A study on additional early physiotherapy after stroke and factors affecting functional recovery Randomized clinical trial of therapeutic exercise in subacute stroke. Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial Exercise to Enhance Mobility and Prevent Falls After Stroke Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial A six-week, resource-efficient mobility program after discharge from rehabilitation improves standing in people affected by stroke: placebo-controlled, randomised trial. Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. A prospective, randomized, single-blinded trial on the effect of early rehabilitation on daily activities and motor function of patients with hemorrhagic stroke Additional Exercises Improve Trunk Performance After Stroke: A Pilot Randomized Controlled Trial Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial. A community-based group exercise program for persons with chronic stroke. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Efficacy of Functional Strength Training on Restoration of Lower-Limb Motor Function Early After Stroke: Phase I Randomized Controlled Trial Rehabilitation of Balance After Stroke With Multisensorial Training: A Single-Blind Randomized Controlled Study Does functional strength training of the leg in subacute stroke improve physical performance? A pilot randomized controlled trial Combined analysis of two randomized trials of community physiotherapy for patients more than one year post stroke [Effects of three-stage rehabilitation treatment on acute cerebrovascular diseases: a prospective, randomized, controlled, multicenter study]. An effectiveness study comparing acupuncture, physiotherapy, and their combination in poststroke rehabilitation: a multicentered, randomized, controlled clinical trial. Training symmetry of weight distribution after stroke: a randomized controlled pilot study comparing task-related reach, Bo bath and feedback training approaches The relation between impairments and functional outcomes poststroke. [Effects of standardized three-stage rehabilitation on recovery of neurological function in stroke patients with hemiplegia]. The Role of Technology in Task-Oriented Training in Persons with Subacute Stroke: A Randomized Controlled Trial [Clinical study of standardized tertiary rehabilitation program in promoting upper and lower limbs motor function in stroke patients]. [Effects of early rehabilitation on activities of daily living and complications in acute stroke patients]. Motor relearning programme for stroke patients: a randomized controlled trial Can physiotherapy after stroke based on the Bobath concept result in improved quality of movement compared to the motor relearning programme. Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico. The Festivals Trial Protocol: A Randomized Evaluation of the Efficacy of Functional Strength Training on Enhancing Walking and Upper Limb Function Later Post Stroke Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study Bobath or Motor Relearning Programme? A follow-up one and four years post stroke Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. Physiotherapy intervention late after stroke and mobility. Lateral weight transference exercises following acute stroke: a preliminary study of clinical effectiveness Preliminary study of the effect of low-intensity home-based physical therapy in chronic stroke patients. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials Development of a behavioral test of visuospatial neglect. Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Comparing stroke rehabilitation outcomes between acute inpatient and nonintense home settings. Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation Bobath or Motor Relearning Programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study Effects of isokinetic strength training on walking in persons with stroke: a double-blind controlled pilot study. The effect of independent practice of motor tasks by stroke patients: a pilot randomized controlled trial Task-specific physical therapy for optimization of gait recovery in acute stroke patients. Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait. Does physiotherapy based on the Bobath concept, in conjunction with a task practice, achieve greater improvement in walking ability in people with stroke compared to physiotherapy focused on structured task practice alone? A pilot randomized controlled trial Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model Task-Oriented Circuit Class Training Program with Motor Imagery for Gait Rehabilitation in Poststroke Patients: A Randomized Controlled Trial
Objective : To investigate whether additional early physiotherapy after stroke improved functional recovery in stroke patients . Design : A prospect i ve , r and omized , controlled study . Setting : One stroke ward and an acute stroke unit in a large teaching hospital , southern China . Subjects : Patients with first-onset stroke consecutively admitted to the stroke centre . Interventions : One group ( n = 78 ) received additional early physiotherapy ( AEP ) for 45 minutes , five days a week for four weeks starting within the first week since stroke onset ; the routine therapy ( RT ) group ( n = 78 ) received no professional rehabilitation therapy . Main outcome measures : Glasgow Coma Scale , Mini-Mental State Examination , Fugl-Meyer Assessment of Motor Recovery , Clinical Neurological Deficit Scale and Modified Barthel Index ( MBI ) . Results : Patients from the AEP group had a high drop-out rate ( n = 28 ) , but those remaining made relatively better functional recovery at 30 days than those from the RT group if measured by MBI . Multiple linear regression analysis revealed that cognitive disturbance , aphasia , double incontinence , site of lesion and sensory impairment might affect functional recovery after stroke . Conclusions : Additional early physiotherapy might improve independence of patients after stroke but failed to show benefit in other aspects in our study . Cognitive disturbance , aphasia , double incontinence , site of lesion as well as sensory impairment might affect functional outcome after stroke 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 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 Background . Exercise interventions can enhance mobility after stroke as well as prevent falls in elderly persons . Objective . Investigate whether an exercise intervention can enhance mobility , prevent falls , and increase physical activity among community-dwelling people after stroke . Method . A r and omized trial with blinding of physical outcome assessment was conducted through local stroke clubs . Both groups , on average 5.9 years poststroke , received exercise classes , advice , and a home program for 12 months . The experimental group ( EG ) program ( n = 76 ) aim ed to improve walking , prevent falls and increase physical activity . The control group ( CG ) program ( n = 75 ) aim ed to improve upper-limb and cognitive functions . The primary outcomes were walking capacity , walking speed measured before and after the intervention , and fall rates monitored monthly . Results . At 12 months , the EG walked 34 m further in 6 minutes ( 95 % confidence interval [ CI ] = 19 - 50 ; P < .001 ) and 0.07 m/s faster over 10 m ( 95 % CI = 0.01 - 0.14 ; P = .03 ) than the CG . The EG had 129 falls , and the CG had 133 . There were no differences in proportion of fallers ( relative risk = 1.22 ; 95 % CI = 0.91 - 1.62 ; P = .19 ) or the rate of falls between groups ( incidence rate ratio = 0.96 ; 95 % CI = 0.59 - 1.51 ; P = .88 ) . Conclusion . The experimental intervention delivered through stroke clubs enhanced aspects of mobility but had no effect on falls Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home . Design R and omised controlled trial with follow-up to 24 weeks . Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherl and s Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic . Patients were r and omly allocated to circuit training or usual physiotherapy , after stratification by rehabilitation centre , with an online r and omisation procedure . Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks . The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency . The control group received usual outpatient physiotherapy . Main outcome measures The primary outcome was the mobility domain of the stroke impact scale ( SIS , version 3.0 ) . Secondary outcomes were st and ing balance , self reported abilities , gait speed , walking distance , stair climbing , instrumental activities of daily living , fatigue , anxiety , and depression . Differences between groups were analysed according to the intention to treat principle . All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks . Results 126 patients were included in the circuit training group and 124 in the usual care group ( control ) , with data from 125 and 117 , respectively , available for analysis . One patient from the circuit training  group and seven from the control group dropped out . Circuit training was a safe intervention , and no serious adverse events were reported . There were no significant differences between groups for the stroke impact scale mobility domain ( β=0.05 ( SE 0.68 ) , P=0.943 ) at 12 weeks . Circuit training was associated with significantly higher scores in terms of gait speed ( 0.09 m/s ( SE 0.02 ) , P<0.001 ) , walking distance ( 20.0 m ( SE 7.4 ) , P=0.007 ) , and modified stairs test ( −1.6 s ( SE 0.7 ) , P=0.015 ) . There were no significant differences between groups for the other secondary outcomes , except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale . With the exception of gait speed ( −0.04 m/s ( SE 0.02 ) , P=0.040 ) , there were no significant differences between groups at follow-up . Conclusion Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient . Trial registration Dutch Trial Register ( NTR1534 ) Objective : To evaluate the efficacy of a task-orientated intervention in enhancing competence in walking in people with stroke . Design : Two-centre observer-blinded stratified block-r and omized controlled trial . Setting : General community . Subjects : Between May 2000 and February 2003 , 91 individuals with a residual walking deficit within one year of a first or recurrent stroke consented to participate . Interventions : The experimental intervention comprised 10 functional tasks design ed to strengthen the lower extremities and enhance walking balance , speed and distance . The control intervention involved the practice of upper extremity activities . Subjects in both groups attended sessions three times a week for six weeks . Main measures : Six-minute walk test ( SMWT ) , 5-m walk ( comfortable and maximum pace ) , Berg Balance Scale , timed ‘ up and go ’ . Results : At baseline , subjects in the experimental ( n = 44 ) and control ( n = 47 ) groups walked an average distance of 209 m ( SD = 126 ) and 204 m ( SD = 131 ) , respectively , on the SMWT . Mean improvements of 40 m ( SD = 72 ) , and 5 m ( SD = 66 ) were observed following the experimental and control interventions , respectively . The between-group difference was 35 m ( 95 % confidence interval ( CI ) 7 , 64 ) . Significant between-group effects of 0.21 m/s ( 95 % CI 0.12 , 0.30 ) and of 0.11 m/s ( 95 % CI 0.03 , 0.19 ) in maximum and comfortable walking speed , respectively , were observed . People with a mild , moderate or severe walking deficit at baseline improved an average of 36 ( SD = 96 ) , 55 ( SD = 56 ) and 18 m ( SD = 23 ) , respectively , in SMWT performance following the experimental intervention . Conclusions : Study findings support the efficacy of a task-orientated intervention in enhancing walking distance and speed in the first year post stroke , particularly in people with moderate walking deficits Objective : To investigate whether provision of additional st and ing practice increases motor recovery and mobility post stroke . Design : A pilot r and omized controlled trial . Setting : A stroke rehabilitation unit in the UK . Participants : Seventeen participants , seven women and ten men , age range 51—92 admitted to the unit 6—58 days post stroke . Intervention : Each participant was r and omly allocated into a control ( conventional physiotherapy ) or treatment ( conventional therapy plus an additional session of st and ing practice ) group . The period of intervention ranged from 14 to 28 days dependent upon length of stay on the unit . Outcome measures : The Gross Functional Tool Section of the Rivermead Motor Assessment , the Trunk Control Test and the Berg Balance Scale were used on admission to the study , at weekly intervals during the intervention , and at 12 weeks ( after discharge ) . Results : Of the 17 participants recruited , three withdrew from the additional intervention group citing  fatigue  as a barrier and 15 completed the study . Participants completing additional st and ing practice demonstrated higher scores in all motor measures at week 12 , but this difference was not statistically significant . There was a statistically significant difference ( P < 0.05 ) in the changes in Berg Balance score when comparing week 1 with week 12 , in support of the group receiving extra st and ing practice . Conclusions : A larger study is required to establish the value of additional st and ing practice after stroke . This pilot demonstrates that the Gross Functional Tool Section of the Rivermead Motor Assessment and the Berg Balance Scale would be useful in such a study . Fatigue may be a significant barrier to ability to participate in more intensive programmes so screening participants for severe fatigue may be useful BACKGROUND AND PURPOSE Many stroke survivors have minimal to moderate neurological deficits but are physically deconditioned and have a high prevalence of cardiovascular problems ; all of these are potentially modifiable with exercise . The purpose s of this r and omized , controlled pilot study were ( 1 ) to develop a home-based balance , strength , and endurance program ; ( 2 ) to evaluate the ability to recruit and retain stroke subjects ; and ( 3 ) to assess the effects of the interventions used . METHODS Twenty minimally and moderately impaired stroke patients who had completed inpatient rehabilitation and who were 30 to 90 days after stroke onset were r and omized to a  control group or to an experimental group that received a therapist-supervised , 8-week , 3-times-per-week , home-based exercise program . The control group received usual care as prescribed by the patients ' physicians . Baseline and postintervention assessment s included the Fugl-Meyer Motor Assessment , the Barthel Index of Activities of Daily Living ( ADL ) , the Lawton Scale of Instrumental ADL , and the Medical Outcomes Study -36 Health Status Measurement . Functional assessment s of balance and gait included a 10-m walk , 6-Minute Walk , and the Berg Balance Scale . Upper extremity function was evaluated by the Jebsen Test of H and Function . RESULTS Of 22 patients who met study criteria , 20 completed the study and 2 refused to participate . The experimental group tended to improve more than the control group in motor function ( Fugl-Meyer Upper Extremity : mean change in score , 8 . 4 versus 2.2 ; Fugl-Meyer Lower Extremity : 4.7 versus -0.9 ; gait velocity : median change , 0.25 versus .09 m/s ; 6-Minute Walk : 195 versus 114 ft ; Berg Balance Score : 7.8 versus 5 ; and Medical Outcomes Study -36 Health Status Measurement of Physical Function : 15 . 5 versus 9 ) . There were no trends in differences in change scores by the Jebsen Test of H and Function , Barthel Index , and Lawton Instrumental ADL Scale . CONCLUSIONS This study demonstrated that a r and omized , controlled clinical trial of a poststroke exercise program is feasible . Measures of neurological impairments and lower extremity function showed the most benefit . Effects of the intervention on upper extremity dexterity and functional health status were equivocal . The lasting effects of the intervention were not assessed Objectives : Bobath based ( BB ) and movement science based ( MSB ) physiotherapy interventions are widely used for patients after stroke . There is little evidence to suggest which is most effective . This single-blind r and omised controlled trial evaluated the effect of these treatments on movement abilities and functional independence . Methods : A total of 120 patients admitted to a stroke rehabilitation ward were r and omised into two treatment groups to receive either BB or MSB treatment . Primary outcome measures were the Rivermead Motor Assessment and the Motor Assessment Scale . Secondary measures assessed functional independence , walking speed , arm function , muscle tone , and sensation . Measures were performed by a blinded assessor at baseline , and then at 1 , 3 , and 6 months after baseline . Analysis of serial measurements was performed to compare outcomes between the groups by calculating the area under the curve ( AUC ) and inserting AUC values into Mann-Whitney U tests . Results : Comparison between groups showed no significant difference for any outcome measures . Significance values for the Rivermead Motor Assessment ranged from p = 0.23 to p = 0.97 and for the Motor Assessment Scale from p = 0.29 to p = 0.87 . Conclusions : There were no significant differences in movement abilities or functional independence between patients receiving a BB or an MSB intervention . Therefore the study did not show that one approach was more effective than the other in the treatment of stroke patients Background Stroke is the most common disabling neurological condition in adults . Falls and poor mobility are major contributors to stroke-related disability . Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population . Currently there is good evidence that exercise can enhance mobility after stroke , yet ongoing exercise programs for general community-based stroke survivors are not routinely available . This r and omised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors . Methods and design Three hundred and fifty community dwelling stroke survivors will be recruited . Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessment s and exercise program .  After the completion of the pre-test assessment , participants will be r and omly allocated to one of two intervention groups . Both intervention groups will participate in weekly group-based exercises and a home program for twelve months . In the lower limb intervention group , individualised programs of weight-bearing balance and strengthening exercises will be prescribed . The upper limb/cognition group will receive exercises aim ed at management and improvement of function of the affected upper limb and cognition carried out in the seated position . The primary outcome measures will be falls ( measured with 12 month calendars ) and mobility . Secondary outcome measures will be risk of falling , physical activity levels , community participation , quality of life , health service utilisation , upper limb function and cognition . Discussion This study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors . We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke . This program , if found to be effective , has the potential to be implemented within existing community services . Trial registration The protocol for this study is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12606000479505 ) Although intervention is effective in reducing the disability associated with stroke , limited re sources mean that physiotherapy services often cease by six months after stroke . The purpose of this clinical trial was to investigate the efficacy of re source -efficient physiotherapy services in improving mobility and quality of life after stroke . Twenty-six people with residual walking difficulties after stroke were r and omised into an experimental or control group after discharge from physiotherapy services . The experimental group participated in a six-week , home-based mobility program . The control group participated in a six-week , home-based program of upper-limb exercises ( i.e. ' sham ' mobility exercises ) . Subjects met with the therapist for prescription of exercises only three times during the six weeks . Strategies used to offset potential problems associated with minimal subject-therapist interaction included videotaped instructions to encourage correct performance of exercises , modification of the environment and involvement of carers to enhance safety , and telephone contact and self-monitoring to promote compliance . St and ing ( Functional Reach ) , walking ( MAS Item 5 ) and quality of life ( SA-SIP30 ) were measured prior to , immediately after , and two months after intervention ceased by an assessor who was blinded to group allocation . Subjects in the experimental group demonstrated significant improvement in st and ing compared to the control group ( p = 0.01 ) which was maintained two months after the cessation of intervention ( p = 0.04 ) . There was no difference between the groups in walking ( p = 0.50 ) or quality of life ( p = 0.70 ) . The six-week , re source -efficient mobility program was effective in improving some of the mobility in people after discharge from stroke rehabilitation . The provision of re source -efficient programs is recommended wherever possible so that people affected by stroke may continue rehabilitation for longer The purpose of this study was to investigate whether additional practice of either upper limb or mobility tasks improved functional outcome during inpatient stroke rehabilitation . This prospect i ve , r and omised , single blind clinical trial recruited 30 stroke subjects into either an Upper Limb or a Mobility Group . All subjects received their usual rehabilitation and an additional session of task-related practice using a circuit class format . Independent assessors , blinded to group allocation , tested all subjects . Outcome measures used were three items of the Jebsen Taylor H and Function Test ( JTHFT ) , two  arm items  of the Motor Assessment Scale ( MAS ) , and three mobility measures , the Timed Up and Go Test ( TUGT ) , Step Test , and Six Minute Walk Test ( 6MWT ) . Both groups improved significantly between pre- and post-tests on all of the mobility measures , however only the Upper Limb Group made a significant improvement on the JTHFT and MAS upper arm items . Following four weeks training , the Mobility Group had better locomotor ability than the Upper Limb Group ( between-group differences in the 6MWT of 116.4 m , 95 % CI 31.4 to 201.3 m , Step Test 2.6 repetitions , 95 % CI -1.0 to 6.2 repetitions , and TUGT -7.6 sec , 95 % CI -15.5 to 0.2 sec ) . The JTHFT dexterity scores in the Upper Limb Group were 6.5 sec ( 95 % CI -7.4 to 20.4 sec ) faster than the Mobility Group . Our findings support the use of additional task-related practice during inpatient stroke rehabilitation . The circuit class format was a practical and effective means to provide supervised additional practice that led to significant and meaningful functional gains To investigate whether early rehabilitation has a positive impact on the recovery of the activities of daily living and motor function after intracerebral hemorrhagic stroke , 364 patients with hemorrhagic stroke were selected and r and omly divided into a rehabilitation group and a control group . The rehabilitation group underwent a st and ardized , three-stage rehabilitation program . The control group was treated with st and ard hospital ward , internal medical intervention . The simplified Fugl-Myere assessment scale ( FMA ) and Modified Barthel Index ( MBI ) were administered at various time points . The magnitude of improvement was significantly higher in the rehabilitation group than in the control group for both the FMA ( p<0.05 ) and MBI scores ( p<0.05 ) . The greatest improvement was observed in the first month post-stroke . Thus , our study shows that early rehabilitation can significantly improve the daily activities and motor functions of patients with stroke Background . Sitting balance and the ability to perform selective trunk movements are important predictors of functional outcome after stroke . However , studies evaluating the effect of exercises aim ed at improving trunk performance are sparse . Objective . To examine the effect of additional trunk exercises on trunk performance after stroke . Methods . An assessor-blinded r and omized controlled trial was carried out at an inpatient stroke rehabilitation center . In total 33 participants were assigned to an experimental group ( n = 17 ) or a control group ( n = 16 ) . In addition to conventional therapy , the experimental group received 10 hours of individual and supervised trunk exercises ; 30 minutes , 4 times a week , for 5 weeks . Trunk performance was evaluated by the Trunk Impairment Scale ( TIS ) and its subscales of static and dynamic sitting balance and coordination . A general linear repeated measures model was used to analyze the results of our study . Results . No significant differences were found pretreatment between the 2 groups for the collected demographic variables , stroke-related parameters , clinical measures , number of therapy sessions received , and primary outcome measure used . Posttreatment , a significantly better improvement was noted in the experimental group compared to the control group for the dynamic sitting balance subscale only ; measuring selective lateral flexion initiated from the upper and lower part of the trunk , ( P = .002 , post hoc power calculation = .90 , effect size = 1.16 ) . Conclusions . Our results suggest that , in addition to conventional therapy , trunk exercises aim ed at improving sitting balance and selective trunk movements have a beneficial effect on the selective performance of lateral flexion of the trunk after stroke 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 PURPOSE The purpose of this study was to evaluate the physical and psychosocial effects of an 8-wk community-based functional exercise program in a group of individuals with chronic stroke . METHODS Twenty-five subjects ( mean age 63 yr ) participated in a repeated measures design that evaluated the subjects with two baseline assessment s 1 month apart , one postintervention assessment , and one retention assessment 1 month postintervention . Physical outcome measures assessed were the Berg Balance Test , 12-Minute Walk Test distance , gait speed , and stair climbing speed . Psychosocial measures assessed were the Reintegration to Normal Living Index ( RNL ) and Canadian Occupational Performance Measure ( COPM ) . The 8-wk training consisted of a 60-min , 3 x wk-1 group program that focused on balance , mobility , functional strength , and functional capacity . The program was design ed to be accessible by reducing the need for costly one-on-one supervision , specialized setting s , and expensive equipment . RESULTS Improvements from the exercise program were found for all physical measures and these effects were retained 1-month postintervention . Subjects with lower function improved the most relative to their initial physical status . Significant effects were found for the COPM , but not the RNL Index ; however , subjects with lower RNL improved the most relative to their initial RNL Score . CONCLUSION A short-term community-based exercise program can improve and retain mobility , functional capacity , and balance and result in a demonstrable impact upon the performance of activities and abilities that were considered meaningful to the subjects . Implementation of such community-based programs has potential for improving activity tolerance and reducing the risk for secondary complications common to stroke ( e.g. , falls result ing in fractures and cardiac events ) OBJECTIVE To evaluate the immediate and retention effects of a 4-week training program on the performance of locomotor-related tasks in chronic stroke . DESIGN R and omized , controlled pilot study with 2-month follow-up . SETTING Rehabilitation center . SUBJECTS A convenience sample consisting of 12 chronic stroke subjects was used . Subjects were r and omly assigned to the experimental or the control group . Three subjects withdrew from the study . INTERVENTION Both experimental and control groups participated in exercise classes three times a week for 4 weeks . The exercise class for the experimental group focused on strengthening the affected lower limb and practicing functional tasks involving the lower limbs , while the control group practice d upper-limb tasks . MAIN OUTCOME MEASURES Lower-limb function was evaluated by measuring walking speed and endurance , peak vertical ground reaction force through the affected foot during sit-to-st and , and the step test . RESULTS The experimental group demonstrated significant immediate and retained ( 2-month follow-up ) improvement ( p < or = .05 ) compared with the control group in walking speed and endurance , force production through the affected leg during sit-to-st and , and the number of repetitions of the step test . CONCLUSION The pilot study provides evidence for the efficacy of a task-related circuit class at improving locomotor function in chronic stroke After stroke , physiotherapy can promote brain reorganization and motor recovery . Combining muscle strength and functional training ( functional strength training , FST ) may be beneficial . The aim of the authors was to compare FST with conventional physiotherapy ( CPT ) while controlling for the potential confounder of therapy intensity in a multicenter , r and omized controlled observer-blind trial . The mean age of the participants was 68.3 ( st and ard deviation [ SD ] = 12.03 ) years at a mean of 34 ( SD = 20 ) days after stroke , with mean peak paretic knee extension torque ( torque ) of 22 ( SD = 25 ) Nm . The estimated sample size was 102 to detect a between-group difference of 0.2 m/s in walking speed . After baseline measures , participants were allocated r and omly to CPT or CPT + CPT or CPT + FST for 6 weeks . Additional experimental therapy was provided for up to 1 hour a day , 4 times each week . Outcomes were measured 6 weeks after baseline and at follow-up 12 weeks thereafter . Measures included walking speed , knee extensor torque , and functional mobility ( Rivermead ) . At outcome , both extraintensity groups showed greater increases in walking speed than the CPT group , but this reached significance only for the CPT + CPT group ( P = .031 ) . The CPT + CPT group also had a greater number of participants who walked at 0.8 m/s or above . No significant differences were observed for torque about the knee or for the Rivermead score . At follow-up , no significant differences were observed . These phase I results justify a subsequent trial of CPT + CPT versus CPT + FST Objective . To compare 2 rehabilitation strategies to improve balance after stroke : ( 1 ) a multisensorial approach based on higher intensity of balance tasks and exercise during visual deprivation and ( 2 ) a conventional neurodevelopmentaltheory-based treatment ( NDT ) that used a general approach for sensorimotor rehabilitation . Methods . This prospect i ve , multicenter , r and omized , parallel-group study measured outcomes with blinded assessors . Sixty-eight patients able to walk without human assistance were entered from 3 to 15 months ( mean , 7 months ) after a first hemispheric stroke . They received 20 sessions in 4 weeks of NDT or multisensorial rehabilitation . On day 0 , day 30 , and day 90 , assessment included the Berg Balance Scale ( BBS ) , posturography , gait ( velocity , double stance phase , climbing 10 steps , amount of walking per day ) , the Functional Independence Measure , and the Nottingham Health Profile . Results . All subjects improved significantly in balance and walking parameters . Regarding the main dependent variable ( BBS on day 30 ) , no difference between groups was found . Analysis of secondary outcomes suggested small differences in favor of the experimental group , but the differences are not likely to be clinical ly relevant . Conclusion . No evidence was found for the superiority of a multisensorial rehabilitation program in ambulatory patients with impairments beyond the time of inpatient therapy . Additional studies are recommended Objective : To examine the effect of functional strength training in subacute stroke . Design : A single-blinded r and omized controlled trial . Setting : Two rehabilitation units . Subjects : Eighteen patients in the subacute phase post stroke , r and omly allocated to a functional strength training ( intervention ) group ( n = 8) and a training-as-usual ( comparison ) group ( n = 10 ) . Intervention : The functional strength training group participated in functional progressive strength training of the affected lower extremity . The training-as-usual group had traditional training , excessive muscle power being avoided to prevent associated reactions . All trained 50 minutes five days a week for four weeks . Main measures : Maximum weight-bearing in st and ing ( primary outcome ) , isometric muscle strength , gait speed and items of Motor Assessment Scale . Results : Maximum weight-bearing on the affected leg improved more in the functional strength training group ( mean 17.4 % of body weight ) than in the training-as-usual group ( mean 5.6 % of body weight ) , but taking test data at inclusion into consideration , the difference in change was not statistically significant ( P = 0.056 ) . More patients in the functional strength training group ( 57 % ) could weight-bear on the affected leg while stepping forward , than in the training-as-usual group ( 17 % ) . Improvement was clinical ly significant in 7 of 9 outcome measures in the functional strength training group ( effect size ≥0.80 , large ) , but in only 3 of 9 in the training-as-usual group . All patients in the functional strength training group and 70 % of the patients in the training-as-usual group rated their overall status as ` much ' or ` very much ' improved . Conclusions : This pilot study indicates that functional strength training of lower extremities improves physical performance more than traditional training Background : Some patients continue to have mobility problems as a long-term consequence of stroke and it is unclear whether routine , further contact with a physiotherapy service is beneficial . Two single-centre , r and omized controlled trials of physiotherapy for patients more than one year post stroke have been undertaken in Oxford and Bradford in the UK and the results from these two trials have been combined to give a more precise estimate of effectiveness . Method : The computerized data bases from both trials were combined for a joint analysis . Outcome measures common to both trials were : Rivermead Mobility Index ; gait speed measured over 10 metres ; Barthel Index ; Frenchay Activities Index ; Hospital Anxiety and Depression Scale . Results : There were 264 patients available for the combined analysis ( Oxford= 94 ; Bradford= 170 ) . There was a significant but clinical ly small improvement in mobility at three months in the combined treatment group measured by the Rivermead Mobility Index ( median of the differences= 0 ( 95 % confidence interval ( CI ) 0 , 1 ) ; interpolated values= 0.43 ( 95 % CI 0.08 , 0.80 ) ) and gait speed ( treatment effect 2.7 m/min ( 95 % CI 0.94 , 4.46 ) ) . There were no other significant differences . Intervention given in both studies was at the discretion of the physiotherapists and was of similar and low intensity ( mean visits Oxford= 4 ( SD 2.5 ) ; Bradford= 5 ( SD 4.5 ) ) . Conclusion : A more effective physiotherapy intervention is required for stroke patients with persisting mobility problems after stroke OBJECTIVE To evaluate the effect of tertiary rehabilitation treatment on acute cerebrovascular diseases . METHODS Fifteen tertiary rehabilitation networks were set up throughout the country . 1078 patients with acute cerebrovascular diseases were r and omly divided into 2 groups : rehabilitation group and control group , out of which 19 patients died , 157 dropped out , and 7 successive evaluations were completed in 902 patients that . 439 of the remaining 902 patients in the rehabilitation group , 266 males and 173 females , aged 61 + /- 11 , 278 cases with cerebral infa rct ion and 161 with cerebral hemorrhage , received routine treatment and early rehabilitation for 28 days in the ward of neurology , and then went home and received community rehabilitation for 6 months or underwent specialized reinforcement training for 2 months and after that went home and received community rehabilitation for 4 months . The 463 patients in the control group , 281 males and 182 females , aged 60 + /- 11 , 291 of which with cerebral infa rct ion and 172 with cerebral hemorrhage , received only routine treatment and early rehabilitation for 28 days in the ward of neurology , and then went home to conduct rehabilitation training by themselves or their family members for 6 months . Evaluation was conducted 7 times , with National Institutes of Health Stroke Scale ( NIHSS ) , Fugl-Meyer motor function scale , Barthel index , SF-36 scale , Lowenstein occupational therapy cognitive assessment ( LOTCA ) , Westen aphasia battery , Hamilton depression scale , and modified Ashworth spasm scale , one week after the onset and by the ends of 1 , 2 , 3 , 4 , 5 , and 6 months after the onset respectively . RESULTS The scores of clinical neurological impairment , Fugl-Meyer scores , SF-36 scores , incidence of PSD , and modified Ashworth scores ( for upper and lower limbs ) were lower , and LOTCA scores and Barthel indexes were higher at different time points in the rehabilitation group than in the control group ; and the differences were statistically significant since the 2nd month after the onset . By the end of the 6th month , the patients of the rehabilitation group basically re-achieved the ability of self-care in daily activities with a Barthel index of 84 + /- 33 . The patients of the control group also recovered to a certain degree , however , to a smaller extent in comparison with the rehabilitation group . CONCLUSION Tertiary rehabilitation treatment of cerebrovascular diseases is effective in improving motor function , ability of daily living activities , and quality of life and reducing the incidence rates of secondary complications CONTEXT Stroke is a leading cause of death and disability worldwide , being the third leading cause of death in the United States and the second and third most common causes of death in Chinese cities and rural areas , respectively . Evaluation of different rehabilitative modalities appears necessary to optimize treatment . OBJECTIVES To compare acupuncture and physiotherapy for effectiveness and reliability in treating hemiplegic patients after stroke . DESIGN The research team design ed a multicentered , three-arm , r and omized controlled trial . Power calculations revealed a targeted sample size of 310 participants . SETTING The study took place at seven in-patient hospitals in China . PARTICIPANTS The research team screened a total of 310 patients . Of that number , 274 completed the study , 15 did not meet the inclusion /exclusion criteria , and 21 dropped out . Adverse events were rare ( less than 1 % ) , mild , and temporary . INTERVENTION The research team r and omly divided participants into three groups that all received conventional care as needed-including psychological counseling , st and ard nursing care , and daily medical evaluation plus ( 1 ) acupuncture , ( 2 ) physiotherapy , or ( 3 ) acupuncture plus physiotherapy . The participants received treatments once a day , 6 days a week for 4 weeks . OUTCOME MEASURES The research team evaluated all patients at baseline , after 2 weeks , and after 4 weeks using the Fugl-Meyer Assessment of Physical Performance ( FMA ) , a modified Barthel Index ( BI ) , and the Neurologic Defect Scale ( NDS ) . RESULTS No significant differences existed between the three groups at baseline . Compared to baseline , participants in all groups improved their FMA , BI , and NDS scores by the end of week 2 ( P≤.05 ) and further improved by the end of week 4 ( P≤.05 ) The study found no statistically significant differences in outcomes between the three groups after treatment ( P>.05 ) . CONCLUSION Acupuncture plus conventional care was similar in effectiveness to physiotherapy treatment plus conventional care for poststroke rehabilitation . The study found no synergistic effects for the combination of acupuncture and physiotherapy in addition to conventional care ; that combination of treatments was no more effective than either treatment by itself . The effectiveness and lack of adverse events associated with acupuncture in this study suggest that it may represent an additional treatment option for stroke patients Objective : To determine ( 1 ) the most effective of three treatment approaches to retrain seated weight distribution long-term after stroke and ( 2 ) whether improvements could be generalized to weight distribution in st and ing . Setting : Inpatient rehabilitation unit . Design : Forty asymmetrical acute stroke subjects were r and omly allocated to one of four groups in this pilot study . Changes in weight distribution were compared between the 10 subjects of each of three treatment groups ( task-specific reach , Bobath , or Balance Performance Monitor [ BPM ] feedback training ) and a no specific treatment control group . One week of measurement only was followed by two weeks of daily training sessions with the treatment to which the subject was r and omly allocated . Measurements were performed using the BPM daily before treatment sessions , two weeks after cessation of treatment and 12 weeks post study . Weight distribution was calculated in terms of mean balance ( percentage of total body weight ) or the mean of 300 balance points over a 30-s data run . Results : In the short term , the Bobath approach was the most effective treatment for retraining sitting symmetry after stroke ( p = 0.004 ) . Training with the BPM and no training were also significant ( p = 0.038 and p = 0.035 respectively ) and task-specific reach training failed to reach significance ( p = 0.26 ) . At 12 weeks post study 83 % of the BPM training group , 38 % of the task-specific reach group , 29 % of the Bobath group and 0 % of the untrained group were found to be distributing their weight to both sides . Some generalization of symmetry training in sitting to st and ing was noted in the BPM training group which appeared to persist long term . Conclusions : Results should be treated with caution due to the small group sizes . However , these preliminary endings suggest that it might be possible to restore postural symmetry in sitting in the early stages of rehabilitation with therapy that focuses on creating an awareness of body position OBJECTIVE To assess the influence of initial stroke impairments on the severity of basic and higher level functional deficits over time and to determine the cumulative impact on functional deficits beyond severity of motor deficits alone . DESIGN Observational study . SETTING Twelve participating hospitals in the Greater Kansas City area , as part of the Kansas City Stroke Study ( October 1995-March 1998 ) . PARTICIPANTS Individuals ( n = 459 ) who sustained an eligible stroke were evaluated prospect ively using st and ardized assessment s at enrollment ( within 14 days of stroke onset , 8.8 + /- 3.5 days ) . MAIN OUTCOME MEASURES Mobility and activities of daily living ( ADLs ) were assessed at 1 , 3 , and 6 months poststroke using the Functional Independence Measure , Barthel index , Lawton Instrumental Activities of Daily Living ( IADL ) , and the Medical Outcomes Study Short-Form Health Survey instruments . RESULTS The cumulative probability of achieving independence with walking , a Barthel index of 60 or greater or 90 or greater , and independence in 3 or more IADL was significantly different for the following 4 impairment groups in descending order : motor ; motor and somatosensory ; motor and hemianopia ; and motor , sensory , and hemianopia . Although motor severity was a strong predictor of outcome ( p < .0001 ) , the additional somatosensory and hemianopia deficits significantly ( p < .05 ) affected time and likelihood of achieving these levels of function . CONCLUSION Cumulative deficits poststroke affect patients ' functional outcome in the first 6 months poststroke beyond the effect of motor severity alone OBJECTIVE To explore the effects of st and ardized three stages ' rehabilitation on the neurological function in stroke patients with hemiplegia . METHODS All 52 patients firstly are brought into two blocks : primary cerebral infa rct ion and primary cerebral hemorrhage then are divided into treated group and controlled group r and omly . Patients in the treated group are given St and ardized Three Stages ' Rehabilitation , while those in the controlled group are only given normal internal medicine treatments that are the same as the treated group but without St and ardized Three Stages ' Rehabilitation . All patients would be assessed with the scale of Clinical Neurological Function Defects ( CNFD ) at the entering time , the end of 1st month , 3rd month and 6th month respectively after stroke . RESULTS The scores of the treated group are lower than those of the controlled group ( P < 0.001 ) at every stage , the margins between every stage 's scores in the treated group are greater than those in the controlled group ( P < 0.001 ) . The scores of the treated group 's patients are about 51 % , 34 % , 18 % and 8 % of total scores at the entering time , the end of 1st month , 3rd month and 6th month after stroke differently , but that of the controlled group are about 58 % , 54 % , 42 % and 37 % of total scores differently . The margins between the scores of entering time and that of the end of 1st month , 3rd month and 6th month in the treated group are 17 % , 33 % and 43 % of total scores respectively , but that of the controlled group are about 5 % , 16 % and 21 % of total scores differently . CONCLUSION St and ardized three stages ' rehabilitation could promote stroke patients ' motor function of every stage obviously This trial compares the effects of task-oriented physical therapy ( PT ) provided with and without the use of rehabilitation technology on locomotor recovery in 63 persons with subacute stroke . Participants in the experimental ( EXP ) group used a treadmill , a Kinetron isokinetic exerciser , and a limb-load monitor , whereas those in the control ( CTL ) group did not while engaging in PT 1 h per day , 5 days per week for 2 months . Locomotor recovery was assessed by clinical ( gait speed , Fugl Meyer motor leg and arm subscores , the Balance Scale , the Timed Up and Go , and the Barthel ambulation subscore ) and laboratory outcomes ( gait kinematics and kinetics ) pre- and posttherapy and 3 months later . Within groups , gait speed ( P < 0.01 ) and all secondary measures improved posttherapy ( P < 0.01 - 0.05 ) , and improvements in clinical measures were maintained at follow-up , but there was no difference between groups ( P > 0.05 ) . When the groups were pooled , the increase in gait speed was associated ( r = 0.52 , P = 0.003 ) with an increase in ankle power generation of the affected leg . The results demonstrate that the efficacy of the task-oriented approach is not dependent on rehabilitation technology OBJECTIVE To investigate the effect of st and ardized tertiary rehabilitation ( STR ) on the upper and lower limbs ' motor function in the patients with cerebral stroke accompanied by hemiplegia . METHODS 1365 patients with cerebral stroke accompanied by hemiplegia enrolled sequentially from 22 hospitals were classified into two groups : cerebral infa rct ion group and hemorrhage group , and then r and omly subdivided into two groups : test group ( n = 688 , administered with STR in addition to routine interventions of neurological medicine ) and control group ( n = 677 , given the routine interventions ) . All patients were assessed with the scale of Modified Fugl-Meyer Motor Assessment ( M-FMMA ) at the time of enrollment and 1 , 3 , and 6 months after the stroke respectively . The evaluation was blind on the part of the physician . RESULTS At each of the following post-stroke checkpoints , the scores of the functions in the cerebral infa rct ion or hemorrhage test group were higher than those in the control ( P < 0.01 ) . The M-FMMA scores at the enrollment , and 1 , 3 , and 6 months after stroke of the cerebral infa rct ion patients in the test group were 28 , 47 , 65 , and 75 respectively , and the M-FMMA scores at the enrollment , and 1 , 3 , and 6 months after stroke of the cerebral infa rct ion patients in the control group were 26 , 37 , 48 , and 55 respectively . The M-FMMA scores at the enrollment , and 1 , 3 , and 6 months after stroke of the cerebral hemorrhage patients in the test group were 23 , 44 , 67 , and 80 respectively , and the M-FMMA scores at the enrollment , and 1 , 3 , and 6 months after stroke of the cerebral hemorrhage patients in the control group were 21 , 32 , 46 , and 55 respectively . During the STR , the scores of functional improvement of both the cerebral infa rct ion and hemorrhage test groups were higher than those of the control groups ( both P < 0.01 ) . By the end of the 6th month after stroke , the scores of functional improvement of both the cerebral infa rct ion and hemorrhage test groups went up by 47 and 56 respectively for the 2 test groups , while went up by 29 and 34 respectively for the 2 control groups . Compared with the control groups , the score of functional improvement of the cerebral infa rct ion test group was 18 points higher , and that of the cerebral hemorrhage test group was 22 points higher . CONCLUSION STR significantly improves the neurological function in the patients with cerebral strokes accompanied by hemiplegia OBJECTIVE To investigate the effects of early rehabilitation on activities of daily living ( ADL ) and complications in patients within 1 month after a first stroke . METHODS 57 stroke patients were r and omly divided into rehabilitation group ( 30 cases ) and control group ( 27 cases ) . Patients in rehabilitation group received rehabilitation intervention ( the main methods were therapeutic exercises , especially Bobath method ) starting on average ( 15+/-4 ) days after stroke . Patients in both groups received the similar pharmological treatments . The demographic information was similar in both groups . Using the degree of deficit of neural function ( DDNF , Chinese version ) , Barthel index and Fugl-Meyer Assessment ( FMA ) scale to assess all patients in pre-therapy stage and post-therapy stage . RESULTS The scores of DDNF , FMA and Barthel index except for the grooming item ( P=0.04 , it is higher in rehabilitation group than in control group ) in the 2 groups were similar at the pre-therapy stage ( P>0.05 ) . At the post-therapy stage , there was no significant difference in the difference values in the grooming item between the pre- and post-stages in the 2 groups . There were significant differences in the difference values between the pre- and post-stages in the 2 groups in eating , bed-chair transfer and short distance walking activities items put together(P=0.05 ) . The differences between the pre- and post-stages in both groups in Barthel index items except the control of feces and urine , and bath items were significant ( P</=0.01 ) . The effects on complications were as follows : At the pre-therapy stage , the number of shoulder h and syndrome in rehabilitation group was higher than the one in control group ( P=0.11 ) , it was lower in rehabilitation group than in control group ( P=0.09 ) at the post-therapy stage . There were no significant differences about drop foot , interior deviation foot and ankle joint contracture conditions between the 2 groups at the pre-therapy stage , but there were significant differences about the 3 conditions at the post-therapy stage ( P</=0.01 ) , and the number of 3 complications was lower in rehabilitation group than in control group . There was no significant difference in shoulder subluxation at the pre- and post-therapy stages between the 2 groups . CONCLUSION Early rehabilitation can effectively improve stroke patients ' ADL , especially in eating , bed-chair transfer and short distance walking activities , and decrease the rate of complications ' incidence within one month after stroke Objective : To study the efficacy of the motor relearning approach in promoting physical function and task performance for patients after a stroke . Design : Matched-pair r and omized controlled trial . Setting : An outpatient rehabilitation centre in Hong Kong . Participants : Fifty-two out patients with either a thrombotic or haemorrhagic stroke who completed either the study or control group . Interventions : The patients received 18 2-h sessions in six weeks of either the motor relearning programme or a conventional therapy programme . Main outcome measures : The Berg Balance Scale , the Timed Up and Go Test , the Functional Independence Measure ( FIM ) , the modified Lawton Instrumental Activities of Daily Living ( IADL ) test , and the Community Integration Question naire . Results : Patients in the motor relearning group showed significantly better performance on all but the Timed Up and Go Test when compared with the control group ( F(1,150)=6.34 - 41.86 , P ≤ 0.015 ) . The interactions between group and occasion were significant on all five outcome measures , indicating that the rates of change across time between the motor relearning and control groups differed ( F(3,150)=3.60 - 33.58 , P < 0.015 ) . Conclusion : The motor relearning programme was found to be effective for enhancing functional recovery of patients who had a stroke . Both ‘ sequential ’ and ‘ function-based ’ concepts are important in applying the motor relearning approach to the rehabilitation of stroke patients BACKGROUND AND PURPOSE The primary aim of the present study was to investigate , based on data from our study in 2000 , whether the Bobath approach enhanced quality of movement better than the Motor Relearning Programme ( MRP ) during rehabilitation of stroke patients . METHODS A r and omized controlled stratified trial of acute stroke patients . The patients were treated according to Motor Relearning Programme and Bobath approach and assessed with Motor Assessment Scale , Sødring Motor Evaluation Scale , Nottingham Health Profile and the Barthel Index . A triangulation of the test scores was made in reference to the Movement Quality Model and biomechanical , physiological , psycho-socio-cultural , and existential themes . RESULTS The items arm ( p = 0.02 - 0.04 ) sitting ( p = 0.04 ) and h and ( p = 0.01 - 0.03 ) were significantly better in the Motor Relearning Programme group than in the Bobath group , in both Sødring Motor Evaluation Scale and Motor Assessment Scale . Leg function , balance , transfer , walking and stair climbing did not differ between the groups . The Movement Quality Model and the movement qualities biomechanical , physiological and psycho-socio-cultural showed higher scoring in the Motor Relearning Programme group , indicating better quality of movement in all items . Regression models established the relationship with significant models of motor performance and self reported physical mobility ( adjusted R(2 ) 0.30 - 0.68 , p < 0.0001 ) , energy ( adjusted R(2 ) 0.13 - 0.14 , p = 0.03 - 0.04 , emotion ( adjusted R(2 ) 0.30 - 0.38 , p < 0.0001 ) and social interaction ( arm function , adjusted R(2 ) 0.25 , p = 0.0001 ) . CONCLUSIONS These analyses confirm that task oriented exercises of the Motor Relearning Programme type are preferable regarding quality of movement in the acute rehabilitation of patients with stroke OBJECTIVE Rehabilitation strategies have been developed to improve functional state in stroke patients . The main objective of this study was to evaluate the effectiveness of the early rehabilitation at hospital and its continuity at home provided by nurses , on the functional recovery of basic and social activities in stroke patients compared with conventional care . DESIGN A r and omised clinical trial was carried out in three general hospitals of the Mexican Institute of Social Security ( IMSS ) in Mexico City between April 2003-May 2004 . PARTICIPANTS Stroke patients . METHODS Two rehabilitation strategies provided by nurses for stroke patients were compared : physiotherapy plus caregiver education in rehabilitation ( strategy 1 , S1 ) vs. education alone ( strategy 2 , S2 ) . The main outcome variables were the basic ( Barthel index ) and social ( Frenchay activities index ) activities of daily living , of each patient . Age , sex , morbidity , stroke symptoms , complications , neurological damage ( Canadian Scale ) , cognitive state ( mini-mental state examination question naire ) and duration of hospitalisation were defined as the control variables . Patients were evaluated at baseline and months one , three and six thereafter . RESULTS One hundred and ten patients with ischaemic stroke were enrolled and r and omised ; 59 were assigned to S1 and 51 to S2 . Comparison of the outcome variables showed that patients improved significantly over time , but no differences were observed between groups . We observed no significant difference in strategy performance with regard to the basic and instrumental activities of daily living . RELEVANCE TO CLINICAL PRACTICE Participants who received physiotherapy with additional caregiver education benefit no more than those whose caregivers received education alone . Those countries that do not have integral rehabilitation programmes for stroke patients should underst and their importance and budget re sources for them . Meanwhile , both caregiver education and nurses trained in specific care and physiotherapy are alternatives that benefit these patients Rationale Functional Strength Training may enhance motor function of people who are more than six months post stroke . Aims to evaluate the clinical efficacy of enhancing upper and lower limb motor function with FST to explore participants ' views ( expectations and experiences ) of FST , and to determine what cost-effectiveness data to collect in a subsequent Phase III trial . Design R and omized , observer-blind trial with embedded qualitative investigation of participants ' views of FST ( n = 6 , purposive sampling ) . Study Participants ( n = 58 ) , six months to five years after stroke with difficulty using their paretic upper ( UL ) and lower limbs ( LL ) for everyday functional activity . All will be r and omized to either FST-UL or FST-LL delivered in their own homes for fours days each week for six weeks . FST involves repetitive progressive resisted exercise during goal directed functional activities . The therapist 's main input is to provide verbal prompting and feedback . Outcomes Measures will be undertaken before r and omization ( baseline ) , after the six-week intervention ( outcome ) and six weeks thereafter ( follow-up ) . Primary outcomes for clinical efficacy will be the Functional Ambulation Categories ( FAC ) and the Action Research Arm Test ( ARAT ) . Clinical efficacy analysis will use the proportional odds model for FAC and a Mann-Whitney test for ARAT . Participants ' views of FST  will be explored at baseline and outcome through audio-taped , semi-structured , narrative approach , interviews . The analytic process for interviews will sort transcribed data thematically and seek categories to inform conceptualization ( theory-building ) . A purpose - design ed cost question naire will identify what cost re source items are likely to be affected by FST Objective : To investigate the effectiveness of Bobath on stroke patients at different motor stages by comparing their treatment with orthopaedic treatment . Design : A single-blind study , with r and om assignment to Bobath or orthopaedic group . Setting : Physical therapy department of a medical centre . Subjects : Twenty-one patients with stroke with spasticity and 23 patients with stroke at relative recovery stages participated . Interventions : Twenty sessions of Bobath programme or orthopaedic treatment programme given in four weeks . Main outcome measures : Stroke Impairment Assessment Set ( SIAS ) , Motor Assessment Scale ( MAS ) , Berg Balance Scale ( BBS ) and Stroke Impact Scale ( SIS ) for impairment and functional limitation level . Results : Participants with spasticity showed greater improvement in tone control ( change score : 1.209±1.03 versus 0.089±0.67 , p = 0.006 ) , MAS ( change score : 7.64±4.03 versus 4.009±1.95 , p = 0.011 ) , and SIS ( change score : 7.309±6.24 versus 1.259±5.33 , p=0.023 ) after 20 sessions of Bobath treatment than with orthopaedic treatment . Participants with relative recovery receiving Bobath treatment showed greater improvement in MAS ( change score : 6.149±5.55 versus 2.779±9.89 , p=0.007 ) , BBS ( change score : 19.189±15.94 versus 6.859±5.23 , p=0.015 ) , and SIS scores ( change score : 8.509±3.41 versus 3.629±4.07 , p = 0.006 ) than those with orthopaedic treatment . Conclusion : Bobath or orthopaedic treatment paired with spontaneous recovery result ed in improvements in impairment and functional levels for patient with stroke . Patients benefit more from the Bobath treatment in MAS and SIS scores than from the orthopaedic treatment programme regardless of their motor recovery stages Objective : The purpose of this follow-up one and four years post stroke was to find out whether the initial physiotherapy approach had had any long-term effects on mortality , motor function , postural control , activities of daily living , life quality , follow-up from community services and living conditions . Design : A r and omized controlled trial of first time ever stroke patients . Group 1 ( n = 33 ) and group 2 ( n = 28 ) had initial physiotherapy according to the Motor Relearning Programme and Bobath , respectively . Main outcome measures : The Motor Assessment Scale ( MAS ) , the Sødring Motor Evaluation Scale ( SMES ) , the Barthel ADL Index , the Nottingham Health Profile ( NHP ) and Berg Balance Scale were used . The following parameters were also registered : incidence of new strokes , other diseases , use of assistive devices , the patient 's accommodation and use of services from the community . Results : The mortality rates were similar in the two groups . In both groups the motor function , postural control and ADL had decreased rapidly , leaving many of the patients dependent and with a high risk of falling . Life quality had increased compared to the acute stage , but was still low in comparison with healthy persons . Patients in both groups lived at home , but were dependent on help from relatives and community services . Physiotherapy as follow-up service was seldom used . The initial physiotherapy approach did not seem to have a major in‘uence on the patients ' ability to cope in the long term . Conclusion : This follow-up at one and four years post stroke showed no major in‘uence of two different initial physiotherapy regimens on long-term function . The study confirmed a rapid deterioration of ADL and motor function and an increased dependence on relatives . The study reveals a gap between the intense treatment in the acute phase and little or no follow-up of physiotherapy treatment or other rehabilitation activities later OBJECTIVE To evaluate the effectiveness of 2 rehabilitative approaches for improving paretic limb reaching by chronic stroke subjects . DESIGN Pre- and posttest reaching to targets ipsilateral , midline , and contralateral to the impaired side . SETTING Training in subjects ' homes ; testing in a laboratory setting . PARTICIPANTS Twelve poststroke volunteers were matched using the Motor Assessment Scale ( MAS ) and then were r and omly assigned to 1 of 2 training conditions . Subjects were subsequently categorized as at a high or low functional level , using the reaching pretest movement time scores . INTERVENTIONS Training ( trunk unrestrained ) using the paretic limb was 4 weeks ( 12 sessions ) . Task-related training ( TRT ) involved reaching to objects placed across the workspace . Progressive resistive exercise ( PRE ) involved whole-arm pulling against resistive therapeutic tubing in planes and distances similar to that in TRT . Main outcome measures Kinematic analysis of arm trajectory and trunk motion using the Peak Performance System , as well as scores on the MAS and the Rivermead Motor Assessment ( RMA ) . RESULTS For low-level groups , TRT result ed in increased substitutive trunk use at the target ipsilateral to the moving arm , and for midline and contralateral targets after PRE . Only low-level , TRT subjects straightened h and paths , which suggested better coordination of elbow-shoulder motion , and improved on the RMA . High-level subjects decreased trunk use at ipsilateral target after PRE , which was not observed after TRT . No significant differences between training conditions were found for other kinematic variables . CONCLUSIONS Training benefits appear to depend on initial level of functioning . Although compensatory trunk use was evident , low-level subjects seemed to benefit most from TRT . High-level subjects , whose kinematics showed fairly normal movement organization , demonstrated less compensatory movement after PRE 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 Objectives : To evaluate a training programme aim ed at improving lateral weight transference in patients following acute stroke to determine main treatment effects , if any , to inform the design of future studies . Design : A single-blind r and omized controlled trial . Setting : The Stroke Unit at The James Cook University Hospital , Middlesbrough , UK . Subjects : Thirty-five patients with an acute stroke . Interventions : All subjects received their usual care , including physiotherapy . The treatment group ( n / 17 ) received 12 additional therapy sessions ( over four weeks ) comprising exercises aim ed at improving lateral weight transference in sitting delivered by trained physiotherapy assistants . Main outcome measures : Measures of dynamic reaching , sitting and st and ing , and static st and ing balance were undertaken by a blind independent observer . Results : Specific measures of weight displacement in st and ing and reaching , and timed st and ing up and sitting down did not detect any differences over time regardless of group . Neither were there any significant changes over time , except for sway during static st and ing ( p B=0.01 ) and time to return to their original position during dynamic reaching ( p / 0.01 ) . Conclusions : A training programme aim ed at improving lateral weight transference did not appear to enhance the rehabilitation of acute stroke patients . Improvements observed in postural control in st and ing and sitting may be attributable to usual care or natural recovery This study was a preliminary examination of the effect of low-intensity home-based physical therapy on the performance of activities of daily living ( ADL ) and motor function in patients more than 1 year after stroke . Twenty patients were recruited from a community stroke register in Nan-Tou County , Taiwan , to a r and omized , crossover trial comparing intervention by a physical therapist immediately after entry into the trial ( Group I ) or after a delay of 10 weeks ( Group II ) . The intervention consisted of home-based physical therapy once a week for 10 weeks . The Barthel Index ( BI ) and Stroke Rehabilitation Assessment of Movement ( STREAM ) were used as st and ard measures for ADL and motor function . At the first follow-up assessment at 11 weeks , Group I showed greater improvement in lower limb motor function than Group II . At the second follow-up assessment at 22 weeks , Group II showed improvement while Group I had declined . At 22 weeks , the motor function of upper limbs , mobility , and ADL performance in Group II had improved slightly more than in Group I , but the between-group differences were not significant . It appears that low-intensity home-based physical therapy can improve lower limb motor function in chronic stroke survivors . Further studies will be needed to confirm these findings The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating The Rivermead Behavioral Inattention Test ( RBIT ) , consisting of nine items sampling activities of daily living , was administered to 28 patients after unilateral right ( 20 ) or left ( 8) cerebrovascular accidents , and to 14 non-brain-damaged controls . All patients were tested on two parallel forms of the RBIT with order of presentation balanced and on at least two of six conventional tests of visual neglect . Control subjects were tested on either form 1 or form 2 of the RBIT .  Interrater reliability of scoring was tested on seven subjects chosen at r and om . Using control scores to determine the cutoff point between visual inattention and noninattention , 14 patients ( 50 % ) showed evidence of visuospatial neglect on the RBIT .  Correlation between the two forms of the test was 0.83 . The RBIT also correlated well with five of the conventional tests . Interrater reliability was 100 % . The RBIT appears to be a valid and reliable test of visuospatial neglect and one which is likely to provide more information about everyday problems than existing measures of neglect Time course and degree of the recovery of walking function after stroke and the influence of initial lower extremity ( LE ) paresis were studied prospect ively in a community-based population of 804 consecutive acute stroke patients .  Walking function and degree of LE paresis were assessed weekly using the Barthel index and the Sc and inavian Neurological Stroke scale , respectively . Initially , 51 % had no walking function , 12 % could walk with assistance , and 37 % had independent walking function . At the end of rehabilitation , 21 % had died , 18 % had no walking function , 11 % could walk with assistance , and 50 % had independent walking function . Recovery of walking function occurs in 95 % of the patients within the first 11 weeks after stroke . The time and the degree of recovery are related to both the degree of initial impairment of walking function and to the severity of LE paresis , p < .0001 . A valid prognosis of walking function in patients with initially no/mild/moderate leg paresis can be made in 3 weeks , and further recovery should not be expected after 9 weeks . A valid prognosis of walking function in patients with initially severe leg paresis or paralysis can be made in 6 weeks , and further improvement of walking function should not be expected later than 11 weeks after stroke OBJECTIVE To compare outcomes in stroke survivors who received rehabilitation services in an acute inpatient rehabilitation setting ( multidisciplinary rehabilitation team ) with outcomes in survivors in a home-based setting ( family caregivers , limited team supervision ) . DESIGN R and omized clinical trial , with mean follow-up after 60 days . SETTING Inpatient rehabilitation setting and home-based setting s. PATIENTS Sixty patients ( age range , 43 - 80yr ) who had a stroke between 1996 and 1999 and had been referred after medical stabilization , r and omly divided into 2 groups : group 1 , inpatient rehabilitation ; group 2 , home-based rehabilitation . INTERVENTIONS Group 1 : therapeutical and neuromuscular exercises with occupational therapy with professional supervision ; group 2 : conventional exercises with family caregiver and limited professional supervision . MAIN OUTCOME MEASURES Spasticity was evaluated with the Ashworth Scale , motor status with Brunnstrom 's stages , functional status with the FIM instrument , and cognitive status with the Mini-Mental State Examination before and after rehabilitation . RESULTS Patients rehabilitated in acute inpatient setting s had better motor , functional , and cognitive outcomes ( p < .05 ) . Spasticity changes did not differ between the groups . CONCLUSION Intense inpatient rehabilitation services for stroke survivors provide significantly more favorable functional and cognitive outcomes with relatively low complications than did nonintense rehabilitation efforts in home setting UNLABELLED Mudge S , Barber PA , Stott NS . Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke : a r and omized controlled trial . OBJECTIVE To determine whether circuit-based rehabilitation would increase the amount and rate that individuals with stroke walk in their usual environments . DESIGN Single-blind r and omized controlled trial . SETTING Rehabilitation clinic . PARTICIPANTS Sixty participants with a residual gait deficit at least 6 months after stroke originally enrolled in the study . Two withdrew in the initial phase , leaving 58 participants ( median age , 71.5y ; range , 39.0 - 89.0y ) who were r and omized to the 2 intervention groups . INTERVENTIONS The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit class design ed to improve walking . The control group received a comparable duration of group social and educational classes . MAIN OUTCOME MEASURES Usual walking performance was assessed using the StepWatch Activity Monitor . Clinical tests were gait speed ( timed 10-meter walk ) and endurance ( six-minute walk test [ 6MWT ] ) , confidence ( Activities-Based Confidence Scale ) , self-reported mobility ( Rivermead Mobility Index [ RMI ] ) , and self-reported physical activity ( Physical Activity and Disability Scale ) . RESULTS Intention-to-treat analysis revealed that the exercise group showed a significantly greater distance for the 6MWT than the control group immediately after the intervention ( P=.030 ) but that this effect was not retained 3 months later . There were no changes in the StepWatch measures of usual walking performance for either group . The exercise and control groups had significantly different gait speed ( P=.038 ) and scores on the RMI ( P=.025 ) at the 3-month follow-up . These differences represented a greater decline in the control group compared with the exercise group for both outcome measures . CONCLUSIONS Circuit-based rehabilitation leads to improvements in gait endurance but does not change the amount or rate of walking performance in usual environments . Clinical gains made by the exercise group were lost 3 months later . Future studies should consider whether rehabilitation needs to occur in usual environments to improve walking performance Objective : To find out if there were any differences in improvement and maintenance of motor function , activity of daily living and grip strength between patients with first-ever stroke receiving two different strategies of physical exercise during the first year after stroke . Design : A longitudinal r and omized controlled stratified trial . Setting : Rehabilitation institutions , community , patients ' homes and nursing homes . Subjects : Seventy-five male and female first-time-ever stroke patients : 35 in an intensive exercise group and 40 in a regular exercise group . Intervention : The intensive exercise group received physiotherapy with focus on intensive exercises in four periods during the first year after stroke . The regular exercise group patients were followed up according to their subjective needs during the corresponding year . Main outcome measures : Motor Assessment Scale , Barthel Index of Activities of Daily Living , and grip strength . Results : Both groups improved significantly up to six months when function stabilized . The groups did not differ significantly on any test occasions . The difference of improvement from admission to discharge was significant in favour of the intensive exercise group , in the Motor Assessment Scale total score ( intensive exercise group 7.5 ; regular exercise group 1.7 , P = 0.01 ) , and in the Barthel Index of Activities of Daily Living total score ( 17.4 versus 8.9 , P = 0.04 ) . Conclusion : Motor function , activities of daily living functions and grip strength improved initially and were maintained during the first year after stroke in all patients irrespective of exercise regime . This indicates the importance of motivation for regular exercise in the first year following stroke , achieved by regular check-ups Objective : To examine whether two different physiotherapy regimes caused any differences in outcome in rehabilitation after acute stroke . Design : A double-blind study of patients with acute first-ever stroke . Sixty-one patients were consecutively included , block r and omized into two groups , and stratified according to gender and hemiplegic site . Group 1 ( 33 patients ) and group 2 ( 28 patients ) had physiotherapy according to Motor Relearning Programme ( MRP ) and Bobath , respectively . The supplemental treatment did not differ in the two groups . Main outcome measures : The Motor Assessment Scale ( MAS ) , the Sødring Motor Evaluation Scale ( SMES ) , the Barthel ADL Index and the Nottingham Health Profile ( NHP ) were used . The following parameters were also registered : length of stay in the hospital , use of assistive devices for mobility , and the patient 's accommodation after discharge from the hospital . Results : Patients treated according to MRP stayed fewer days in hospital than those treated according to Bobath ( mean 21 days versus 34 days , p = 0.008 ) . Both groups improved in MAS and SMES , but the improvement in motor function was significantly better in the MRP group . The two groups improved in Barthel ADL Index without significant differences between the groups . However , women treated by MRP improved more in ADL than women treated by Bobath . There were no differences between the groups in the life quality test ( NHP ) , use of assistive devices or accommodation after discharge from the hospital . Conclusion : The present study indicates that physiotherapy treatment using the MRP is preferable to that using the Bobath programme in the acute rehabilitation of stroke patients OBJECTIVES The goal most often stated by persons with stroke is improved walking function . The purpose of this study was to determine the effects of isokinetic strength training on walking performance , muscle strength , and health-related quality of life in survivors of chronic stroke . METHODS Twenty participants ( age , 61.2 + /- 8.4 years ) with chronic stroke were r and omized into 2 groups . The experimental group undertook maximal concentric isokinetic strength training , whereas the control group received passive range of motion of the paretic lower extremity 3 times a week for 6 weeks . The Kin-Com Isokinetic Dynamometer ( Chattanooga Group Inc. , TN ) was used for both the strengthening and passive range of motion exercises . The Mann-Whitney U test was used to compare the changes in scores ( postintervention minus baseline ) between the control and experimental groups for a composite lower extremity strength score , walking speed ( level-walking and stair-walking ) and health-related quality of life measure ( 36-Item Short Form Health Survey [ SF-36 ] ) . RESULTS Both the experimental and control groups increased their strength and walking speed postintervention ; however , there were no differences in the changes in walking speed between the groups . There was a trend ( P = .06 ) toward greater strength improvement in the experimental group compared with the control group . No changes in SF-36 scores were found in either group . CONCLUSIONS Intervention aim ed at increasing strength did not result in improvements in walking . The results of this study stress the importance of controlled clinical trials in determining the effect of specific treatment approaches . Strength training in conjunction with other task-related training may be indicated Objective : To investigate the effect of independent practice of sitting balance as an addition to st and ard physiotherapy treatment for patients with stroke . Design : R and omized controlled trial , using blocked r and omization procedure with 2:1 ratio . Subjects : In patients with diagnosis of stroke , having achieved one minute of independent sitting balance but not yet achieved 10 independent steps , and with no known previous disabilities , pathology or neurological de”cit affecting mobility prior to stroke . Intervention : A four-week regime of independent practice aim ed at improving aspects of balance , as an addition to st and ard physiotherapy treatment based on the Bobath Approach . Main outcome measure : Proportion of patients achieving ‘ normal ’ symmetry of weight distribution during sitting , st and ing , rising to st and , sitting down , and reaching . Results : Nineteen subjects were r and omized to the control group ; nine to the intervention group . There were no clinical ly signi”cant differences in measured outcome between the groups . Conclusions : The regime of independent practice had no measured bene”cial effect on the balance ability of patients with recently acquired stroke A r and omized controlled pilot trial was conducted to estimate the effects of early , intensive , gait-focused physical therapy on ambulatory ability in acute , stroke patients . Twenty-seven patients with middle cerebral artery infa rct of thromboembolic origin confirmed by computed axial tomography scan were stratified and r and omly assigned to the experimental group , to a control group that received early , intensive and conventional therapy , or to a group receiving routine conventional therapy that started later and was not intense . Assessment s at entry , six weeks , and three and six months by independent evaluators permitted comparisons with reference to clinical measures of motor performance , balance , and functional capacity , and laboratory measures of gait movements . Group results at six weeks demonstrated that gait velocity was similar in the two conventional groups thereby eliminating the timing of the interventions as an important factor . At that point , gait velocity was faster in the experimental group . The difference translated into a moderate effect size of 0.58 . The time dedicated to gait training but not to total therapy time was correlated ( rs = 0.63 ) to gait velocity . This effect disappeared at three and six months after stroke . These pilot results justify planning a large trial to test the effectiveness of a therapeutic protocol that focuses on early and intense gait therapy in an effort to facilitate early ambulation following stroke 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 : To compare the short-term effects of two physiotherapy approaches for improving ability to walk in different environments following stroke : ( i ) interventions based on the Bobath concept , in conjunction with task practice , compared to ( ii ) structured task practice alone . Design : R and omized controlled trial . Setting : Two rehabilitation centres Participants : Twenty-six participants between four and 20 weeks post-stroke , able to walk with supervision indoors . Interventions : Both groups received six one-hour physiotherapy sessions over a two-week period . One group received physiotherapy based on the Bobath concept , including one hour of structured task practice . The other group received six hours of structured task practice . Outcome measures : The primary outcome was an adapted six-minute walk test , incorporating a step , ramp and uneven surface . Secondary measures were gait velocity and the Berg Balance Scale . Measures were assessed before and after the intervention period . Results : Following the intervention , there was no significant difference in improvement between the two groups for the adapted six-minute walk test ( 89.9 ( st and ard deviation ( SD ) 73.1 ) m Bobath versus 41 ( 40.7 ) m task practice , P = 0.07 ) . However , walking velocity showed significantly greater increases in the Bobath group ( 26.2 ( SD 17.2 ) m/min versus 9.9 ( SD = 12.9 ) m/min , P = 0.01 ) . No significant differences between groups were recorded for the Berg Balance Scale ( P = 0.2 ) . Conclusion : This pilot study indicates short-term benefit for using interventions based on the Bobath concept for improving walking velocity in people with stroke . A sample size of 32 participants per group is required for a definitive study Objective . To determine whether Adaptive Physical Activity ( APA-stroke ) , a community-based exercise program for participants with hemiparetic stroke , improves function in the community . Methods . Nonr and omized controlled study in Tuscany , Italy , of participants with mild to moderate hemiparesis at least 9 months after stroke . Forty-nine participants in a geographic health authority ( Empoli ) were offered APA-stroke ( 40 completed the study ) . Forty-four control participants in neighboring health authorities ( Florence and Pisa ) received usual care  ( 38 completed the study ) . The APA intervention was a community-based progressive group exercise regimen that included walking , strength , and balance training for 1 hour , thrice a week , in local gyms , supervised by gym instructors . No serious adverse clinical events occurred during the exercise intervention . Outcome measures included the following : 6-month change in gait velocity ( 6-Minute Timed Walk ) , Short Physical Performance Battery ( SPPB ) , Berg Balance Scale , Stroke Impact Scale ( SIS ) , Barthel Index , Hamilton Rating Scale for Depression , and Index of Caregivers Strain . Results . After 6 months , the intervention group improved whereas controls declined in gait velocity , balance , SPPB , and SIS social participation domains . These between-group comparisons were statistically significant at P < .00015 . Individuals with  depressive symptoms at baseline improved whereas controls were unchanged ( P < .003 ) . Oral glucose tolerance tests were performed on a subset of participants in the intervention group . For these individuals , insulin secretion declined 29 % after 6 months ( P = .01 ) . Conclusion . APA-stroke appears to be safe , feasible , and efficacious in a community setting Abstract Background and Objective : The ability to walk is impaired in more than 80 % of poststroke patients . The objective of the present study was to evaluate the effectiveness of the task-oriented circuit class training ( TOCCT ) with motor imagery ( MI ) on the gait during the subacute phase after a stroke . Method : This was a r and omized , controlled , assessor-blinded trial in a neurology department of a university hospital . A convenience sample of 30 people , 4 to 12 weeks ( mean , 6.3 weeks ) after the stroke was r and omized into 2 groups ( the TOCCT with MI and st and ard training group ) of 15 people each . Twenty-nine participants completed the 6-week follow-up . Participants were assigned to receive either the TOCCT with MI or dose-matched st and ard training program based on the Bobath ’s neurodevelopmental technique , 7 days a week for 2 weeks , as out patients or in patients . Outcome measures were the Functional Ambulation Classification ( FAC ) , the Rivermead Visual Gait Assessment ( RVGA ) , step length asymmetry , walking speed , and 6-minute walk test ( 6MWT ) . Results : The TOCCT with MI group showed a positive improvement in the mean/median scores on most of the outcome measures at post and follow-up assessment s in comparison to the control group . However , statistically significant differences were observed in changes between the groups at post and follow-up assessment for FAC , RVGA , walking speed , and 6MWT ( ANOVA , P = .001 to .049 ; Mann-Whitney U test , P = .001 ) . Conclusion : Among the patients who had a stroke within the previous 4 to 12 weeks , the TOCCT with MI produced statistically significant and clinical ly relevant improvements in the gait and the gait-related activities
BACKGROUND Various approaches to physical rehabilitation may be used after stroke , and considerable controversy and debate surround the effectiveness of relative approaches .
Some physiotherapists base their treatments on a single approach ; others use a mixture of components from several different approaches .
OBJECTIVES To determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke , and to assess if any one physical rehabilitation approach is more effective than any other approach .
For the previous versions of this review , the objective was to explore the effect of ' physiotherapy treatment approaches ' based on historical classifications of orthopaedic , neurophysiological or motor learning principles , or on a mixture of these treatment principles .
For this up date of the review , the objective was to explore the effects of approaches that incorporate individual treatment components , categorised as functional task training , musculoskeletal intervention ( active ) , musculoskeletal intervention ( passive ) , neurophysiological intervention , cardiopulmonary intervention , assistive device or modality .
In addition , we sought to explore the impact of time after stroke , geographical location of the study , dose of the intervention , provider of the intervention and treatment components included within an intervention .