Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. Randomized clinical trial of therapeutic exercise in subacute stroke. A randomized trial evaluation of the Oswestry Standing Frame for patients after stroke Do people with acquired brain impairment benefit from additional therapy specifically directed at the hand? A randomized controlled trial Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study) Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke: A Randomized Controlled Pilot Study A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial Effects of intensive therapy using gait trainer or floor walking exercises early after stroke. Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke Early and Repetitive Stimulation of the Arm Can Substantially Improve the Long-Term Outcome After Stroke: A 5-Year Follow-up Study of a Randomized Trial The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial What is the benefit of a high-intensive exercise program on health-related quality of life and depression after stroke? A randomized controlled trial Effects of a Community-Based Intensive Motor Training Program Combined With Early Supported Discharge After Treatment in a Comprehensive Stroke Unit: A Randomized, Controlled Trial Enhanced physical therapy improves recovery of arm function after stroke. 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. Analysis of fMRI and finger tracking training in subjects with chronic stroke. Additional Exercises Improve Trunk Performance After Stroke: A Pilot Randomized Controlled Trial Arm Training Induced Brain Plasticity in Stroke Studied with Serial Positron Emission Tomography Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial. Reduction of spastic hypertonia during repeated passive knee movements in stroke patients. Balance outcomes after additional sit-to-stand training in subjects with stroke: a randomized controlled trial A community-based group exercise program for persons with chronic stroke. Classification and natural history of clinically identifiable subtypes of cerebral infarction Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot study of immediate and long-term outcomes. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial How feasible is the attainment of community ambulation after stroke? A pilot randomized controlled trial to evaluate community-based physiotherapy in subacute stroke Training symmetry of weight distribution after stroke: a randomized controlled pilot study comparing task-related reach, Bo bath and feedback training approaches Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study. The Role of Technology in Task-Oriented Training in Persons with Subacute Stroke: A Randomized Controlled Trial Effect of 6 weeks wobble board exercises on static and dynamic balance of stroke survivors. The influence of early cycling training on balance in stroke patients at the subacute stage. Results of a preliminary trial Effectiveness of modified constraint-induced movement therapy on upper limb function in stroke subjects. [Computer-based rehabilitation of cognitive impairments and motor arm function of patients with hemiparesis after stroke]. Effectiveness of unilateral and symmetrical bilateral task training for arm during the subacute phase after stroke: a randomized controlled trial Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: a single-blind, randomized, controlled trial. Motor relearning programme for stroke patients: a randomized controlled trial Rehabilitation of postural disturbances of hemiplegic patients by using trunk control retraining during exploratory exercises. Motor learning following unilateral 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 Lateral weight transference exercises following acute stroke: a preliminary study of clinical effectiveness The results of clinical trials in stroke rehabilitation research. Gait outcomes after additional backward walking training in patients with stroke: a randomized controlled trial The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial Group exercise can improve participants' mobility in an outpatient rehabilitation setting: a randomized controlled trial Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Bobath or Motor Relearning Programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. 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. Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke
BACKGROUND AND PURPOSE Arm function recovery is notoriously poor in stroke patients . The effect of treatment modalities , particularly those directed at improving upper limb function , has been studied primarily in chronic stroke patients . The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke . METHODS In a single-blind , r and omized , controlled multicenter trial , 100 consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group . The intervention was applied for 6 weeks . Patients were evaluated for level of impairment ( Brunnström-Fugl-Meyer test ) and disability ( Action Research Arm test , Barthel Index ) before , midway , and after the intervention period and at follow-up 6 and 12 months after stroke . RESULTS Patients in the experimental group performed better on the Brunnström-Fugl-Meyer test than those in the control group throughout the study period , but differences were significant only at follow-up . Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability . The effect of the therapy was attributed to the repetitive stimulation of muscle activity . The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention . No adverse effects due to the intervention were found . CONCLUSIONS Adding a specific intervention during the acute phase after stroke improved motor recovery , which was apparent 1 year later . These results emphasize the potential beneficial effect of therapeutic interventions for the arm 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 : St and ing is believed to have benefits in addressing motor and sensory impairments after stroke . One device to facilitate st and ing for severely disabled patients is the Oswestry St and ing Frame . Objective : To evaluate the effectiveness of the Oswestry St and ing Frame for severely disabled stroke patients . Design : A single centre , r and omized controlled trial . Setting : An inpatient stroke rehabilitation unit . Subjects : Patients were recruited if they had a clinical diagnosis of stroke , were medically stable and unable to achieve any score on the Trunk Control Test or unable to st and in mid-line without the assistance of two therapists . Intervention : The intervention ( n=71 ) and control ( n=69 ) groups both received usual stroke unit care but the intervention group also received a minimum of 14 consecutive days ' treatment using the st and ing frame . Main outcome measures : The primary outcome measure was the Rivermead Mobility Index ( RMI ) . Secondary measures included the Barthel Index ; the Rivermead Motor Assessment ; the balanced sitting and sitting to st and ing components of the Motor Assessment Scale ; the Trunk Control Test and the Hospital Anxiety and Depression Scale . Blind assessment was undertaken at baseline , six weeks , 12 weeks and six months post stroke . Information on re source use was also collected . Results : There was no statistically significant difference between groups in any of the outcome measures or for re source use . Mann-Whitney U-tests for the RMI change from baseline scores to six weeks , 12 weeks and six months post stroke were p=0.310 ; p=0.970 and p=0.282 , respectively . Conclusion : Use of the Oswestry St and ing Frame did not improve clinical outcome or provide re source savings for this severely disabled patient group Objective : To determine the benefits of additional therapy specifically directed at the h and in people with acquired brain impairment . Design : An assessor-blinded r and omized controlled trial . Setting : Rehabilitation hospital . Participants : A sample of 39 adults with h and impairment following stroke ( 90 % ) or traumatic brain injury ( 10 % ) . The median ( interquartile ) time since injury was 1.6 months ( 0.5—3.5 months ) . Intervention : The experimental group ( n = 20 ) received an additional one-hour session of task-specific motor training for the h and five times a week over a six-week period . The training was administered on a one-to-one basis . The control group ( n = 19 ) received st and ard care which consisted of 10 minutes of h and therapy three times a week . Both groups continued to receive therapy directed at the shoulder and elbow . Outcome measures : Primary outcomes were the Action Research Arm and Summed Manual Muscle Tests measured at the beginning and end of the six-week period . Results : The mean ( SD ) Action Research Arm Test values for experimental participants improved from the beginning to the end of study from 10 points ( 15 ) to 21 points ( 23 ) and the equivalent values for the Summed Manual Muscle Test improved from 35 % ( 33 ) to 49 % ( 35 ) . There were similar improvements in control participants . The mean between-group differences for the Action Research Arm and Summed Manual Muscle Tests were -6 points ( 95 % confidence interval ( CI ) , -20 to 8) and 3 % ( 95 % CI , -10 to 16 ) , respectively . Conclusion : H and and overall arm function of all participants improved over the six-week period , however there was not a clear benefit from providing additional h and therapy BACKGROUND The incidence of stroke is predicted to rise because of the rapidly ageing population . However , over the past two decades , findings of r and omised trials have identified several interventions that are effective in prevention of stroke . Reliable data on time-trends in stroke incidence , major risk factors , and use of preventive treatments in an ageing population are required to ascertain whether implementation of preventive strategies can offset the predicted rise in stroke incidence . We aim ed to obtain these data . METHODS We ascertained changes in incidence of transient ischaemic attack and stroke , risk factors , and premorbid use of preventive treatments from 1981 - 84 ( Oxford Community Stroke Project ; OCSP ) to 2002 - 04 ( Oxford Vascular Study ; OXVASC ) . FINDINGS Of 476 patients with transient ischaemic attacks or strokes in OXVASC , 262 strokes and 93 transient ischaemic attacks were incident events . Despite more complete case-ascertainment than in OCSP , age-adjusted and sex-adjusted incidence of first-ever stroke fell by 29 % ( relative incidence 0.71 , 95 % CI 0.61 - 0.83 , p=0.0002 ) . Incidence declined by more than 50 % for primary intracerebral haemorrhage ( 0.47 , 0.27 - 0.83 , p=0.01 ) but was unchanged for subarachnoid haemorrhage ( 0.83 , 0.44 - 1.57 , p=0.57 ) . Thus , although 28 % more incident strokes ( 366 vs 286 ) were expected in OXVASC due to demographic change alone ( 33 % increase in those aged 75 or older ) , the observed number fell ( 262 vs 286 ) . Major reductions were recorded in mortality rates for incident stroke ( 0.63 , 0.44 - 0.90 , p=0.02 ) and in incidence of disabling or fatal stroke ( 0.60 , 0.50 - 0.73 , p<0.0001 ) , but no change was seen in case-fatality due to incident stroke ( 17.2 % vs 17.8 % ; age and sex adjusted relative risk 0.85 , 95 % CI 0.57 - 1.28 , p=0.45 ) . Comparison of premorbid risk factors revealed substantial reductions in the proportion of smokers , mean total cholesterol , and mean systolic and diastolic blood pressures and major increases in premorbid treatment with antiplatelet , lipid-lowering , and blood pressure lowering drugs ( all p<0.0001 ) . INTERPRETATION The age-specific incidence of major stroke in Oxfordshire has fallen by 40 % over the past 20 years in association with increased use of preventive treatments and major reductions in premorbid risk factors Background and Purpose — The success of gait rehabilitation after stroke depends on active walking exercises . However , the disabling after-effects of stroke often make such exercises impossible at the onset of therapy . To facilitate treadmill training of paraparetic patients , a robot-driven gait orthosis ( Lokomat ) was developed . We investigated the effects of the Lokomat when used with hemiparetic patients . Methods — The authors conducted a r and omized , controlled pilot study of 30 acute stroke survivors . The treatment group received 30 minutes of robotic training daily and the control group 30 minutes of conventional physiotherapy daily in addition to 30 minutes of conventional physiotherapy for each group . Outcome measures were independence of gait , gait speed , gait parameters , and body tissue composition . Results — After 4 weeks of therapy , the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved . The functional ambulation category ( median± interquartile range ) was at baseline 0±0 in control and 0±1 in the therapy group and increased after therapy to 1±3 in both groups significantly ( P=0.01 ) . There was no significant difference in gain of these parameters between the groups . The Lokomat group had a significantly longer single stance phase ( sec ; mean±SEM ) on the paretic leg when walking on the floor . At baseline , it was 0.19±0.17 and after therapy 0.49±0.07 ( P=0.014 ) . The control group had increased their body weight approximately 1.33±1.40 kg ( mean±SEM ; P=0.046 ) , mostly as fat mass , whereas the Lokomat group had lost fat mass approximately −2.9±1.0 kg ( mean±SEM ; P=0.016 ) and increased their muscle mass approximately 3.36±1.4 kg ( mean± SEM ; P=0.031 ) . Conclusions — This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation . Although there was no difference between groups in gain of functional scores , the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition 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 analyse the effects of gait therapy for patients after acute stroke in a r and omized controlled trial . METHODS Fifty-six patients with a mean of 8 days post-stroke participated in : ( i ) gait trainer exercise ; ( ii ) walking training over ground ; or ( iii ) conventional treatment . Patients in the gait trainer exercise and walking groups practice d gait for 15 sessions over 3 weeks and received additional physiotherapy .  Functional Ambulatory Category and several secondary outcome measures assessing gait and mobility were administered before and after rehabilitation and at 6-month follow-up . Patients also evaluated their own effort . RESULTS Walking ability improved more with intensive walk training compared with conventional treatment ; median Functional Ambulatory Category was zero in all patients at the start of the study , but it was 3 in both walk-training groups and 0.5 in the conventional treatment group at the end of the therapy . Median Functional Ambulatory Category was 4 in both walk-training groups and 2.5 in conventional treatment group at 6-month follow-up . Mean accomplished walking distance was not different between the gait trainer exercise and over ground walking groups . Borg scale indicated more effort in over ground walking . Secondary outcomes also indicated improvements . CONCLUSION Exercise therapy with walking training improved gait function irrespective of the method used , but the time and effort required to achieve the results favour the gait trainer exercise . Early intensive gait training result ed in better walking ability than did conventional treatment 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 — Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke , with follow-ups at a maximum of 12 months . The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke . Subjects and Methods — One hundred consecutive stroke patients were r and omly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group . The intervention period was 6 weeks . Assessment s of the patients were made before , midway , and after intervention , and at 6 and 12 months after stroke . In this study , 62 patients were reassessed at 5 years after stroke . The Brunnström-Fugl-Meyer ( BFM ) test , Action Research Arm ( ARA ) test , and Barthel index ( BI ) were used as the primary outcome measures . Results — At the 5-year follow-up , there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group . The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA . No effect was found for the BI . The treatment was most effective in patients with a severe initial motor deficit . Conclusions — Adding a specific intervention for the arm during the acute phase after a stroke result ed in a clinical ly meaningful and long-lasting effect on motor function . The effect can be attributed to early , repetitive , and targeted stimulation OBJECTIVES To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific , influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity . DESIGN Secondary analysis of a two-center , observer-blinded , r and omized , controlled trial . SETTING General community . PARTICIPANTS Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke . INTERVENTION Task-oriented interventions targeting walking or upper extremity ( UE ) function were provided three times a week for 6 weeks . MEASUREMENTS Activities-specific Balance Confidence Scale , Six-Minute Walk Test , 5-m walk , Berg Balance Scale , and Timed " Up and Go " administered at baseline and postintervention . RESULTS The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the UE intervention . Treatment effects were largest in persons with low self-efficacy at baseline and for activities relating to tasks practice d. In the walking group , change in balance self-efficacy correlated with change in functional walking capacity ( correlation coefficient=0.45 , 95 % confidence interval=0.16 - 0.68 ) . Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age , sex , comorbidity , time poststroke , and functional mobility on change in self-efficacy . CONCLUSION Task-oriented walking retraining enhances balance self-efficacy in community-dwelling individuals with chronic stroke . Benefits may be partially the result of improvement in walking capacity . The influence of baseline level of self-efficacy , depressive symptoms , and prognostic variables on treatment effects are of clinical importance and must be verified in future studies 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 Abstract The aim of the study was to evaluate the impact of a high-intensive exercise program containing high-intensive functional exercises implemented to real-life situations together with group discussion s on falls and security aspects in stroke subjects with risk of falls . This was a pre-specified secondary outcome for this study . For evaluation , Short Form-36 ( SF-36 ) health-related quality of life ( HRQoL ) and the Geriatric Depression Scale-15 ( GDS-15 ) were used . This was a single-center , single-blinded , r and omized , controlled trial . Consecutive ≥55 years old stroke patients with risk of falls at 3–6 months after first or recurrent stroke were r and omized to the  intervention group ( IG , n=15 ) or to the control group ( CG , n=19 ) who received group discussion with focus on hidden dysfunctions but no physical fitness training . The 5-week high-intensive exercise program was related to an improvement in the CG in the SF-36 Mental Component Scale and the Mental Health subscale at 3 months follow-up compared with baseline values while no improvement was seen in the IG at this time . For the SF-36 Physical Component Scale , there was an improvement in the whole study group at 3 and 6 months follow-up compared with baseline values without any significant changes between the IG and CG . The GDS-15 was unchanged throughout the follow-up period for both groups . Based on these data , it is concluded that high-intensive functional exercises implemented in real-life situations should also include education on hidden dysfunctions after stroke instead of solely focus on falls and safety aspects to have a favorable impact on Background and Purpose — Increased amount of therapy seems to be beneficial for motor recovery after stroke . The primary aim of the present study was to evaluate the effect of a 4-week community-based intensive motor training program combined with early supported discharge after initial treatment in a comprehensive stroke unit on balance . Secondary aims were to evaluate the effect on other functional outcome measures . Methods — This was a single-blind , r and omized , controlled trial with a 26-week follow-up . Sixty-two patients were recruited within 14 days after stroke and were r and omly allocated to a st and ard treatment group (  n=32  ) or to an intensive motor training group ( n=30 ) receiving 3 sessions of physical therapy and a structured home exercise program in addition to st and ard treatment every week for the first 4 weeks after discharge from hospital . Primary outcome measure was Berg Balance Scale . Secondary measures were Barthel Index , Motor Assessment Scale , Step Test , 5-meter Walk Test , and Stroke Impact Scale . Results — The mean ( SD ) minutes of physical therapy per week was 171.0 ( 65.8 ) in the intensive motor training group vs 85.6(69.9 ) in the st and ard treatment group . There were no statistical significant differences between the groups on any measure at end of follow-up except for a trend toward higher Motor Assessment Scale score ( P=0.059 ) and gait speed ( P=0.095 ) in the intensive motor training group . Conclusion — In this r and omized , controlled trial , a community-based intensive motor training program , doubling the amount of physical therapy during the first 4 weeks after discharge , did not show significant improvement of balance or any other functional outcomes Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia . A detailed study was carried out of recovery of arm function after acute stroke , and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning . In a single-blind r and omised trial , 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups . At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength , range and speed of movement . This effect seemed concentrated amongst those who had a milder initial impairment . More work is needed to discover the reasons for this improved recovery , and whether further development of this therapeutic approach might offer clinical ly significant gains for some patients 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 H and movement recovery and cortical reorganization were studied in 10 subjects with chronic stroke using  functional MRI ( fMRI ) before and after training with an intensive finger movement tracking programme . Subjects were assigned r and omly to a treatment or control group . The treatment group received 18 - 20 sessions of finger tracking training using target waveforms under variable conditions . The control group crossed over to receive the same treatment after the control period . For comparison with a healthy population , nine well elderly females were also studied ; however , the well elderly controls did not cross over after the control period . The dependent variables consisted of a Box and Block score to measure prehensile ability ( subjects with stroke only ) , a tracking accuracy score and quantification of active cortical areas using fMRI . For the tracking tests , the subjects tracked a sine wave target on a computer screen with extension and flexion movements of the paretic index finger . Functional brain images were collected from the frontal and parietal lobes of the subject with a 4 tesla magnet . Areas of interest included the sensorimotor cortex ( SMC ) , primary motor area ( M1 ) , primary sensory area ( S1 ) , premotor cortex ( PMC ) and supplementary motor area ( SMA ) . Comparison between all subjects with stroke and all well elderly subjects at pre-test was analysed with two- sample t-tests . Change from pre-test to post-test within subjects was analysed with paired t-tests . Statistical significance was set at P < 0.05 . Stroke treatment subjects demonstrated significant improvement in tracking accuracy , whereas stroke control subjects did not until after crossover treatment . At pre-test , the cortical activation in the subjects with stroke was predominantly ipsilateral to the performing h and , whereas in the well elderly subjects it was contralateral . Activation for the stroke treatment group following training switched to contralateral in SMC , M1 , S1 and PMC . The stroke control group 's activation remained ipsilateral after the control period , but switched to contralateral after crossover to receive treatment . All well elderly subjects maintained predominantly contralateral activation throughout . Transfer of skill to functional activity was shown in significantly improved Box and Block scores for the stroke treatment group , with no such improvement in the stroke control group until after crossover . We concluded that individuals with chronic stroke receiving intensive tracking training showed improved tracking accuracy and grasp and release function , and that these improvements were accompanied by brain reorganization 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 We used serial positron emission tomography ( PET ) to study training-induced brain plasticity after severe hemiparetic stroke . Ten patients were r and omized to either  task-oriented arm training or to a control group  and scanned before and after 22.6 + /- 1.6 days of treatment using passive movements as an activation paradigm . Increases of regional cerebral blood flow ( rCBF ) were assessed using statistical parametric mapping ( SPM99 ) . Before treatment , all stroke patients revealed bilateral activation of the inferior parietal cortex ( IPC ) . After task-oriented arm training , activation was found bilaterally in IPC and premotor cortex , but also in the contralateral sensorimotor cortex ( SMC ) . The control group only showed weak activation of the ipsilateral IPC . After treatment , the training group revealed relatively more activation bilaterally in IPC , premotor areas , and in the contralateral SMC .  Five normal subjects showed no statistical significant differences between two separate PET studies . In this group of patients , task-oriented arm training induced functional brain reorganization in bilateral sensory and motor systems 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 OBJECTIVES To quantify changes in spastic hypertonia during repeated passive isokinetic knee movements in stroke patients and to assess the role of muscle activity . DESIGN A between-groups design with repeated measures . SETTING Rehabilitation center for stroke patients . PARTICIPANTS Ten stroke patients with hypertonia and 10 healthy subjects matched for age and gender . INTERVENTION With an isokinetic apparatus , movements were imposed on the knee in series of 10 repetitions at speeds of 60 degrees /s , 180 degrees /s , and 300 degrees /s . MAIN OUTCOME MEASURES Spastic hypertonia was assessed on the basis of torque measurement and electromyographic activity of the quadriceps , hamstrings , and gastrocnemius muscles . RESULTS Compared with the controls , stroke patients presented a significantly stronger torque reduction during the mid- and endphases of movements at all speeds tested ( P<.05 ) . The strongest torque decline occurred during knee flexion and during the first movements . The effect increased toward the end phase of movements and with increasing speeds . The effect of movement repetitions on torque measurements was unchanged after electromyographic activity was included in the statistical analysis , except during extension movements at 180 degrees /s and 300 degrees /s . CONCLUSION Passive movements of the knee induced a decrease of spastic hypertonia in stroke patients through a combination of reflexive and mechanical factors . The role of these mechanisms is velocity dependent and differs for flexion and extension movements Objective : To determine the effectiveness of sit-to-st and training in individuals with stroke . Design : R and omized controlled trial . Setting : Rehabilitation medical centre . Participants : Thirty-two subjects with stroke were r and omly assigned to the control and experimental groups ( n = 16 for each group ) . Interventions : Subjects in both groups received 30 minutes of general physical therapy three times a week for four weeks . Subjects in the experimental group received additional sit-to-st and training for 15 minutes each time . The total amount of therapy received was 45 minutes in the experimental group and 30 minutes in the control group each time . Main outcome measures : The weight-bearing distribution during quiet st and ing , the directional control and maximal excursion during limits of stability test , the scores of Berg Balance Scale and the extensor muscle strength of lower extremity were assessed before and after completing the 12 treatment sessions . Results : Our data showed significant improvements in directional control anteriorly in the experimental group ( from 47.4 (36.6)% to 62.6 (26.1)% ) compared with the control group ( from 68.7 (16.7)% to 62.8 (29.7)% ) ( P = 0.028 ) . A significant improvement in affected hip extensor strength was noted in the experimental group ( from 19.3 (9.8)% to 22.6 (8.4)% ) compared with the control group ( from 24.4 (9.0)% to 22.8 (7.2)% ) ( P = 0.006 ) . Significant improvements were noted only in the experimental group after treatment , including bilateral extensors , except the affected plantar flexors , the weight distribution in st and ing , the maximal excursion ( Panterior = 0.049 ; Paffected = 0.023 ) and the directional control ( Paffected = 0.013 ; Pnon-affected = 0.025 ) . Conclusions : Additional sit-to-st and training is encouraged due to effects on dynamic balance and extensor muscles strength in subjects with 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 ) We describe the incidence and natural history of four clinical ly identifiable subgroups of cerebral infa rct ion in a community-based study of 675 patients with first-ever stroke . Of 543 patients with a cerebral infa rct , 92 ( 17 % ) had large anterior circulation infa rcts with both cortical and subcortical involvement ( total anterior circulation infa rcts , TACI ) ; 185 ( 34 % ) had more restricted and predominantly cortical infa rcts ( partial anterior circulation infa rcts , PACI ) ; 129 ( 24 % ) had infa rcts clearly associated with the vertebrobasilar arterial territory ( posterior circulation infa rcts , POCI ) ; and 137 ( 25 % ) had infa rcts confined to the territory of the deep perforating arteries ( lacunar infa rcts , LACI ) . There were striking differences in natural history between the groups . The TACI group had a negligible chance of good functional outcome and mortality was high . More than twice as many deaths were due to the complications of immobility than to direct neurological sequelae of the infa rct . Patients in the PACI group were much more likely to have an early recurrent stroke than were patients in other groups . Those in the POCI group were at greater risk of a recurrent stroke later in the first year after the index event but had the best chance of a good functional outcome . Despite the small anatomical size of the infa rcts in the LACI group , many patients remained substantially h and icapped . The findings have important implication s for the planning of stroke treatment trials and suggest that various therapies could be directed specifically at the subgroups 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 OBJECTIVE To evaluate the immediate and long-term effects of 2 upper-extremity rehabilitation approaches for stroke compared with st and ard care in participants stratified by stroke severity . DESIGN Nonblinded , r and omized controlled trial ( baseline , postintervention , 9mo ) design . SETTING Inpatient rehabilitation hospital and outpatient clinic . PARTICIPANTS Sixty-four patients with recent stroke admitted for inpatient rehabilitation were r and omized within severity strata ( Orpington Prognostic Scale ) into 1 of 3 intervention groups . Forty-four patients completed the 9-month follow-up . INTERVENTIONS St and ard care ( SC ) , functional task practice ( FT ) , and strength training ( ST ) . The FT and ST groups received 20 additional hours of upper-extremity therapy beyond st and ard care distributed over a 4- to 6-week period . MAIN OUTCOME MEASURES Performance measures of impairment ( Fugl-Meyer Assessment ) , strength ( isometric torque ) , and function ( Functional Test of the Hemiparetic Upper Extremity [ FTHUE ] ) . RESULTS Compared with SC participants , those in the FT and ST groups had significantly greater increases in Fugl-Meyer motor scores ( P=.04 ) and isometric torque ( P=.02 ) posttreatment . Treatment benefit was primarily in the less severe participants , where improvement in FT and ST group Fugl-Meyer motor scores more than doubled that of the SC group . Similar results were found for the FTHEU and isometric torque . During the long term , at 9 months , the less severe FT group continued to make gains in isometric muscle torque , significantly exceeding those of the ST group ( P<.05 ) . CONCLUSIONS Task specificity and stroke severity are important factors for rehabilitation of arm use in acute stroke . Twenty hours of upper extremity-specific therapy over 4 to 6 weeks significantly affected functional outcomes . The immediate benefits of a functional task approach were similar to those of a resistance-strength approach , however , the former was more beneficial in the long-term BACKGROUND We investigated the effects of different intensities of arm and leg rehabilitation training on the functional recovery of activities of daily living ( ADL ) , walking ability , and dexterity of the paretic arm , in a single-blind r and omised controlled trial . METHODS Within 14 days after stroke onset , 101 severely disabled patients with a primary middle-cerebral-artery stroke were r and omly assigned to : a rehabilitation programme with emphasis on arm training ; a rehabilitation programme with emphasis on leg training ; or a control programme in which the arm and leg were immobilised with an inflatable pressure splint . Each treatment regimen was applied for 30 min , 5 days a week during the first 20 weeks after stroke . In addition , all patients underwent a basic rehabilitation programme . The main outcome measures were ability in ADL ( Barthel index ) , walking ability ( functional ambulation categories ) , and dexterity of the paretic arm ( Action Research arm test ) at 6 , 12 , 20 , and 26 weeks . Analyses were by intention to treat . FINDINGS At week 20 , the leg-training group ( n=31 ) had higher scores than the control group ( n=37 ) for ADL ability ( median 19 [ IQR 16 - 20 ] vs 16 [ 10 - 19 ] , p<0.05 ) , walking ability ( 4 [ 3 - 5 ] vs 3 [ 1 - 4 ] , p<0.05 ) , and dexterity ( 2 [ 0 - 56 ] vs 0 [ 0 - 2 ] , p<0.01 ) . The arm-training group ( n=33 ) differed significantly from the control group only in dexterity ( 9 [ 0 - 39 ] vs 0 [ 0 - 2 ] , p<0.01 ) . There were no significant differences in these endpoints at 20 weeks between the arm-training and leg-training groups . INTERPRETATION Greater intensity of leg rehabilitation improves functional recovery and health-related functional status , whereas greater intensity of arm rehabilitation results in small improvements in dexterity , providing further evidence that exercise therapy primarily induces treatment effects on the abilities at which training is specifically aim ed Objective : This pilot r and omized controlled trial evaluated an assistant-led , community-based intervention to improve community mobility and participation after stroke , and examined the potential for independent community ambulation in people with subacute stroke who present with moderate gait deficit . Design : A multicentre , pilot r and omized controlled trial . Setting : Three hospitals and three community setting s in New Zeal and . Subjects : Thirty post-acute , home-dwelling stroke survivors were r and omly allocated to receive intervention in the community ( n = 14 ) or as hospital out patients ( n = 16 ) twice a week for seven weeks . Interventions : The community intervention involved practice of functional gait activities in community environments relevant to each participant . Hospital-based physiotherapy was based upon a Motor Relearning approach . Main measures : The primary outcome measure was gait speed ( m/min ) . Secondary outcomes included endurance ( six-minute walk time ) , Activities-specific Confidence Balance Scale , and the Subjective Index of Physical and Social Outcomes measured at baseline , post intervention and six months . Results : Large gains in gait speed were obtained for participants in both groups : community group mean ( SD ) 16 ( 16.1 ) m/min ; physiotherapy group mean ( SD ) 15.9 ( 16.1 ) m/min , maintained at six months . There were no significant differences between groups for primary and secondary outcomes after treatment ( P = 0.86 ANOVA ) or at six months ( P = 0.83 ANOVA ) . Only 11 participants reported independent community ambulation . Levels of social integration were low to moderate . Conclusions : A community-based gait recovery programme appears a practicable alternative to routine physiotherapy , however independent community ambulation is a challenging rehabilitation goal 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 Compensation by the unaffected upper extremity ( UE ) was studied in stroke patients who were unable to use the affected UE . The main aim was to evaluate the need of teaching compensatory techniques to stroke patients during rehabilitation of UE function . The study was prospect i ve and community based and included 636 consecutive acute stroke patients .  UE function and UE paresis were assessed weekly using the Barthel Index subscores for feeding and grooming and the  Sc and inavian Stroke Scale ( SSS ) subscores for arm and h and . Rehabilitation was performed according to the Bobath technique . Initially , 214 had severe UE paresis according to  SSS ; the arm could not move against gravity and the fingertips could not reach palm . In 64 of the 115 patients discharged alive , the affected UE definitely remained useless despite intensive and longst and ing rehabilitation . Improvement of UE function was seen in 25 of these patients ( 39 % ) and was possible only through compensation by the unaffected UE . Patients who gained UE function by compensation were younger ( p < 0.01 ) , had less severe stroke ( p < 0.01 ) , smaller ( p < 0.01 ) , and subcortically located ( p = 0.02 ) lesions and less affection of higher cortical function ( p = 0.01 ) . Recovery of UE function in more than half of the stroke patients with initial severe UE paresis can be achieved only by compensation by the unaffected UE 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 Balance is a complex motor skill and it is frequently disturbed among stroke survivors . Rehabilitation experts are still facing challenges in achieving good stability . The primary aim of this study was to determine the effect of a wobble board exercise program on static and dynamic balance of hemiplegic subjects . Seventeen ( 17 ) stroke survivors were r and omly selected into two groups . The subjects in the experimental group were trained on wobble board for six weeks while the control group received only the baseline treatment programs . The modified version of the timed balance test was used to assess balance while the foursquare step test was used to assess dynamic balance . Descriptive statistics and Analysis of variance ( ANOVA ) were used to analyze the data obtained . The result showed that there was significant difference in the static balance ( eye closed ) ( F=7.49 , P < 0.05 ) and dynamic balance ( F3.20 , P < 0.05 ) between the groups but there was no significant difference in static balance ( eye opened ) ( F= 1.75 , P > 0.05 ) . The study concluded that wobble board exercise improved both static ( eye closed ) and dynamic balance of stroke survivor used in this study Objective : To investigate the effect of early cycling training on balance and motor abilities of stroke patients in their subacute stage . Design : R and omized clinical trial . Setting : Inpatient rehabilitation . Subjects : Twenty-four patients who had had a first stroke were r and omly assigned to a cycling training group ( n = 10 ) or to a control ( n = 14 ) group . Intervention : All subjects received their usual rehabilitation programme ; the cycling training group received in addition a daily session of leg cycle ergometer , lasting three weeks . Both groups were followed for six weeks . Main outcome measurements : Balance was assessed using the Postural Assessment Scale for Stroke Patients ( PASS ) and the st and ing balance test . The motor function of the lower extremity was also assessed by the Fugl-Meyer Assessment ( FMA ) . Results : In the within-group comparison , both the exercise group and the control group had improved significantly ( P B=0.01 ) with time with respect to PASS total ( exercise group 18.79=2.8 to 31.19=2.2 , control group 18.19=3.2 to 26.49=3.8 ) and PASS subscores , as well as the FMA score ( exercise group 17.29=7.5 to 29.19=5.9 , control group 16.69=6.4 to 22.19=6.8 ) . In addition there was a significant group = time interaction effect , with exercise group patients demonstrating better performance in both the total PASS score and PASS subscores and FMA score relative to the control patients ( P B=0.01 ) . Conclusions : These preliminary findings suggest that stroke patients in the subacute stage can improve their motor and balance abilities after an early short duration of cycling training BACKGROUND AND PURPOSE Of all stroke survivors , more than 50 % are left with motor disabilities . Impairment of upper limb movement is a common motor disability . Constraint-Induced Movement Therapy ( CIMT ) is an intervention which has been used for the treatment of upper extremity motor disabilities in stroke patients . Although CIMT is an effective intervention , a recent survey revealed that this procedure is viewed with apprehension by many clinicians because of concerns about practicality and re source issues . We developed a modified CIMT that reserves the massed training of the affected arm without any physical restriction of the intact one and then used it on our stroke patients . This study was design ed to evaluate the effectiveness of this Modified-Constraint-Induced Movement Therapy ( m-CIMT ) . METHODS Thirty stroke patients were r and omly assigned to either an m-CIMT ( n=13 ) or a control group ( n=17 ) . Subjects in the m-CIMT group received a 2-week course of m-CIMT . Outcomes were evaluated using the Wolf Motor Function Test ( WMFT ) . RESULTS After only 2 weeks of training , significant differences ( p<0.05 ) in favor of m-CIMT were found in the following 6 elements of the WMFT : Extend elbow with weight , Lift pencil , Stack checkers , Flip cards , Turn key in lock , and Lift basket . CONCLUSION The present study shows that our m-CIMT is useful in improving the function of the affected upper extremity in stroke patients OBJECTIVE To evaluate the usefulness of the computer program made for the patients after stroke to treat their cognitive impairments and hemiparesis . RESEARCH DESIGN AND METHODS The experimental group involved 10 patients after stroke who were obliged to train on a computer every day during their three-week stay on the rehabilitation ward . The control group involved 10 patients after stroke who did not participate in any computer training during their rehabilitation process . The first part of the computer tasks trains the attention impairments and visual-motor co-ordination problems . We modified the joystick by adding special buttons to train movements of the wrist , thumb and forefinger of the impaired h and . Computer tasks are made in the way to stimulate both the cognitive functions and h and dexterity at the same time . RESULTS This initial research shows a statistically significant improvement of the cognitive functions and h and dexterity among patients from the experimental group . According to these results we did not observe any significant improvement in the cognitive functions among patients who did not train on a computer ( control group ) . CONCLUSIONS The results of this research suggest the usefulness of this computer program in training cognitive impairments and visual-motor co-ordination as well as h and dexterity among the patients after stroke Objective : To evaluate the effect of an arm training programme combining repetition of unilateral and symmetrical bilateral tasks for people in the subacute phase after stroke . Design : R and omized controlled trial . Setting : Inpatient functional rehabilitation unit . Subjects : Forty-one people who had had a stroke , in the subacute phase , receiving conventional arm occupational and physical therapy  , were r and omized to an experimental group ( n=20 ) and a control group ( n=21 ) . Interventions : In addition to the usual arm therapy in the rehabilitation unit , the experimental group received an arm therapy programme ( 15 - 20 45-min sessions ) based on repetition of unilateral and symmetrical bilateral tasks . The control group received additional usual arm therapy of a similar duration and frequency to the experimental treatment . Main measures : The effect of the programme was judged on the basis of : ( 1 ) arm impairments ( motor function , grip strength , gross and fine manual dexterity and motor co-ordination ) , ( 2 ) arm disabilities in tasks related to daily activities , and ( 3 ) functional independence in activities of daily living ( ADL ) and instrumental ADL ( IADL ) . Results : Although both experimental and control groups of participants improved similarly during the study period , the statistical analyses did not show any difference between the groups at the end of the treatment for the different dependent variables evaluated : ( 1 ) arm impairments : p=0.43 - 0.79 ; ( 2 ) arm disabilities : p=0.16 - 0.90 ; and ( 3 ) functional independence : p=0.63 and 0.90 . Conclusions : An arm training programme based on repetition of unilateral and symmetrical bilateral practice did not reduce impairment and disabilities nor improve functional outcomes in the subacute phase after stroke more than the usual therapy OBJECTIVE To test the efficacy of the arm ability training ( AAT ) on a sample of patients with central arm paresis after traumatic brain injury ( TBI ) or stroke . DESIGN Single-blind , r and omized , controlled trial . SETTING Inpatient rehabilitation center . PATIENTS Consecutive sample of 74 patients of whom 60 ( 45 with stroke , 15 with TBI ) completed the study ; 37 patients received a 1-year follow-up . INTERVENTION Daily AAT with ( n = 20 ) or without ( n = 20 ) knowledge of results , or no AAT ( n = 20 ) during a 3-week intervention period . MAIN OUTCOME MEASURES Summary time scores of the Test Evaluant les Membres superieurs des Personnes Agees (TEMPA)-a test of upper extremity function with daily function-like activities ( focal disability)- and kinematic analysis of aim ed movements . RESULTS Patients with AAT realized superior improvement as compared with controls . Mean improvement in the time needed to perform ( 1 ) all TEMPA tasks was 41.4 versus 12.8 seconds ( p = .0012 ) ; ( 2 ) unilateral TEMPA tasks , 16.5 versus 4.2 seconds ( p = .0036 ) ; and ( 3 ) the ballistic component of aim ed movements , 96 versus 20ms ( p = .0115 ) . Knowledge of result did not substantially modify these effects . A functional benefit existed at 1-year follow-up . CONCLUSION The AAT reduces focal disability among stroke and TBI patients with mild central arm paresis 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 OBJECTIVE To assess use of the Bon Saint Côme device for axial postural rehabilitation in hemiplegic patients , a technique based on voluntary trunk control during exploratory retraining . DESIGN A 3-month r and omized controlled trial . SETTING A public neurorehabilitation center . PATIENTS Twenty consecutive hemiplegic patients with axial postural disturbance result ing from recent stroke were r and omly assigned to a device group ( DG ) or control group ( CG ) . The 2 groups of 10 patients were similar . INTERVENTION For 1 month , the DG patients followed an experimental program for 1 hour daily and conventional neurorehabilitation for 1 hour daily , whereas CG patients had conventional neurorehabilitation for 2 hours daily . For the next 2 months , all 20 patients had conventional neurorehabilitation for 2 hours daily . MAIN OUTCOME MEASURES Patients were assessed on days 0 , 30 , and 90 by using a battery of postural tests , gait evaluation , the Bells neglect test , and the FIM instrument . RESULTS On day 30 , postural and neglect tests improved significantly more in DG than in CG . The benefit remained at day 90 . Gait improved earlier in DG than in CG . FIM scores improved equally . CONCLUSIONS Voluntary trunk control retraining during spatial exploration with the Bon Saint Côme device appears to be a useful approach for rehabilitation of postural disorders in hemiplegic patients . Treatments design ed to improve spatial cognition deficits probably enhance postural disorder recovery in hemiplegia OBJECTIVE To determine the effect of different motor learning schedules on stroke patients '  rate of acquisition and retention of a functional movement sequence using the hemiparetic upper limb . DESIGN R and omized controlled group study using a retention design with two retention trials . SETTING Outpatient neurorehabilitation clinic . PATIENTS Twenty-four patients with chronic hemiparesis secondary to a single unilateral cerebral stroke without evidence of severe cognitive or language impairment . MAIN OUTCOME MEASURE The primary hypothesis was that hemiparetic motor learning that occurred under conditions of context ual interference ( ie , r and om practice ) would be retained better than learning that occurred under conditions of repetitive drill ( blocked practice ) . RESULTS A significant difference was found among the three groups ( ie , r and om- practice , blocked- practice , control ) on both the first retention measure ( chi 2 = 13.50 , p < .01 ) and the second retention measure ( chi 2 = 12.59 , p < .01 ) . More importantly , a significant difference was found between the r and om- practice and blocked- practice groups on both the first retention measure ( U = 68.5 , p < .01 ) and the second retention measure ( U = 62.0 , p = .05 ) . CONCLUSIONS Findings provide empirical evidence to support the contention that r and om practice is more effective than blocked practice , with respect to retention over time , when hemiparetic stroke patients attempt to learn functional motor skills 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 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 UNLABELLED RESEARCH PROBLEM AND METHODS : There are currently 1.5 million stroke survivors in the United States . More than half of these individuals have significant residual physical disability and functional impairment .  Survivors of stroke constitute the largest group of patients receiving rehabilitation services in this country . We examined existing clinical trials investigating the effectiveness of stroke rehabilitation programs to improve functional outcomes and discharge destination .  One hundred twenty-four research reports were initially identified . From this sample , 36 trials meeting selected criteria were evaluated by the methods of meta- analysis . RESULTS A total of 3717 patients participated in the 36 clinical trials included in the meta- analysis . The results revealed a mean d-index of 0.40 + /- 0.33 . This effect size index was converted to a U3 value of 65.5 , indicating that the average patient receiving a program of focused stroke rehabilitation performed better than approximately 65.5 % of those patients in comparison groups ( 95 % confidence interval , 63.6 % to 67.3 % ) . The results also revealed a significant interaction between type of research design and method of recording the outcome of a clinical trial . Blind recording of the outcome measure appears to be an essential design characteristic in clinical trials that do not r and omize patients to conditions . CONCLUSIONS Programs of focused stroke rehabilitation may improve functional performance for some patients who have experienced a stroke . The improvement in performance appears related to early initiation of treatment , but not to the duration of intervention . Improvements are also associated with the patient 's age and the type of design . Research design should be considered an important moderator variable in planning and interpreting future clinical trials of treatment effectiveness in stroke rehabilitation Objective : To examine the effectiveness of additional backward walking training on gait outcome of patients post stroke . Design : R and omized controlled trial . Setting : Medical centre . Subjects : Twenty-five subjects with stroke , who were lower extremity Brunnstrom motor recovery stage at 3 or 4 and were able to walk 11 m with or without a walking aid or orthosis , r and omly allocated to two groups , control ( n = 12 ) and experimental ( n = 13 ) . Interventions : Subjects in both groups participated in 40 min of conventional training programme three times a week for three weeks . Subjects in experimental group received additional 30 min of backward walking training for three weeks at a frequency of three times per week . Main measures : Gait was measured using the Stride Analyzer . Gait parameters of interest were walking speed , cadence , stride length , gait cycle and symmetry index . Measures were made at baseline before commencement of training ( pre-training ) and at the end of the three-week training period ( post-training ) . Results : After a three-week training period , subjects in experimental group showed more improvement than those in control group for walking speed ( change score : 8.609 ± 6.95 versus 3.659 ± 2.92 , p-value = 0.032 ) , stride length ( change score : 0.0909 ± 0.076 versus 0.00649 ± 0.078 , p-value = 0.006 ) , and symmetry index ( change score : 44.079 ± 53.29 versus 5.309 ± 13.91 , p-value = 0.018 ) . Conclusions : This study demonstrated that asymmetric gait pattern in patients post stroke could be improved from receiving additional backward walking therapy Objective : To evaluate the efficacy of a task-oriented intervention in enhancing arm function in people with stroke . Design : Two-centre , observer-blinded , stratified , block-r and omized controlled trial . Setting : General community . Patients : Ninety-one individuals within one year of a first or recurrent stroke consented to participate between May 2000 and February 2003 . Interventions : The experimental intervention involved practice of functional , unilateral and bilateral tasks that were design ed to improve gross and fine manual dexterity whereas the control intervention was composed of walking tasks . Members in both groups participated in three sessions a week for six weeks . Main outcome measure(s ) : The primary test of arm function was the Box and Block Test . Secondary tests included the Nine-Hole Peg Test , maximal grip strength , the Test d'Evaluation des Membres supé rieurs des Personnes Agées ( TEMPA ) and the Stroke Rehabilitation Assessment of Movement . Results : Results are for the more affected arm . Baseline performance on the Box and Block Test was an average of 26 blocks ( st and ard deviation ( SD=16 ) in the experimental group ( n=47 ) and 26 blocks ( Sd=18 ) in the control group ( n=44 ) . These values represent approximately 40 % of age-predicted values . Values for the postintervention evaluation were an average of 28 ( SD=17 ) and 28 ( SD=19 ) blocks for the experimental and control group respectively . No meaningful change on other measures of arm function was observed . Conclusions : A task-oriented intervention did not improve voluntary movement or manual dexterity of the affected arm in people with chronic stroke Objective : To establish the effects of group exercise on mobility and strength . Design : R and omized controlled trial . Setting : Two public hospital outpatient rehabilitation services . Participants : One hundred and seventy-three people ( mean age 74.9 years , SD 10.8 ) with impaired mobility were r and omized and 159 people ( 92 % ) completed the trial . Interventions : Five-week , twice-weekly ` circuit-style ' group exercise programme run by a physiotherapist ( n = 85 ) and a no-intervention waiting list control group ( n = 88 ) . Main outcome measures : Three aspects of mobility : balance while st and ing and stepping ( Step Test , semi-t and em and t and em stance times ) ; sit-to-st and ability ( rate and minimum height ) and gait ( 6-metre and 6-minute walk tests ) . Lower limb muscle strength ( knee flexion and extension ) . Results : At retest , exercise participants had improved significantly more than their control counterparts on measures of balance while stepping , sit to st and and gait . Exercise participants averaged 1.6 more steps on the 15-second Step Test ( 95 % confidence interval ( CI ) 0.5 to 2.8 , P=0.005 ) , walked an average of 0.12 m/s faster ( 95 % CI 0.05 to 0.2 , P=0.002 ) and took 2.5 fewer steps in 6 metres ( 95 % CI —4.2 to —0.8 , P=0.004 ) . Exercise participants also averaged 0.04 more sit-to-st and s/second , ( 95 % CI 0.003 to 0.08 , P=0.037 ) and walked an average of 30.9 metres further in 6 minutes ( 95 % CI 9.4 to 52.4 , P=0.005 ) . There were no clinical ly important or statistically significant between-group differences at retest for the measures of strength ( knee extension and flexion ) , balance while st and ing or minimal sit-to-st and height . Conclusion : This short- duration circuit class programme improved mobility , but not strength 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 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 Time course and degree of recovery of upper extremity ( UE ) function after stroke and the influence of initial UE paresis were studied prospect ively in a community-based population of 421 consecutive stroke patients admitted acutely during a 1-year period .  UE function was assessed weekly , using the Barthel Index subscores for feeding and grooming . UE paresis was assessed by the Sc and inavian Stroke Scale subscores for h and and arm . The best possible UE function was achieved by 80 % of the patients within 3 weeks after stroke onset and by 95 % within 9 weeks ; in patients with mild UE paresis , function was achieved within 3 and 6 weeks , respectively , and in patients with severe UE paresis within 6 and 11 weeks , respectively . Full UE function was achieved by 79 % of patients with mild UE paresis and only by 18 % of patients with severe UE paresis . A valid prognosis of UE function can be made within 3 and 6 weeks in patients with mild and severe UE paresis , respectively . Further recovery of UE function should not be expected after 6 and 11 weeks respectively , in these groups of patients OBJECTIVE To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke . DESIGN R and omized controlled trial . SETTING Rehabilitation research laboratory and a community hall . PARTICIPANTS A sample of 63 people ( > or = 50y ) with chronic deficits result ing from stroke ( onset > or = 1y ) . INTERVENTIONS The arm group underwent an exercise program design ed to improve upper-extremity function ( 1h/session , 3 sessions/wk for 19wk ) . The leg group underwent a lower-extremity exercise program . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , Fugl-Meyer Assessment ( FMA ) , h and -held dynamometry ( grip strength ) , and the Motor Activity Log . RESULTS Multivariate analysis showed a significant group by time interaction ( Wilks lambda=.726 , P=.017 ) , indicating that overall , the arm group had significantly more improvement than the leg group . Post hoc analysis demonstrated that gains in WMFT ( functional ability ) ( P=.001 ) and FMA ( P=.001 ) scores were significantly higher in the arm group . The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke . Participants with moderate arm impairment benefited more from the program . CONCLUSIONS The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke . This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness 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 Objective : To examine the effectiveness of task-oriented progressive resistance strength training on lower extremity strength and functional performance in chronic stroke subjects . Design : Single-blind , r and omized controlled trial . Setting : Medical centre and district hospital . Subjects : Forty-eight subjects at least one year post stroke . Interventions : Participants r and omly allocated to two groups , control  ( n-/24 ) and experimental  ( n-/24 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group were put on a four-week task-oriented progressive resistance strength training . Main measures : Lower extremity muscle strength , gait velocity , cadence , stride length , six-minute walk test , step test , and timed up and go test . Results : Muscle strength significantly improved in the experimental group for strong side muscle groups ( ranged from 23.9 % to 36.5 % ) and paretic side muscle groups ( ranged from 10.1 % to 77.9 % ) . In the control group muscle strength changes ranged from 6.7 % gain to 11.2 % decline . The experimental group showed significant improvement in all selected measures of functional performance except for the step test . In the control group , the number of repetitions of the step test significantly decreased ( -20.3 % ) with no change in other functional tests . There was a significant difference between groups for muscle strength and all functional measures . The strength gain was significantly associated with gain in the functional tests . Conclusions : The task-oriented progressive resistance strength training programme could improve lower extremity muscle strength in individuals with chronic stroke and could carry over into improvement in functional abilities
BACKGROUND Repetitive task training ( RTT ) involves the active practice of task-specific motor activities and is a component of current therapy approaches in stroke rehabilitation .
OBJECTIVES Primary objective : To determine if RTT improves upper limb function/reach and lower limb function/balance in adults after stroke .
Secondary objectives : 1 ) To determine the effect of RTT on secondary outcome measures including activities of daily living , global motor function , quality of life/health status and adverse events .
2 ) To determine the factors that could influence primary and secondary outcome measures , including the effect of ' dose ' of task practice ; type of task ( whole therapy , mixed or single task ) ; timing of the intervention and type of intervention .