rehabilitation of Walking With Electromyographic Biofeedback in Foot‐Drop After Stroke Randomized clinical trial of therapeutic exercise in subacute stroke. Responsiveness and predictability of gait speed and other disability measures in acute stroke. Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial Are stroke patients discharged sooner if in-patient rehabilitation services are provided seven v six days per week? Stroke motor recovery: active neuromuscular stimulation and repetitive practice schedules Is dosage of physiotherapy a critical factor in deciding patterns of recovery from stroke: a pragmatic randomized controlled trial. Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome? Positional feedback and electrical stimulation: an automated treatment for the hemiplegic wrist. Modified constraint induced therapy: a randomized feasibility and efficacy study. Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. Prevention of shoulder subluxation after stroke with electrical stimulation. Electromyographic biofeedback for gait training after stroke Effectiveness of an intensive outpatient rehabilitation program for postacute stroke patients. Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. The rehabilitation of gait in patients with hemiplegia: a comparison between conventional therapy and multichannel functional electrical stimulation therapy. Electromyographic feedback in the remobilization of stroke patients: a controlled trial. Electromyographic biofeedback and physical therapy of the hemiplegic upper limb. Relationship between functional electrical stimulation duty cycle and fatigue in wrist extensor muscles of patients with hemiparesis. Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis: an exploratory study. Remedial therapy after stroke: a randomised controlled trial. Assessing research outcomes by postal questionnaire with telephone follow-up. TOTAL Study Group. Trial of Occupational Therapy and Leisure. Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial. Failure of electrical myofeedback to augment the effects of physiotherapy in stroke The effects of common peroneal stimulation on the effort and speed of walking: a randomized controlled trial with chronic hemiplegic patients Intermittent compression for the treatment of the oedematous hand in hemiplegic stroke: a randomized controlled trial. Kinesthetic biofeedback: a treatment modality for elbow range of motion in hemiplegia. Effects of feedback stimulation training and cyclical electrical stimulation on knee extension in hemiparetic patients. Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: a randomized pilot study. Shoulder Pain in Hemiplegia: The Role of Exercise A multicentre randomized controlled trial of leisure therapy and conventional occupational therapy after stroke Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial Myofeedback for muscle retraining in hemiplegic patients. Feedback of ankle joint angle and soleus electromyography in the rehabilitation of hemiplegic gait. Physiotherapy intervention late after stroke and mobility. Low TENS treatment on post-stroke paretic arm: a three-year follow-up Biofeedback and functional electric stimulation in stroke rehabilitation. Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Can augmented physiotherapy input enhance recovery of mobility after stroke? A randomized controlled trial A randomized controlled trial of strapping to prevent post-stroke shoulder pain Biofeedback treatment of foot-drop after stroke compared with standard rehabilitation technique: effects on voluntary control and strength. The effectiveness of EMG biofeedback in the treatment of arm function after stroke. Progressive resistance strengthening exercises after stroke: a single-blind randomized controlled trial. A control study of muscle force recovery in hemiparetic patients during treatment with functional electrical stimulation. Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement Partial body weight treadmill training in persons with chronic stroke. Modified Constraint-Induced Therapy after Subacute Stroke: A Preliminary Study Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait. The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation An exploration of the effects of weighted garments on balance and gait of stroke patients with residual disability Biofeedback in strokes. Functional electrical stimulation to the affected lower limb and recovery after cerebral infarction.
BACKGROUND AND PURPOSE It has been suggested that cyclic neuromuscular electrical stimulation ( ES ) may enhance motor recovery after stroke . We have investigated the effects of ES of the wrist extensors on impairment of wrist function and on upper-limb disability in patients being rehabilitated after acute stroke . METHODS We recruited 60 hemiparetic patients ( mean age , 68 years ) 2 to 4 weeks after stroke into a r and omized , controlled , parallel-group study comparing st and ard rehabilitation treatment with st and ard treatment plus ES of wrist extensors ( 3 times 30 minutes daily for 8 weeks ) . Isometric strength of wrist extensors was measured using a device built for that purpose . Upper-limb disability was assessed with use of the  Action Research Arm Test ( ARAT ) . Observations were continued for 32 weeks ( 24 weeks after the finish of ES or the control intervention phase ) . RESULTS The change in isometric strength of wrist extensors ( at an angle of 0 degrees extension ) was significantly greater in the ES group than the control group at both 8 and 32 weeks ( P=0.004 , P=0.014 by Mann Whitney U test ) . At week 8 the grasp and grip subscores of the ARAT increased significantly in the ES group compared with that in the control group ( P=0.013 and P=0.02 , respectively ) ; a similar trend was seen for the total ARAT score ( P=0.11 ) . In the subgroup of 33 patients with some residual wrist extensor strength at study entry ( moment at 0 degrees extension > 0 ) , the ARAT total score had increased at week 8 by a mean of 21.1 ( SD , 12.7 ) in the ES group compared with 10.3 ( SD , 9.0 ) in the control group ( P=0.024 , Mann Whitney U test ) ; however , at 32 weeks the differences between these 2 subgroups were no longer statistically significant . CONCLUSIONS ES of the wrist extensors enhances the recovery of isometric wrist extensor strength in hemiparetic stroke patients .  Upper-limb disability was reduced after 8 weeks of ES therapy , with benefits most apparent in those with some residual motor function at the wrist . However , it is not clear how long the improvements in upper-limb disability are maintained after ES is discontinued Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients OBJECTIVE To determine the influence of functional electrical stimulation ( FES ) on subluxation and shoulder pain in hemiplegic patients . DESIGN Controlled study of 24 months ' duration beginning in the first month after onset of stroke . SUBJECTS AND SETTING One hundred twenty hemiplegic patients with both subluxed and painful shoulder were followed for rehabilitation before and after discharge between 1989 and 1993 . All subjects received conventional rehabilitation based on the Bobath concept . In addition , patients were alternately assigned to a control group or to receive additional FES for 5 weeks on muscles surrounding their subluxed and painful shoulder . MAIN MEASURES Clinical examinations , including range of motion , pain assessment , and x-rays , were performed at the start of the study , between the second and fourth weeks after onset of stroke , and subsequently at 6 , 12 , and 24 months . RESULTS The FES group showed significantly more improvement than the control group in both pain relief ( 80.7 % vs. 55.1 % , p<.01 ) and reduction of subluxation ( 78.9 % vs. 58.6 % , p<.05 ) . Furthermore , recovery of arm motion appeared to be significantly improved in the FES group ( 77.1 % vs. 60.3 % in the control group , p<.01 ) . CONCLUSION The FES program was significantly effective in reducing the severity of subluxation and pain and possibly may have facilitated recovery of the shoulder function in hemiplegic patients Background and Purpose Motor dysfunction after unilateral deafferentation in primates can be overcome by restraining the unaffected limb . We asked whether a constraint-induced movement ( CIM ) program could be implemented within 2 weeks after stroke and whether CIM is more effective than traditional upper-extremity ( UE ) therapies during this period . Methods Twenty-three persons were enrolled in a pilot r and omized , controlled trial that compared CIM with traditional therapies . A blinded observer rated the primary end point , the Action Research Arm Test ( ARA ) .  Inclusion criteria were the following : ischemic stroke within 14 days , persistent hemiparesis , evidence of preserved cognitive function , and presence of a protective motor response . Differences between the groups were compared by using Student ’s t tests , ANCOVA , and Mann-Whitney U tests . Results Twenty subjects completed the 14-day treatment . Two adverse outcomes , a recurrent stroke and a death , occurred in the traditional group ; 1 CIM subject met rehabilitation goals and was discharged before completing 14 inpatient days . The CIM treatment group had significantly higher scores on total ARA and pinch subscale scores ( P < 0.05 ) . Differences in the mean ARA grip , grasp , and gross movement subscale scores did not reach statistical significance . UE activities of daily living performance was not significantly different between groups , and no subject withdrew because of pain or frustration . Conclusions A clinical trial of CIM therapy during acute rehabilitation is feasible . CIM was associated with less arm impairment at the end of treatment . Long-term studies are needed to determine whether CIM early after stroke is superior to traditional therapies Experimental and control groups of 10 hemiparetic stroke patients each underwent a 6 week , twice daily gait training program . The control group participated in a conventional physical therapy gait program . The experimental group trained in the same basic program with the addition of rhythmic auditory stimulation ( RAS ) .  Patients entered the study as soon as they could complete 5 strides with h and -held assistance . The training program had to be completed within 3 months of the patients ' stroke . In the experimental group RAS was used as a timekeeper to synchronize step patterns and gradually entrain higher stride frequencies . Study groups were equated by gender , lesion site , and age . Motor function was assessed at pretest using Barthel , Fugl-Meyer , and Berg Scales . Walking patterns were assessed during pre- and post-test without RAS present . Pre- vs post-test measures revealed a statistically significant ( P<0.05 ) increase in velocity ( 164 % vs 107 % ) , stride length ( 88 % vs 34 % ) , and reduction in EMG amplitude variability of the gastrocnemius muscle ( 69 % vs 33 % ) for the RAS-training group compared to the control group . The difference in stride symmetry improvement ( 32 % in the RAS-group vs 16 % in the control group ) was statistically not significant . The data offer evidence that RAS is an efficient tool to enhance efforts in gait rehabilitation with acute stroke patients Background and Purpose Alterations of gait cycle and foot-drop on the paretic limb are characteristic of stroke patients .  Electromyographic biofeedback treatment has been used in rehabilitation of walking , but results are controversial . We performed gait analysis to evaluate the efficacy of electromyographic biofeedback compared with physical therapy . Methods Sixteen patients with ischemic stroke were enrolled in the study . The experimental group ( 4 men , 4 women ) received electromyographic biofeedback treatment together with physical therapy . The control group ( 5 men , 3 women ) was treated with physical therapy only .  Clinical and functional evaluations before and after treatment were performed using Canadian Neurological , Adams , Ashworth , Basmajian , and Barthel Index scales . Computerized gait analysis was performed in all patients . Results Electromyographic biofeedback patients showed significantly increased scores on the Adams scale ( P<.05 ) and Basmajian scale ( P<.01 ) . Gait analysis in this group showed a recovery of foot-drop in the swing phase ( P<.02 ) after training . Conclusions Our data confirm that the electromyographic biofeedback technique increases muscle strength and improves recovery of functional locomotion in patients with hemiparesis and foot-drop after cerebral ischemia BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care OBJECTIVES To identify the most responsive method of measuring gait speed , to estimate the responsiveness of other outcome measures , and to determine whether gait speed predicts discharge destination in acute stroke . DESIGN A prospect i ve cohort study . SETTING Five acute-care hospitals . PATIENTS Fifty subjects with residual gait deficits after a first-time stroke . INTERVENTIONS Five- ( 5mWT ) and 10-meter walk tests ( 10mWT ) at comfortable and maximum speeds , with 2 evaluations conducted an average + /- st and ard deviation ( SD ) of 8 + /- 3 and 38 + /- 5 days poststroke . MAIN OUTCOME MEASURE St and ardized response mean ( SRM = mean change/SD of change ) was used to estimate responsiveness for each walk test , the Berg Balance Scale , the Barthel Index , the Stroke Rehabilitation Assessment of Movement ( STREAM ) , and the Timed Up and Go ( TUG ) . RESULTS The SRMs were 1.22 and 1.00 for the 5mWT , and .92 and .83 for the 10mWT performed at a comfortable and maximum pace , respectively . The SRMs for the Berg Balance Scale , the Barthel Index , the STREAM , and the TUG were 1.04,.99,.89 , and .73 , respectively . The probability of discharge to a rehabilitation center for persons walking at < or = 0.3 m/s or > 0.6 m/s at the first evaluation was.95 and .22 , respectively . CONCLUSIONS The 5mWT at a comfortable pace is recommended as the measure of choice for clinicians and research ers who need to detect longitudinal change in walking disability in the first 5 weeks poststroke BACKGROUND Community physiotherapy is often prescribed for stroke patients with long-term mobility problems . We aim ed to assess the effectiveness of this treatment in patients who had mobility problems 1 year after stroke . METHODS We screened 359 patients older than 50 years for a single-masked , r and omised controlled trial to assess the effects of community physiotherapy . Assessment s were made at baseline , 3 , 6 , and 9 months in 170 eligible patients assigned treatment or no intervention . The primary outcome measure was mobility measured by the Rivermead mobility index . Secondary outcome measures were gait speed , number of falls , daily activity ( Barthel index scores ) , social activity ( Frenchay activities index ) , hospital anxiety and depression scale , and emotional stress of carers ( general health question naire 28 ) . Analyses were by intention to treat . FINDINGS Follow-up was available for 146 patients ( 86 % ) . Changes in scores on the Rivermead mobility index ( score range 0 - 15 ) differed significantly between treatment and control groups at 3 months ( p=0.018 ) , but only by a median of 1 point ( 95 % CI 0 - 1 ) , with an interpolated value of 0.55 ( 0.08 - 1.04 ) . Gait speed was 2.6 m/min ( 0.30 - 4.95 ) higher in the treatment group at 3 months . Neither treatment effect persisted at 6-months ' and 9-months ' follow-up . Treatment had no effect on patients ' daily activity , social activity , anxiety , depression , and number of falls , or on emotional stress of carers . INTERPRETATION Community physiotherapy treatment for patients with mobility problems 1 year after stroke leads to significant , but clinical ly small , improvements in mobility and gait speed that are not sustained after treatment ends A comparison was made of 113 consecutive patients who suffered a cerebrovascular accident and were hospitalized at a rehabilitation inpatient unit by dividing them into two groups : one group received the traditional 6-day/wk treatment regimen , and another group received treatment during the entire week ( 7 days/wk ) . When the patients were asked whether they had a preference ( which did not affect their group assignment ) , 82 % preferred a 6-day/wk program and 18 % preferred a 7-day/wk program . The length of inpatient stay for the 57 patients enrolled in the 6-day/wk program was 20.14 days ; for the 56 patients enrolled in the 7-day/wk program , the average length of stay was 20.11 days . This represents no significant difference . The functional recoveries were evaluated in areas that can affect length of stay , including dressing , bladder control , ambulation , and problem-solving . Both groups demonstrated significant gains in each domain when the intake and discharge ratings were compared . However , these gains were not significantly different when the 6- and 7-day/wk groups were compared . The results of the study contained herein , therefore , suggest that a 6-day/wk program for patients who have suffered a cardiovascular accident is just as effective as a 7-day/wk program Objective : To investigate progress toward motor recovery in patients with chronic hemiparesis ( mean time since stroke 3.2 years ) , comparing different types of practice schedules . Design : To increase voluntary control of the upper extremity , active neuromuscular stimulation was administered during blocked and r and om practice schedules as patients performed three specific movements : wrist/finger extension , elbow joint extension , and shoulder joint abduction . Methods : 34 stroke subjects volunteered to participate and were r and omly assigned to one of three treatment groups : blocked practice ( the same movement was repetitively performed on successive trials ) combined with active neuromuscular stimulation ; r and om practice ( different movements on successive trials ) along with active stimulation ; or no active stimulation assistance control group . Subjects completed two days of 90 minute training for each of two weeks with at least 24 hours of rest between sessions . A session was three sets of 30 successful active neuromuscular stimulation trials with the three movements executed 10 times/set . Results : Mixed design analyses on three categories of behavioural measures indicated motor improvements for the blocked and r and om practice /stimulation groups in comparison with the control group during the post-test period , with a larger number of blocks moved , faster premotor and motor reaction times , and less variability in the sustained muscular contraction task . Conclusions : Upper extremity rehabilitation intervention of active stimulation and blocked practice performed as well as stimulation/r and om practice . Moreover , these purpose ful voluntary movement findings support and extend sensorimotor integration theory to both practice schedules BACKGROUND AND PURPOSE The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams . Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this results . Physiotherapy is one component of most rehabilitation teams and recent systematic review s have shown that patients with stroke receiving more physiotherapy  achieve more recovery from disability . However , information about the actual amounts of physiotherapy needed to achieve this result is not known . METHOD A pragmatic , r and omized , single-blind , controlled trial comparing recovery from disability in subjects receiving the current st and ard amount of 30 minutes ' physiotherapy with those receiving double that amount ( 60 minutes ) . The study included measures of physical performance and function , psychological aspects of anxiety and depression , and perceived control over recovery . RESULTS Some 114 subjects were recruited to the study ; full six-week data are available for 104 subjects and six-month data for 93 subjects . Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference . Scrutiny of the recovery curves of the whole sample showed that , in half the sample , three distinct patterns of recovery were demonstrated . CONCLUSION These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients . The subgroup analysis of patterns of recovery must be regarded as speculative , but provides the basis for hypotheses about those likely to respond well to more intensive therapy Objective : To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome . Design : A r and omized controlled trial . Setting : A stroke unit which provides acute care and rehabilitation for all stroke admissions . Subjects : One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days . Intervention : The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist , commencing within 10 days of stroke , and available up to 30 minutes/day , five days/week for six weeks . The control group received stroke unit care . Main outcome measures : The primary outcome measure was the Action Research Arm Test ( ARAT ) three months after stroke . Secondary outcome measures : Motricity Index ; Frenchay Arm Test ; upper limb pain ; Barthel ADL Index ; Nottingham E-ADL Scale ; and costs to health and social services at three and six months after stroke . Results : There were no differences in outcomes between the intervention and control groups three and six months after stroke . During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as in patients . The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group ( p = 0.001 ) . There were no differences in service costs . Conclusions : An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke . The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias Positional feedback ( PF ) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients . Thirty adult hemiparetic patients lacking normal voluntary wrist extension were r and omly placed in control and study groups . The control group received conventional therapy while the study group received positional feedback stimulation training ( PFST ) in addition to conventional treatment . At the end of the 4-week program , study patients showed a 280 % increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70 % increase when positioned in 30 degrees of flexion . Control patients showed no significant changes in torque . Study patients made an average 200 % gain in selective range of motion over their starting levels while controls made only a 50 % increase . Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision This case series examined the feasibility and efficacy of a modified constraint induced therapy ( CIT ) protocol administered on an outpatient basis . The Fugl-Meyer Assessment of Motor Recovery After Stroke ( Fugl ) , Action Research Arm Test ( ARA ) , Wolf Motor Function Test ( WMFT ) , and  Motor Activity Log  ( MAL ) were administered to six patients between 2 and 6 months poststroke ( CVA ) exhibiting stable motor deficits and learned nonuse of the affected limb . Two patients then participated in half-hour physical and occupational therapy sessions three times/week for 10 weeks . During the same period , their unaffected arms and h and s were restrained 5 days/week during 5 hours identified as times of frequent use . Two other patients received regular therapy and two control patients received no therapy . The ARA , Fugl , WMFT , and MAL were again administered after 10 weeks . Patients receiving modified CIT exhibited substantial improvements on the Fugl , ARA , and WMFT , as well as increases in amount and quality of use of the limb using the MAL . Patients receiving traditional or no therapy exhibited no improvements . Results suggest that modified CIT may be an efficacious method of improving function and use of the affected arms of patients exhibiting learned nonuse BACKGROUND AND PURPOSE After stroke , many individuals have chronic unilateral motor dysfunction in the upper extremity that severely limits their functional movement control . The purpose of this study was to determine the effect of electromyography-triggered neuromuscular electrical stimulation on the wrist and finger extension muscles in individuals who had a stroke > or = 1 year earlier . METHODS Eleven individuals volunteered to participate and were r and omly assigned to either the electromyography-triggered neuromuscular stimulation experimental group ( 7 subjects ) or the control group ( 4 subjects ) . After completing a pretest involving 5 motor capability tests , the poststroke subjects completed 12 treatment sessions ( 30 minutes each ) according to group assignments . Once the control subjects completed 12 sessions attempting wrist and finger extension without any external assistance and were posttested , they were then given 12 sessions of the rehabilitation treatment . RESULTS The Box and Block test and the force-generation task ( sustained muscular contraction ) revealed significant findings ( P<0 . 05 ) . The experimental group moved significantly more blocks and displayed a higher isometric force impulse after the rehabilitation treatment . CONCLUSIONS Two lines of evidence clearly support the use of the electromyography-triggered neuromuscular electrical stimulation treatment to rehabilitate wrist and finger extension movements of hemiparetic individuals > or = 1 year after stroke . The treatment program decreased motor dysfunction and improved the motor capabilities in this group of poststroke individuals BACKGROUND AND PURPOSE Subluxation is a significant problem in poststroke hemiplegia , result ing in pain and loss of function . Current treatments are not proved and not considered effective . It has been demonstrated that cyclical electrical stimulation of the shoulder muscles can reduce existing subluxation . The purpose of this study was to determine whether electrical stimulation could prevent subluxation in both the short and long terms . METHODS A prospect i ve , r and omized controlled study was used to determine the efficacy of electrical stimulation in preventing shoulder subluxation in patients after cerebrovascular accidents . Forty patients were selected and r and omly assigned to a control or treatment group . They had their first assessment within 48 hours of their stroke , and those in the treatment group were immediately put on a regimen of electrical stimulation for 4 weeks . All patients were assessed at 4 weeks after stroke and then again at 12 weeks after stroke . Assessment s were made of shoulder subluxation , pain , and motor control . RESULTS The treatment group had significantly less subluxation and pain after the treatment period , but at the end of the follow-up period there were no significant differences between the 2 groups . CONCLUSIONS Electrical stimulation can prevent shoulder subluxation , but this effect was not maintained after the withdrawal of treatment Objective : To examine the effects of electromyographic ( EMG ) biofeedback training on the recovery of gait in the acute phase post stroke . Design : Patients were r and omly assigned to EMG biofeedback or control groups . They received treatment three times a week for six weeks . All patients were assessed prior to treatment , after 18 treatment sessions , and at three months follow-up . Setting : The study was carried out at Scunthorpe General Hospital in North Lincolnshire . The subjects were acute stroke patients who had been admitted on to the medical and elderly wards . Interventions : The EMG biofeedback group were treated using EMG as an adjunct to physiotherapy . The patients were encouraged to facilitate or inhibit abnormal muscle tone via auditory or visual signals transmitted from electrodes placed over the appropriate muscles . The control group were treated using the same techniques , electrodes were used with this group of patients , but the EMG machine was turned off and faced away from the patient and the therapist to control the placebo effect . Outcome measures : A large battery of outcome measures was used for physical and psychological assessment . The physical measures consisted of active movement , muscle tone , sensation , proprioception , mobility and activities of daily living ( ADL ) . The psychological measures included orientation , memory , spatial performance , language and IQ . Results : Twenty-one patients were included in the study . Scores were combined into four groups : mild EMG , severe EMG , mild control and severe control . Results showed that there was an improvement in physical scores for active movement , mobility and ADL over time , but there was no significant difference between the EMG and control groups . Scores on the psychological tests were within normal limits , and there was no difference in performance between the EMG and control groups . Conclusions : This study showed no significant differences in the rate of improvement after stroke between the two groups . Although EMG biofeed-back was used as an adjunct to physiotherapy and represented clinical practice , the results provide little evidence to support the clinical significance of using EMG biofeedback to improve gait in the acute phase after stroke The effectiveness of ongoing rehabilitation services for postacute stroke survivors is poorly documented . We design ed a r and omized control , single-blinded study to demonstrate the effectiveness of intensive outpatient therapy . The treatment intervention consisted of 1 hr each of physical and occupational therapy , four times per week , for 12 wk ; therapy focused on neuromuscular facilitation and functional tasks . All subjects were screened before the therapies and after 3 mo and 9 mo . Forty-nine stroke survivors , who were at least l yr ( mean , 2.9 yr ) poststroke , were r and omized with two treated patients to each control ( no treatment supplied ) . All patients had received inpatient rehabilitation at the time of their acute stroke , but no patient had any ongoing therapy  within the last 6 mo . The outcome measures included the Functional Independence Measure ( FIM ) , Brunnstrom stages of motor recovery , timed mobility tasks , and the Jebson h and evaluation . We also evaluated the level of depression , self-esteem , and socialization . The treated patients demonstrated an improvement of 6.6 points over the 3 mo of therapy compared with only 1.5 points in the control group in the FIM motor score transformed using Rasch analysis . The change from time 0 to 3 mo was significant in the treated group but not in the controls . Treated patients maintained their gains at the 9-mo follow-up , and controls lost ground . The treated group improved in terms of socialization and self-esteem as evidence d by a lower Sickness Impact Profile , whereas the controls tended to get worse . There was a trend toward less depression , but this did not reach a P = 0.05 level of significance . This study demonstrates that significant functional gains can still be attained in the postacute stroke survivor , despite prior inpatient rehabilitation services BACKGROUND AND PURPOSE Of all stroke survivors , 30 % to 66 % are unable to use their affected arm in performing activities of daily living . Although forced use therapy appears to improve arm function in chronic stroke patients , there is no conclusive evidence . This study evaluates the effectiveness of forced use therapy . METHODS In an observer-blinded r and omized clinical trial , 66 chronic stroke patients were allocated to either forced use therapy ( immobilization of the unaffected arm combined with intensive training ) or a reference therapy of equally intensive bimanual training , based on Neuro-Developmental Treatment , for a period of 2 weeks . Outcomes were evaluated on the basis of the Rehabilitation Activities Profile ( activities ) , the Action Research Arm ( ARA ) test ( dexterity ) , the upper extremity section of the Fugl-Meyer Assessment scale , the Motor Activity Log ( MAL ) , and a Problem Score . The minimal clinical ly important difference ( MCID ) was determined at the onset of the study . RESULTS One week after the last treatment session , a significant difference in effectiveness in favor of the forced use group compared with the bimanual group ( corrected for baseline differences ) was found for the ARA score ( 3.0 points ; 95 % CI , 1.3 to 4.8 ; MCID , 5.7 points ) and the MAL amount of use score ( 0.52 points ; 95 % CI , 0.11 to 0.93 ; MCID , 0.50 ) . The other parameters revealed no significant differential effects . One-year follow-up effects were observed only for the ARA . The differences in treatment effect for the ARA and the MAL amount of use scores were clinical ly relevant for patients with sensory disorders and hemineglect , respectively . CONCLUSIONS The present study showed a small but lasting effect of forced use therapy on the dexterity of the affected arm ( ARA ) and a temporary clinical ly relevant effect on the amount of use of the affected arm during activities of daily living ( MAL amount of use ) . The effect of forced use therapy was clinical ly relevant in the subgroups of patients with sensory disorders and hemineglect , respectively BACKGROUND AND PURPOSE Gait rehabilitation in patients with severe hemiplegia requires substantial effort . Preliminary studies indicate potential beneficial effects of using multichannel functional electrical stimulation ( MFES ) for gait rehabilitation in these patients . In this study , a new method of gait rehabilitation for nonambulatory patients with hemiplegia by means of MFES added to conventional therapy was introduced . The results of the method 's application were evaluated by comparing it with conventional therapeutic methods . SUBJECTS The proposed rehabilitation method was tested on a group of 20 patients with severe hemiplegia secondary to cerebrovascular accident . Subjects were r and omly assigned to one of two groups . One group received 3 weeks of MFES followed by 3 weeks of conventional therapy . The other group received 3 weeks of conventional therapy followed by 3 weeks of MFES . METHODS The effects of each therapeutic method were evaluated by measurements of temporal-distance variables and ground reaction forces and by assessment of each subject 's physical status according to the Fugl-Meyer evaluation scale . RESULTS There was improved performance of the subjects during MFES combined with conventional therapy as compared with conventional therapy alone . CONCLUSION AND DISCUSSION The superiority of the MFES method as compared with conventional therapy was mainly attributed to the enhanced motor learning accomplished by application of MFES . These results , however , are preliminary , and further research is needed Electromyographic biofeedback was compared with simple exercise therapy as to its effectiveness in improving  foot-drop in 22 stroke patients . The study was design ed to be a rigorous trial of biofeedback and the patients tested were aged and had stroke of long duration . One group of 11 patients underwent 6 weeks of exercise therapy 2 sessions per week for 15 minutes per session ; the 2nd group of 11 patients underwent similar therapy with EMG feedback . All therapy was conducted by a research assistant who was not a trained therapist . The groups were assessed blind before treatment , after treatment and a 6-week follow-up . The significantly greater improvements in the biofeedback group in terms of muscle strength at the end of treatment were maintained at follow-up . On the range of movement and gait analysis measures , both groups showed some improvement after treatment . However , at follow-up this improvement had relapsed for the exercise group while for the biofeedback group it had been maintained . It is argued that controlled trials are possible in biofeedback and that using patients as their own controls is not justified in view of the present findings and the previously reported literature A long-term , comparison-group outcome trial with a partial crossover design was carried out on the effects of  electromyographic biofeedback ( EMGBF ) plus physiotherapy ( PT ) versus PT alone in the treatment of the hemiplegic upper limb in stroke patients who were at least six months beyond the onset of their disability . Both the experimental and the control groups benefited from their treatment , but EMGBF was shown to have an additional effect , both in the experimental patients , and in the control patients when they switched over to the experimental treatment condition The purpose of this study was to investigate , in a sample of patients with hemiparesis secondary to cerebrovascular accident , the relationship between the ratio of stimulus on time to off time and muscle fatigue using a commercial electrical stimulation unit . An experimental model was used to test the hypothesis that the smaller the stimulus off time relative to stimulus on time , the greater will be the muscle fatigue over time . The wrist extensor muscles of 18 patients with hemiparesis were stimulated electrically , and isometric force output was recorded continuously using an adapted strain gauge-recorder apparatus . For each testing session , peak on time of the electrical stimulus was set at 5 seconds , and off time was set at 5 , 15 , or 25 seconds . Six r and omly assigned treatment groups participated in three separate treatment sessions in a different order at 48-hour intervals . Treatment sessions were continued either until wrist extensor muscle force output decreased to 50 % of its initial value or for a maximum of 30 minutes . Data analysis revealed that significant differences in muscle tension developed among all duty cycles ( p less than .01 ) . Duty-cycle ratios of 1:1 , 1:3 , and 1:5 were shown to be progressively less fatiguing . Within the limits of this investigation , the 1:5 duty-cycle ratio was determined to be the best suited for initial use in programs of prolonged stimulation to the wrist extensor muscles of patients with hemiparesis . The hypothesis was accepted that the smaller the stimulus off time ( rest interval ) with respect to the stimulus on time , the greater will be the muscle fatigue over time Abstract Objective : To establish if a brief programme of domiciliary occupational therapy could improve the recovery of  patients with stroke discharged from hospital . Design : Single blind r and omised controlled trial . Setting : Two hospital sites within a UK teaching hospital . Subjects : 138 patients with stroke with a definite plan for discharge home from hospital . Intervention : Six week domiciliary occupational therapy or routine follow up . Main outcome measures : Nottingham extended activities of daily living score and “ global outcome ” ( deterioration according to the Barthel activities of daily living index , or death ) . Results : By eight weeks the mean Nottingham extended activities of daily living score in the intervention group was 4.8 points ( 95 % confidence interval −0.5 to 10.0 , P=0.08 ) greater than that of the control group . Overall , 16 ( 24 % ) intervention patients had a poor global outcome compared with 30 ( 42 % ) control patients ( odds ratio 0.43 , 0.21 to 0.89 , P=0.02 ) . These patterns persisted at six months but were not statistically significant . Patients in the intervention group were more likely to report satisfaction with a range of aspects of services . Conclusion : The functional outcome and satisfaction of patients with stroke can be improved by a brief occupational therapy programme carried out in the patient 's home immediately after discharge . Major benefits may not , however , be sustained OBJECTIVE To evaluate and compare the effects of 3-hour versus 6-hour daily training sessions in constraint-induced movement therapy ( CIMT ) . DESIGN Intervention study , 2-group r and omized trial ; baseline , pretreatment , and posttreatment measures ; 1-month follow-up ( weekly measures ) . SETTING University department of psychology in Germany . PARTICIPANTS A convenience sample of 15 adults with chronic hemiparesis ( 13 stroke , 2 traumatic brain injury ) . INTERVENTION CIMT ( 14 consecutive days ; constraint of unaffected h and for a target of 90 % of waking hours ) with either 6 hours ( 6h/d group , n=7 ) or 3 hours ( 3h/d group , n=8 ) of shaping training with the affected h and per day . MAIN OUTCOME MEASURES The Motor Activity Log and Wolf Motor Function Test . RESULTS Significant improvements in motor function in the laboratory and increased use of the affected h and in the real-world environment were found in both groups . The beneficial effects were significantly greater in the 6h/d group than in the 3h/d group . CONCLUSION The 3-hour CIMT training schedule significantly improved motor function in chronic hemiparesis , but it was less effective than the 6-hour training schedule Of 1094 patients with a confirmed stroke admitted to Northwick Park , a district general hospital , 364 ( 33 % ) died while in hospital , 215 ( 20 % ) were fully recovered when discharged , and 329 ( 30 % ) were too frail or too ill from diseases other than stroke to be considered for active rehabilitation . Only 121 ( 11 % ) were suitable for intensive treatment .  They and 12 patients referred direct to out patients were allocated at r and om to one of three different courses of rehabilitation . Intensive was compared with conventional rehabilitation and with a third regimen which included no routine rehabilitation , but under which patients were encouraged to continue with exercises taught while in hospital and were regularly seen at home by a health visitor .  Progress at three months and 12 months was measured by an index of activities of daily living . Improvement was greatest in those receiving intensive treatment , intermediate in those receiving conventional treatment , and least in those receiving no routine treatment .  Decreasing intensity of treatment was associated with a significant increase in the proportions of patients who deteriorated and in the extent to which they deteriorated . Probably only a few stroke patients , mostly men , are suitable for  intensive outpatient rehabilitation  , but for those patients the treatment is effective and realistic BACKGROUND Face-to-face assessment of research outcomes is expensive and may introduce bias . Postal question naires offer a cheaper alternative which avoids observer bias , but non-response and incomplete response reduce the effective sample size and may be equally serious sources of bias . This study examines the extent and potential effects of missing data in the postal collection of outcomes for a large rehabilitation trial . METHODS Question naires containing a number of established scales were posted to participants in a trial of occupational therapy after stroke . Response was maximized by telephone and postal reminders , and incomplete question naires were followed up by telephone .  Scale scores obtained by imputing values to question naire items missing on return were compared with those achieved by telephone follow-up . FINDINGS Response to the initial posting was 60 % , rising to 85 % after reminders . Participants receiving the experimental treatment were more likely to respond without a reminder . There were no significant differences on any known factors between eventual responders and non-responders . Of the question naires , 43 % were incomplete on return : partial responders were significantly different to complete responders on baseline disability and home circumstances . Of the incomplete question naires , 71 % were resolved by telephone follow-up . In these , the scale scores achieved by telephone were generally higher than those derived by conventional imputation . CONCLUSION Postal outcome assessment achieved a good response rate , but considerable effort was needed to minimize non-response and incomplete response , both of which could have been serious sources of bias BACKGROUND AND PURPOSE After stroke , the ability to balance in sitting is critical to independence . Although impairments in sitting balance are common , little is known about the effectiveness of rehabilitation strategies design ed to improve it . The purpose of this r and omized placebo-controlled study was to evaluate the effect of a 2-week task-related training program aim ed at increasing distance reached and the contribution of the affected lower leg to support and balance . METHODS Twenty subjects at least 1 year after stroke were r and omized into an experimental or control group . The experimental group participated in a st and ardized training program involving practice of reaching beyond arm 's length . The control group received sham training involving completion of cognitive-manipulative tasks within arm 's length .  Performance of reaching in sitting was measured before and after training using electromyography , videotaping , and two force plates . Variables tested were movement time , distance reached , vertical ground reaction forces through the feet , and muscle activity . Subjects were also tested on sit-to-st and , walking , and cognitive tasks .  Nineteen subjects completed the study . RESULTS After training , experimental subjects were able to reach faster and further , increase load through the affected foot , and increase activation of affected leg muscles compared with the control group ( P < .01 ) . The experimental group also improved in sit-to-st and . The control group did not improve in reaching or sit-to-st and . Neither group improved in walking . CONCLUSIONS This study provides strong evidence of the efficacy of task-related motor training in improving the ability to balance during seated reaching activities after stroke Electromyographic biofeedback has been used with some success to treat patients with disturbances of muscle tone result ing from neurological disease . The aim of this study was to incorporate electrical myofeedback as an integral part of a physiotherapeutic regime design ed to improve quality of movement and function in limbs weakened or paralysed by stroke . A portable , inexpensive E. M. G. biofeedback machine was used . Stainless steel skin electrodes were applied which needed minimal skin preparation . Twelve adults , ( five male , seven female , mean age 44.2 years and 51.3 years respectively ) who were referred for treatment due to weakness of limb muscles due to disease of the brain or spinal cord , were treated . The mean time from onset of incidence to treatment was 75.5 days . Each patient received six weeks of treatment . This was divided into two phases . Phase 1 , ( weeks 1 , 2 , 3 ) and phase 2 ( weeks 4 , 5 , 6 ) . Physiotherapy , and physiotherapy with biofeedback was r and omly allocated to either phase . Each patient acted as his/her own control . A vali date d assessment was carried out by an independent therapist at the start of treatment , after three weeks and after six weeks of treatment . General function , knee function , range of movement of the affected side and timed tests were measured . Results show an overall improvement in general function . The second phase of treatment was slightly more favourable to improvement , but there was no indication that biofeedback significantly improved the outcome . In three tests it was equally significant to the physiotherapy applied ; in one test it improved the effectiveness of physiotherapy and in one test it reduced the effectiveness of physiotherapy . This suggests that a six week course of physiotherapy improved muscular function and range of movements in patients with weakness due to upper motor neurone disease , but that these effects are not enhanced by myofeedback Objective : To measure the effect of the Odstock Dropped Foot Stimulator ( ODFS ) , a common peroneal stimulator , on the effort and speed of walking . Design : A r and omized controlled trial . Subjects : Hemiplegic patients who had suffered a single stroke at least six months prior to the start of the trial whose walking was impaired by a drop-foot . Interventions : The treatment , functional electrical stimulation ( FES ) group , used the stimulator and received a course of physiotherapy ; the control group received physiotherapy alone . Main outcome measures : Changes in walking speed measured over 10 m and the effort of walking measured by physiological cost index ( PCI ) . Results : Thirty-two subjects completed the trial , 16 in the FES group and 16 in the control group .  Mean increase in walking speed between the beginning and end of the trial was 20.5 % in the FES group ( when the stimulator was used ) , and 5.2 % in the control group . Improvement was also measured in PCI with a reduction of 24.9 % in the FES group ( when the stimulator was used ) and 1 % in the control group . No improvement in these parameters was measured in the FES group when the stimulator was not used . Conclusion : Walking was statistically significantly improved when the ODFS was worn but no ' carry-over ' was measured . Physiotherapy alone , in this group of subjects with established stroke , did not improve walking OBJECTIVE To evaluate the efficacy of intermittent pneumatic compression in treating oedema in the hemiplegic h and of stroke patients . DESIGN Single-blind r and omized control trial . SETTING acute and rehabilitation elderly care wards in a teaching district . SUBJECTS 37 Subjects with a first ever hemisphere stroke were r and omized to treatment with st and ard physiotherapy either alone or combined with intermittent pneumatic compression . MAIN OUTCOME MEASURES The effect of treatment on oedema was assessed using measures of the h and volume of the hemiplegic h and . The impact on function was assessed using the motricity index . RESULTS The treated group showed no change in the mean stroke h and volume . In the control group the mean stroke h and volume decreased by 3.2 ml . There was no statistically significant difference between the groups . The median scores for the motricity index increased for both groups but there was no significant difference between the groups and any improvement in motor function was independent of any treatment effects . CONCLUSION Intermittent pneumatic compression at the prescribed pressure and duration of this study is not an effective treatment for the oedematous stroke h and Two treatment modalities for increasing active elbow extension with hemiplegic subjects were tested . Twenty subjects were r and omly assigned to one of two treatment groups -- an experimental treatment technique using kinesthetic biofeedback , or a control group consisting of an occupational therapy approach aim ed at increasing functional use of the envolved upper extremity . The results indicate that kinesthetic biofeedback was as beneficial as conventional occupational therapy . It was also demonstrated that an individual 's age , sex , or length of time beyond one-year post-CVA did not significantly affect treatment outcome . A majority of subjects in both treatment groups improved in ways not directly related to treatment , which suggests the need for long-term follow up of hemiplegic patients Positional feedback stimulation training and cyclical electrical stimulation were used in combination as a treatment for facilitating knee extension in hemiparetic patients . Forty adult hemiparetic patients who demonstrated minimal active control of their quadriceps femoris muscles were r and omly assigned to control or study groups . The control patients received a program of physical therapy , and the study patients received the positional feedback stimulation training in addition to their therapy program . The stimulation training provided the patient with immediate auditory and visual feedback of his changing joint angle while he voluntarily extended his knee . When the patient reached a near maximal extension effort , electrical stimulation of the quadriceps femoris muscle was automatically triggered , completing the patient 's available range of motion in extension . The stimulation training was supplemented with two hours of cyclical electrical stimulation daily . At the end of four weeks , analysis revealed a statistically significant increase in knee extension torque and active synergistic range of motion in the study group . No change was noted in their ability to extend their knees using isolated quadriceps femoris muscle control . This study suggests that positional feedback stimulation training is effective when used to augment a facilitation program for improving knee extension control in hemiparetic patients OBJECTIVE To assess the efficacy of electromyogram (EMG)-triggered neuromuscular stimulation ( EMG-stim ) in enhancing upper extremity motor and functional recovery of acute stroke survivors . DESIGN A pilot r and omized , single-blinded clinical trial . SETTING Freest and ing inpatient rehabilitation facility . PATIENTS Nine subjects who were within 6 weeks of their first unifocal , nonhemorrhagic stroke were r and omly assigned to either the EMG-stim ( n = 4 ) or control ( n = 5 ) group . All subjects had a detectable EMG signal ( > 5 microV ) from the surface of the paretic extensor carpi radialis and voluntary wrist extension in synergy or in isolation with muscle grade of < 3/5 . INTERVENTION All subjects received two 30-minute sessions per day of wrist strengthening exercises with EMG-stim ( experimental ) or without ( control ) for the duration of their rehabilitation stay . MAIN OUTCOME MEASURES Upper extremity Fugl-Meyer motor assessment and the feeding , grooming , and upper body dressing items of the Functional Independence Measure ( FIM ) were assessed at study entry and at discharge . RESULTS Subjects treated with EMG-stim exhibited significantly greater gains in Fugl-Meyer ( 27.0 vs 10.4 ; p = .05 ) , and FIM ( 6.0 vs 3.4 ; p = .02 ) scores compared with controls . CONCLUSION Data suggest that EMG-stim enhances the arm function of acute stroke survivors One of the causes for shoulder pain associated with hemiplegia is thought to be vigorous range of motion to the involved upper extremity . The objective of this study was to analyze the occurrence of pain in patients treated with one of the three exercise programs commonly used in the rehabilitation of hemiplegia : 1 ) range of motion by the therapist , 2 ) skate board and 3 ) overhead pulley . Of the 48 hemiplegic patients evaluated , 28 were assigned to one of the three exercise groups . Comparing the number of patients who developed pain in each group , there was a significant difference , with 8 % of the patients in the range of motion by the therapist group , 12 % of the patients in the skate board group and 62 % of the patients in the overhead pulley group developing pain ( x2=8.44 ) ( P=0.014 ) . The three groups did not differ in the side of involvement ( P=0.57 ) , extent of hemiplegia ( P=0.25 ) or presence of subluxation ( P=0.84 ) . Use of overhead pulley has the highest risk of developing shoulder pain and should be avoided during rehabilitation of stroke patients Objective : To evaluate the effects of leisure therapy and conventional occupational therapy ( OT ) on the mood , leisure participation and independence in activities of daily living ( ADL ) of stroke patients 6 and 12 months after hospital discharge . Design : Multicentre r and omized controlled trial . Setting and participants : Four hundred and sixty-six stroke patients from five UK centres . Main outcome measures : The General Health Question naire ( 12 item ) , the Nottingham Extended ADL Scale and the Nottingham Leisure Question naire , assessed by post  , with  telephone clarification . Results : Four hundred and forty ( 94 % ) and 426 ( 91 % ) subjects were alive at 6 and 12 months , respectively . Three hundred and seventy-four ( 85 % of survivors ) and 311 ( 78 % of survivors ) responded at 6 and 12 month follow-up respectively . At six months and compared to the control group , those allocated to leisure therapy had nonsignificantly better GHQ scores ( –1.2 : 95 % CI –2.9 , + 0.5 ) , leisure scores ( + 0.7 , 95 % CI –1.1 , + 2.5 ) and Extended ADL scores ( + 0.4 : 95 % CI –3.8 , + 4.5 ) : the ADL group had nonsignificantly better GHQ scores ( –0.1 : 95 % CI –1.8 , + 1.7 ) and Extended ADL scores ( + 1.4 : 95 % CI –2.9 , + 5.6 ) and nonsignificantly worse leisure scores ( –0.3 : 95 % CI –2.1 , + 1.6 ) . The results at 12 months were similar . Conclusion : In contrast to the findings of previous smaller trials , neither of the additional OT treatments showed a clear beneficial effect on mood , leisure activity or independence in ADL measured at 6 or 12 months BACKGROUND Patients who have a stroke are not always admitted to hospital , and 22 - 60 % remain in the community , frequently without coordinated rehabilitation . We aim ed to assess the efficacy of an occupational therapy intervention for patients with stroke who were not admitted to hospital . METHODS In this single-blind r and omised controlled trial , consecutive stroke patients on a UK community register in Nottingham and Derbyshire were allocated r and omly to up to 5 months of occupational therapy at home or to no intervention ( control group ) 1 month after their stroke . The aim of the occupational therapy was to encourage independence in personal and instrumental activities of daily living . Patients were assessed on outcome measures at baseline ( before r and omisation ) and at 6 months . The primary outcome measure was the score on the extended activities of daily living ( EADL ) scale at 6 months . Other outcome measures included the Barthel index , the general health question naire 28 , the carer strain index , and the London h and icap scale . All assessment s were done by an independent assessor who was unaware of treatment allocation . The analysis included only data from completed question naires . FINDINGS 185 patients were included : 94 in the occupational therapy group and 91 in the control group . 22 patients were not assessed at 6 months . At follow-up , patients who had occupational therapy had significantly higher median scores than the controls on : the EADL scale ( 16 vs 12 , p<0.01 , estimated difference 3 [ 95 % CI 1 to 4 ] ) ; the Barthel index ( 20 vs 18 , p<0.01 , difference 1 , [ 0 - 1 ] ) ; the carer strain index ( 1 vs 3 , p<0.05 , difference 1 [ 0 to 2 ] ) ; and the London h and icap scale ( 76 vs 65 , p<0.05 , difference 7 , [ 0.3 to 13.5 ] ) . There were no significant differences on the general health question naire between the patient or carer . INTERPRETATION Occupational therapy significantly reduced disability and h and icap in patients with stroke who were not admitted to hospital The use of audiovisual displays of myoelectric potentials ( myofeedback ) has been suggested for retraining and strengthening of paretic muscles in patients with hemiplegia from stroke . This controlled study examines the specificity and efficiency of myofeedback in the strengthening of paretic muscles in hemiplegic patients . Eighteen patients with trace to fair-minus grade of deltoid muscle power result ing from strokes that had occurred at least six weeks earlier were r and omly assigned to the six possible orders of accurate ( true ) , positive noncontingent ( placebo ) and no feedback conditions . On three successive days , each patient received one session of each feedback condition , consisting of 20 isometric contractions of five seconds each with ten seconds of intervening rests . In addition , each patient 's motivational level was rated . Averaged myoelectric potentials were quantified for each contraction for analysis . When the data were analyzed without grouping , no statistical differences among the three feedback conditions were noted . However , when the subjects were grouped according to age and motivational level , during true and no feedback sessions , the older and the poorly motivated groups were found to show progressive increment of myoelectric output , whereas the younger and the better motivated showed the opposite results . With placebo feedback , both groups showed progressive decrement of myoelectric output . It is concluded that the effect of myofeedback is nonspecific at least in its short-term application for the retraining of hemiplegically paretic muscles A computer-assisted feedback system was developed to present to walking subjects instantaneous feedback of their muscle activity or joint angular excursions during gait . Targets for muscle activity or joint motion were displayed on the feedback screen along with timing cues that prompted muscle activity or joint flexion/extension at specific times during the gait cycle . The purpose was to compare the effectiveness of joint angle and electromyographic ( EMG ) feedback to a focused program of physical therapy for gait . Eight hemiplegic stroke patients were treated with ankle joint angle feedback , EMG biofeedback from the soleus muscle , and conventional physical therapy for gait in a three-period crossover design . PT was given either first or last in the sequence of treatments . Gait analysis prior to and following each type of treatment revealed that the feedback treatments result ed in significant increases in stride length and walking velocity and in positive changes in push-off impulse , gait symmetry , and st and ing weight-bearing symmetry , as evaluated in a general linear model and paired t-tests . Overall , physical therapy produced no significant changes . However , when physical therapy was the first treatment of the sequence , significant increases in stride length and velocity were observed . When physical therapy was last , there were significant negative changes in gait symmetry and st and ing weight-bearing symmetry , and negative trends in stride length , walking velocity , and push-off impulse . It is concluded that computer-assisted feedback is an effective tool for retraining gait in stroke patients OBJECTIVE --To determine whether the intervention of a physiotherapist improved mobility in patients seen more than one year after stroke . DESIGN --R and omised crossover trial comparing two groups offered intervention by a physiotherapist , one immediately after entry into the trial and the other after a delay of three months . The intervention consisted of identifying problems and offering advice and help to solve the problems . SETTING -- Patients ' homes in Oxfordshire . SUBJECTS-- Patients who had reduced mobility due to a stroke more than one year before entry ; 60 were recruited from a community stroke register and 34 in other ways . MAIN OUTCOME MEASURES --St and ard measures of mobility including gait speed , functional ambulation categories , the Nottingham extended activities of daily living index , and individual items from the Barthel activities of daily living index and the Frenchay activities index . Measures of manual dexterity , depression , and anxiety were used as controls . RESULTS --94 patients entered the trial and 49 were r and omised to immediate and 45 to delayed physiotherapy ; 89 were compared at the crossover point . At r and omisation the two groups were comparable . At three months the group given early therapy showed an improvement in gait speed whereas the untreated group had declined ( differences of -3.9 v 6.4 s to walk 10 m ; p less than 0.01 ) ; between three and six months the group given delayed therapy showed improvement and the previously treated group declined ( differences of 6.5 v -3.9 s to walk 10 m ; p less than 0.01 ) . A 9 % ( 95 % confidence interval 0 % to 18 % ) decrease in time taken to walk 10 m was associated with treatment and a 12 % ( 2 % to 19 % ) increase when patients were untreated . Other measures did not change significantly . CONCLUSION --Intervention of an experienced physiotherapist late after stroke specifically improves mobility , albeit by a small amount , but the effects do not seem to be maintained , perhaps because there is an underlying decline in mobility in these patients . Gait speed offers a simple and sensitive measure of outcome Objective : To determine whether stroke patients with initial increases in arm motor recovery following low-frequency transcutaneous electrical nerve stimulation ( low TENS ) treatment go on to show long-term benefits . Also whether the same therapy results in long-term improvements in motor function , spasticity or activities of daily living ( ADL ) . Design : A three-year follow-up study . Subjects : Twenty-eight stroke patients , who had participated in a r and omized trial of daily treatment with low-frequency ( 1.7 Hz ) transcutaneous electrical nerve stimulation ( low TENS ) on the paretic arm for three months starting 6–12 months after stroke . Outcomes : Fugl-Meyer Motor Performance Scale for evaluation of changes in arm motor function . A 6-point Ashworth Scale to measure spasticity . Barthel Index to evaluate performance in ADL . Results : Motor function of the paretic arm had deteriorated in both treatment and control groups . Increased spasticity was seen in both groups . ADL score remained at a similar level in the low TENS group , whereas the control group had deteriorated during the same time period . Conclusions : Low TENS stimulation started 6–12 months after stroke may not have a specific effect on arm motor function years after completion of treatment The study examined the efficacy of functional electric stimulation ( FES ) and biofeedback ( BFB ) treatment of gait dysfunction in patients with hemiplegia after stroke . These two therapeutic modalities were tested alone and in combination in a prospect i ve , controlled , r and omized trial . The authors hypothesized that in concurrent use , these two modalities would complement one another . Thirty-six hemiplegic patients undergoing rehabilitation after stroke were accepted for study and r and omized into four groups to receive either control , FES , BFB , or combined therapies . Each patient received 30 minutes of treatment three times per week for six weeks , in addition to their general rehabilitation program . Quantitative gait analysis was performed biweekly on each subject during the experimental therapy and for four weeks afterward . Thirty-two subjects completed the study . Combined therapy with BFB and FES result ed in improvements in both knee and ankle minimum flexion angles during swing phase that were statistically significant with p = 0.05 and p = 0.02 , respectively . Velocity of gait , cycle time , and symmetry of stance phases also improved . The length of time elapsed since the stroke did not prove to be a significant factor BACKGROUND AND PURPOSE Visual biofeedback/forceplate systems are often used for treatment of balance disorders . In this study , the research ers investigated whether the addition of visual biofeedback/forceplate training could enhance the effects of other physical therapy interventions on balance and mobility following stroke . SUBJECTS The study included a sample of convenience of 13 out patients with hemiplegia who ranged in age from 30 to 77 years ( mean=60.4 , SD=15.4 ) and were 15 to 538 days poststroke . METHODS Subjects were assigned r and omly to either an experimental group or a control group when the study began , and their cognitive and visual-perceptual skills were tested by a psychologist . Subjects were also assessed using the Berg Balance Scale and the Timed " Up & Go " Test before and after 4 weeks of physical therapy . Both groups received physical therapy interventions design ed to improve balance and mobility 2 to 3 times per week . The experimental group trained on the NeuroCom Balance Master for 15 minutes of each 50-minute treatment session . The control group received other physical therapy for 50 minutes . RESULTS Following intervention , both groups scored higher on the Berg Balance Scale and required less time to perform the Timed " Up & Go " Test . These improvements corresponded to increased independence of balance and mobility in the study population . However , a comparison of mean changes revealed no differences between groups . DISCUSSION AND CONCLUSION Although both groups demonstrated improvement following 4 weeks of physical therapy interventions , no additional effects were found in the group that received visual biofeedback/forceplate training combined with other physical therapy Objective : To discover if the provision of additional  inpatient physiotherapy after stroke speeds the recovery of mobility . Design : A multisite single-blind r and omized controlled trial ( RCT ) comparing the effects of augmented physiotherapy input with normal input on the recovery of mobility after stroke . Setting : Three rehabilitation hospitals in North Glasgow , Scotl and . Subjects : Patients admitted to hospital with a clinical diagnosis of stroke , who were able to tolerate and benefit from mobility rehabilitation .  Intervention : We aim ed to provide double the amount of physiotherapy to the augmented group . Main measures : Primary outcomes were mobility milestones ( ability to st and , step and walk ) , Rivermead Mobility Index ( RMI ) and walking speed . Results : Seventy patients were recruited . The augmented therapy group received more direct contact with a physiotherapist ( 62 versus 35 minutes per weekday ) and were more active ( 8.0 % versus 4.8 % time st and ing or walking ) than normal therapy controls . The augmented group tended to achieve independent walking earlier ( hazard ratio 1.48 , 95 % confidence interval 0.90–2.43 ; p=0.12 ) and had higher Rivermead Mobility Index scores at three months ( mean difference 1.6 ; 0.1 to 3.3 ; p=0.068 ) but these differences did not reach statistical significance . There was no significant difference in any other outcome . Conclusions : A modest augmented physiotherapy programme result ed in patients having more direct physiotherapy time and being more active . The inability to show statistically significant changes in outcome measures could indicate either that this intervention is ineffective or that our study could not detect modest changes Objective : To determine whether strapping the shoulder in hemiplegic stroke patients : ( 1 ) prevents the development , or reduces the severity , of shoulder pain , ( 2 ) preserves range of movement in the shoulder , and ( 3 ) improves the functional outcomes for the arm and patient overall . Design : A prospect i ve , r and omized , single-blind controlled trial of shoulder strapping versus no strapping . Setting : Care of the elderly wards in a teaching hospital , Christchurch , New Zeal and . Subjects : All patients admitted with an acute hemiplegic stroke , who had persisting weakness of shoulder abduction . Intervention : The treatment group had their affected shoulder strapped for six weeks from r and omization in addition to st and ard physiotherapy . Main outcome measures : All subjects were assessed at entry ( week 0 ) , at end of the treatment phase ( week 6 ) and two months later ( week 14 ) . A visual analogue scale ( VAS ) was used to assess shoulder pain severity whereas shoulder range of movement to the point of pain ( SROMP ) assessed passive range of movement and pain . Functional Independence Measure ( FIM ) , Motor Assessment Scale ( MAS ) and Rankin Disability Index measured functional outcomes . Results : Ninety-eight subjects participated ( 49 strapped , 49 controls ) . Intention to treat analysis showed no significant difference in pain , range of movement or functional outcomes after the intervention phase or at the final assessment . However there were trends for less pain at six weeks ( VAS , p = 0.11 ) and better final upper limb function ( MAS , p = 0.16 ) in strapped patients . Skin reactions were uncommon ( 6.1 % ) . The presence of neglect or sensory loss , but not subluxation , at baseline was independently associated with poor outcome . Range of movement was lost early ( mean difference SROMP between hemiplegic and contralateral shoulders at baseline = 15.2 ° ( 95 % CI 10.9–19.5 ) ) and continued throughout the study . Shoulder strapping did not alter the rate at which range of movement was lost . Conclusions : No significant benefit with shoulder strapping was demonstrated and reasons for this are discussed . Range of movement in the hemiplegic shoulder is lost very early and any preventive treatments need to begin within the first 1–2 days after a stroke The effectiveness of biofeedback training was compared to conventional physical therapy training in 20 adult hemiparetic patients with chronic foot-drop . They were r and omly placed into two groups of ten patients each : the first group treated over five weeks with therapeutic exercise and the second group treated over five weeks with therapeutic exercise plus biofeedback training . In the second group receiving the biofeedback training the increase in both strength and range of motion was approximately twice as great as in the first group . The improvement displayed by even the first group of patients suggests that a potential for functional improvement exists that is often unexploited . The addition of biofeedback facilitates the process . Four patients in the biofeedback group achieved and retained conscious control of dorsiflexion ; three of them are now able to walk without the use of the short leg brace The study was design ed to evaluate the effect of electromyographic ( EMG ) biofeedback on the recovery of arm function after stroke . Patients who had impaired arm function and were between 2 and 8 weeks after stroke were r and omly allocated to receive either treatment incorporating EMG biofeedback or a control treatment in addition to their routine physiotherapy . The two groups of 20 patients were compared before and after 6 weeks of treatment and at follow-up 6 weeks later . There were no significant differences between the groups before treatment or at follow-up , but at the end of treatment those who received EMG biofeedback scored significantly higher on tests of arm function .  Patients with severe impairment were shown to benefit most from EMG biofeedback but there was no difference in response to treatment according to patient 's age or side of stroke . Men had higher arm function scores than women before and at the end of treatment , but not at follow-up OBJECTIVE To determine the effectiveness of progressive resistance strengthening exercises to improve gross motor function and walking in patients receiving intensive rehabilitation after stroke . DESIGN R and omized controlled trial . SETTING Five inpatient rehabilitation programs affiliated with teaching hospitals . PARTICIPANTS Inclusion criteria included less than 6 months poststroke and recovery of the leg stages 3 to 5 on the Chedoke-McMaster Stroke Assessment ( CMSA ) . INTERVENTIONS Both groups received conventional physical therapy programs . In addition , the experimental group performed 9 lower-extremity progressive resistance exercises 3 times a week for the duration of their stay , whereas the control group did the same exercises and for the same duration but without resistance . MAIN OUTCOME MEASURES The Disability Inventory of the CMSA and the 2-minute walk test ( 2MWT ) at baseline , 4 weeks , discharge , and 6 months after discharge . RESULTS Over the length of stay , the rate of change in the Disability Inventory was.27 points per day in the experimental group and .29 points per day in the control group ; the between-group difference was -.02 points per day ( 95 % confidence interval [ CI ] , -.10 to.06 ; P=.62 ) . At discharge , the rate of change in the 2MWT was -.01 m in the experimental group and .15 m in the control group ; the between-group difference was -.16 m ( 95 % CI , -.37 to.05 ; P=.14 ) . CONCLUSIONS Progressive resistance strengthening exercises as applied in our study were not effective when compared with the same exercises given without resistance A group of forty-nine hemiparetic patients with limited emotional , communication and sensibility involvement and with recent lesion of cerebrovascular aetiology was r and omly divided into two groups of twenty-four and twenty-five subjects . Both groups received traditional physiotherapy treatment for one hour/day , one group received twenty min/day of peroneal nerve stimulation . The maximum voluntary dorsal flexion moments of the ankle joint of the affected and non affected extremities were measured with an isometric brace twice a week for one month and for both groups . The recovery of moment in the stimulated group turned out to be about three times greater than in the control group and considerably less dependent upon age , time from lesion , initial value , side of lesion . Three patients using a peroneal brace at home as an assisting device were again evaluated two months later and a further improvement was observed . This work gives statistical support to previous observations based on very few cases and provides a statistically reliable answer concerning the entity of FES induced recovery of muscle force in hemiparetic subjects Objective : To demonstrate the effect of rhythmical auditory stimulation in a musical context for gait therapy in hemiparetic stroke patients , when the stimulation is played back measure by measure initiated by the patient 's heel strikes ( musical motor feedback ) . Does this type of musical feedback improve walking more than a less specific gait therapy ? Design : The r and omized controlled trial considered 23 registered stroke patients . Two groups were created by r and omization : the control group received 15 sessions of conventional gait therapy and the test group received 15 therapy sessions with musical motor feedback . Setting : Inpatient rehabilitation hospital . Subjects : Median post-stroke interval was 44 days and the patients were able to walk without technical aids with a speed of approximately 0.71 m/s . Main outcome measures : Gait velocity , step duration , gait symmetry , stride length and foot rollover path length ( heel-on – toe-off distance ) . Result : The test group showed more mean improvement than the control group : stride length increased by 18 % versus 0 % , symmetry deviation decreased by 58 % versus 20 % , walking speed increased by 27 % versus 4 % and rollover path length increased by 28 % versus 11 % . Conclusion : Musical motor feedback improves the stroke patient 's  walk in selected parameters more than conventional gait therapy . A fixed memory in the patient 's mind about the song and its timing may stimulate the improvement of gait even without the presence of an external pacemaker PURPOSE A series of pilot studies were conducted to examine the effects of partial body weight ( PBW ) ambulation in people with chronic stroke . METHODS First , we compared gait characteristics during 3 modes of walking : level ground ambulation ; level ground ambulation with PBW ; and treadmill ambulation with PBW . Second , we examined the effects of repeated PBW treadmill training during level ground ambulation . RESULTS Improved symmetry in stance/swing times and sEMG activity of pre-tibialis and quadriceps muscle groups during PBW either over level ground or on the treadmill occurred in 10 chronic stroke subjects . Increased single limb support and decreased double limb support improved overall gait symmetry during level ground ambulation in 8 subjects following 6 - -8 weeks repeated PBW treadmill training .  Tinetti Balance score also significantly improved . No changes in sEMG were observed . CONCLUSION These results suggest that PBW treadmill may help normalize gait and improve balance in the person with chronic stroke Objective : To determine the efficacy of a modified constraint-induced therapy ( mCIT ) administered to patients with subacute stroke . Design : Prospect i ve , multiple-baseline , before-after , r and omized clinical trial . Setting : Subacute outpatient clinic . Subjects : Fourteen patients with subacute stroke who exhibited learned nonuse and stable motor deficits in their affected upper limbs . Intervention : Four patients participated in half-hour , structured physical and occupational therapy sessions that emphasized affected arm use in valued functional activities , 3 times per week for 10 weeks . Their less affected upper limbs were restrained 5 days per week during 5 hours identified as times of frequent use ( mCIT ) . Five patients received regular therapy ( TR ) with similar therapeutic contact time to mCIT , and 5 patients received no therapy ( CON ) . Main Outcome Measures : The Fugl-Meyer Assessment of Motor Recovery ( Fugl ) , Action Research Arm ( ARA ) test , and Motor Activity Log ( MAL ) . Results : After intervention , Fugl , ARA , and MAL scores remained virtually the same for TR and CON groups ; scores improved by 11.4 and 11.5 points , respectively , on the Fugl and ARA for the mCIT group . Amount and quality of arm use , as measured by the MAL , also improved for mCIT patients ( 2.49 and 0.47 , respectively ) . Conclusions : mCIT may be an efficacious method of improving affected arm function and use in stroke patients exhibiting learned nonuse BACKGROUND AND PURPOSE The effects of different duration s of rehabilitation sessions for the upper extremities ( UEs ) and lower extremities ( LEs ) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated . SUBJECTS AND METHODS Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with ( 1 ) an emphasis on the LEs , ( 2 ) an emphasis on the paretic UE , or ( 3 ) a condition in which the paretic arm ( UE ) and leg ( LE ) were immobilized with an inflatable pressure splint ( control treatment ) . The 3 treatment regimens were applied for 30 minutes , 5 days a week , during the first 20 weeks after onset of stroke . All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 11/2-hour session of training in activities of daily living . A repeated- measures design was used . Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds . In addition , mean continuous relative phase ( CRP ) between paretic arm and leg ( PAL ) movements and nonparetic arm and leg ( NAL ) movements and st and ard deviations of CRP of both limb pairs as a measurement of stability ( variability ) were evaluated . RESULTS Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment . No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the st and ard deviation of CRP of both limb pairs . DISCUSSION AND CONCLUSION With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions , no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found . Increasing walking speed , however , result ed in a larger mean CRP for both limb pairs , with increased stability and asymmetry of walking , indicating that walking speed influences interlimb coordination in hemiplegic gait Objective : It is uncertain whether self-propulsion in a wheelchair should be encouraged or discouraged in the early stages of stroke rehabilitation . Design : A two-centre pilot study to assess the feasibility of performing a multicentre r and omized controlled trial on this subject . Setting : Clatterbridge and Aintree Stroke Rehabilitation Units , Merseyside , UK . Subjects : Forty early stroke patients ( mean age 67 years ) in whom it was uncertain whether self-propulsion in a wheelchair should be encouraged were studied . Intervention : A central r and omization service at Newcastle University was used to determine the policy about wheelchair provision and use for each patient . They were allocated to either an ‘ encouraged to self-propel ’ or a ‘ discouraged from self-propulsion group ’ . Outcome measures used : Independent outcome assessment was performed by postal question naire and telephone interview using the Barthel ADL Scale , Nottingham Extended ADL Scales and the shortened General Health Question naire ( GHQ-12 ) at 3 and 12 months . Patient 's length of stay and their Ashworth tone score were also measured either at three months or when they were discharged from hospital . Results : After considerable preparation time it was possible to conduct a trial on self-propulsion in early stroke rehabilitation in the two-pilot centres . No major differences were found between the pilot groups for any of the outcome measures . Conclusions : A multicentre r and omized controlled trial to assess this question is feasible but further work is being conducted before proceeding , to satisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures . Address for correspondence : JA Barrett , Clatterbridge Hospital , Wirral , Merseyside CH69 4JY , UK . e-mail : Objective : To explore the effects of weighted garments on the balance and gait of stroke patients . Design : A pilot r and omized controlled study with blinded measurement . Setting : Weighted garments were worn by patients living in the community and measurement was made in a hospital-based gait laboratory . Subjects : Twenty-four adults who were at least six months post stroke and were able to walk 10 metres with or without assistance or a walking aid . Intervention : The six-week treatment-phase subjects were given a set of weighted garments which they were shown how to apply and instructed to wear on their paretic side . Subjects r and omly allocated to the six-week control phase were not given any weighted garments . Main outcome measures : Balance was measured with the Berg Balance Scale . Gait was measured using GaitMat II , an instrumented walkway . Gait parameters of interest were velocity and symmetry of : step length ; single support time ; double support time ; and support base width . Measures were made at baseline before r and omization ( baseline ) and at the end of the six weeks of intervention ( outcome ) . Results : No statistically significant differences were found between the treatment and control groups at outcome for balance ( Mann – Whitney U-test ; p = 0.74 ) , gait velocity ( p = 0.68 ) or symmetry of gait parameters ( p = 0.33 to p = 0.75 ) . Conclusions : We found no evidence to support the clinical use of these weighted garments for stroke survivors The effectiveness of  biofeedback therapy , using the electromyograph , was compared with conventional physiotherapy treatments in eleven hemiparetic patients with severe disability of the upper limb . These were divided r and omly into two groups , a group of six patients receiving biofeedback treatments and five receiving physiotherapy treatments with conventional techniques . The results showed greater improvements in the biofeedback group in most fields of testing , and the patients in this group had a greater degree of control over the patterns of movement in the upper limb and the relaxation of spastic muscle groups . It was concluded that a wide range of hemiparetic patients should benefit in some degree by treatment of this form Functional electrical stimulation ( FES ) may improve recovery  after stroke . We studied its effects in 38 postcerebral infa rct patients . Twenty were r and omly assigned to receive FES producing ankle dorsiflexion on the affected side and physical therapy . The remaining 18 received physical therapy only . Subjects were evaluated prior to commencing therapy , at its completion after 4 weeks , and again 4 weeks later using functional and electrophysiological measures . Functional deficit in most patients improved ( p < 0.01 ) . Although no significant differences were observed when those treated with FES and those not treated were compared at 4 and 8 weeks , there was significant improvement in the rate of recovery using an ambulation score ( p < 0.05 ) , and there was a similar trend in the Barthel Index for FES-treated patients ( p < 0.1 ) . Our results indicate that FES may confer additional benefit in acute stroke rehabilitation . Further studies are needed to delineate how best to use it
Objective : To determine the evidence for physical therapy interventions aim ed at improving functional outcome  after stroke .