Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. Rhythmic facilitation of gait training in hemiparetic stroke rehabilitation Impact of Time on Improvement of Outcome After Stroke Predicting Improvement in Gait After Stroke: A Longitudinal Prospective Study Perception of Verticality After Recent Cerebral Hemispheric Stroke Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial Dynamical structure of center-of-pressure trajectories in patients recovering from stroke Coordination of Hemiparetic Locomotion after Stroke Rehabilitation Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Effects of problem-oriented willed-movement therapy on motor abilities for people with poststroke cognitive deficits. Gait recovery is not associated with changes in the temporal patterning of muscle activity during treadmill walking in patients with post-stroke hemiparesis Impairment–oriented training and adaptive motor cortex reorganisation after stroke: a fTMS study [Intensive rehabilitation after apoplexy--a controlled pilot study]. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial Anticipatory postural adjustment in selected trunk muscles in post stroke hemiparetic patients. Training symmetry of weight distribution after stroke: a randomized controlled pilot study comparing task-related reach, Bo bath and feedback training approaches Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial [Effects of early rehabilitation on activities of daily living and complications in acute stroke patients]. Disentangling the contribution of the paretic and non-paretic ankle to balance control in stroke patients Reliability of the PEDro scale for rating quality of randomized controlled trials. Recovery of standing balance and functional mobility after stroke. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study Can forced-use therapy be clinically applied after stroke? An exploratory randomized controlled trial. Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. [The painful hemiplegic shoulder: effects of exercises program according to Bobath]. Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs. Long-term effect of body weight-supported treadmill training in Parkinson's disease: a randomized controlled trial. Bobath or Motor Relearning Programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study The effect of independent practice of motor tasks by stroke patients: a pilot randomized controlled trial Recovery of Gait After Stroke: What Changes? Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait.
CONTEXT Reorganization in central motor networks occurs during early recovery from hemiparetic stroke . In chronic stroke survivors , specific rehabilitation therapy can improve upper extremity function . OBJECTIVE To test the hypothesis that in patients who have chronic motor impairment following stroke , specific rehabilitation therapy that improves arm function is associated with reorganization of cortical networks . DESIGN , SETTING , AND PATIENTS A r and omized controlled clinical trial conducted in a US ambulatory rehabilitation program with 21 patients ( median [ IQR ] , 50.3 [ 34.8 - 77.3 ] months after unilateral stroke ) . Data were collected between 2001 and 2004 . INTERVENTIONS Patients were r and omly assigned to bilateral arm training with rhythmic auditory cueing ( BATRAC ) ( n = 9 ) or st and ardized dose-matched therapeutic exercises ( DMTE ) ( n = 12 ) . Both were conducted for 1 hour , 3 times a week , for 6 weeks . MAIN OUTCOME MEASURES Within 2 weeks before and after the intervention , brain activation during elbow movement assessed by functional magnetic resonance imaging ( fMRI ) and functional outcome assessed using arm function scores . RESULTS Patients in the BATRAC group but not in the DMTE group increased hemispheric activation during paretic arm movement ( P = .03 ) . Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum ( P = .009 ) . BATRAC was associated with significant increases in activation in pre central ( P<.001 ) and post central gyri ( P = .03 ) and the cerebellum ( P<.001 ) , although 3 BATRAC patients showed no fMRI changes . Considering all patients , there were no differences in functional outcome between groups . When only BATRAC patients with fMRI response were included ( n = 6 ) , BATRAC improved arm function more than DMTE did ( P = .02 ) . CONCLUSIONS These preliminary findings suggest that BATRAC induces reorganization in contralesional motor networks and provide biological plausibility for repetitive bilateral training as a potential therapy for upper extremity rehabilitation in hemiparetic stroke Experimental and control groups of 10 hemiparetic stroke patients each underwent a 6 week , twice daily gait training program . The control group participated in a conventional physical therapy gait program . The experimental group trained in the same basic program with the addition of rhythmic auditory stimulation ( RAS ) .  Patients entered the study as soon as they could complete 5 strides with h and -held assistance . The training program had to be completed within 3 months of the patients ' stroke . In the experimental group RAS was used as a timekeeper to synchronize step patterns and gradually entrain higher stride frequencies . Study groups were equated by gender , lesion site , and age . Motor function was assessed at pretest using Barthel , Fugl-Meyer , and Berg Scales . Walking patterns were assessed during pre- and post-test without RAS present . Pre- vs post-test measures revealed a statistically significant ( P<0.05 ) increase in velocity ( 164 % vs 107 % ) , stride length ( 88 % vs 34 % ) , and reduction in EMG amplitude variability of the gastrocnemius muscle ( 69 % vs 33 % ) for the RAS-training group compared to the control group . The difference in stride symmetry improvement ( 32 % in the RAS-group vs 16 % in the control group ) was statistically not significant . The data offer evidence that RAS is an efficient tool to enhance efforts in gait rehabilitation with acute stroke patients Background and Purpose — Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke . The aim of the present study was to study the effects of progress of time on observed improvements in motor strength , synergisms , and activities during the first 16 weeks poststroke . Methods — Based on data from a previous study , 101 patients with first-ever ischemic middle cerebral artery strokes were prospect ively investigated during the first 16 weeks after stroke . Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model . The biweekly time change ( progress of time ) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index , reduction in visuospatial inattention based on the letter cancellation task , and improvement in walking ability , dexterity , and activities of daily living measured with the Functional Ambulation Categories , Action Research Arm test , and Barthel Index . Results — Time explained a significant change of 8.4 ( 42 % ) measurement units on the Barthel Index for the first 10 weeks poststroke , 1.1 ( 22 % ) measurement units on Functional Ambulation Categories , and 19 % on the Action Research Arm test for the first 6 and 8 weeks poststroke . Approximately 25 % ( for Fugl-Meyer – arm ) to 26 % ( for Motricity Index – arm ) of the significant change in measurements units was explained by time alone for the upper limb compared with 33 % for Fugl-Meyer – leg and 39 % for Motricity Index – leg of the lower limb . Time accounted for a reduction of 16 % in the letter cancellation task . Observed associations did not change after controlling for covariates such as age , gender , hemisphere of stroke , type of stroke , or intervention . Conclusion — Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining ≈16 % to 42 % of the observed improvements in the first 6 to 10 weeks after stroke onset Background and Purpose — To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability . Methods — A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population . Prospect i ve cohort study based on 18 repeated measurements over time during the first poststroke year . Baseline characteristics as well as longitudinal information from functional ambulation categories ( FAC ) , Fugl – Meyer leg score ( FM-leg ) , Motricity index leg score ( MI-leg ) , letter cancellation task ( LCT ) , Fugl-Meyer balance ( FM-balance ) , and timed balance test ( TBT ) were obtained . Intervention consisted of a basic rehabilitation program with additional arm , leg , or air splint therapy . Main outcome measure constituted change scores on FAC over time . Results — In total , 1532 of the 1717 change scores were available for regression analysis . The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC ( & bgr;=0.094 ; P<0.001 ) followed by changes scores on FM-leg ( & bgr;=0.014 ; P<0.001 ) and reduction in LCT omissions ( & bgr;=−0.010 ; P<0.001 ) and MI leg test ( & bgr;=0.001 ; P<0.001 ) . In addition , time itself was significantly negatively associated with improvement ( & bgr;=−0.002 ; P<0.001 ) . Conclusion — Improvement in st and ing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability , whereas reduction in visuospatial inattention is independently related to improvement of gait . Finally , time itself is an independent covariate that is negatively associated with change on FAC , suggesting that most pronounced improvements occur earlier after stroke Background and Purpose — Perception of the subjective visual vertical ( SVV ) is affected by cerebral hemispheric lesions . Knowledge of this disturbance is of interest for the study of its possible relation to balance disturbances . There is still uncertainty about the possible effects of a visual field defect and of the side and site of the lesion . This study was conducted to assess SVV with the head upright or tilted and to explore its relation to a visual field defect , visuospatial neglect , and the site of lesion . Methods — Forty patients with hemiplegia after a recent hemispheric stroke ( 20 with left and 20 with right stroke ) were studied . The site of the lesion was determined on CT scan , with special attention focused on the vestibular cortex . A neurological examination with determination of the visual field and visual neglect was conducted before SVV was tested . Subjects sat in a dark room and adjusted a luminous rod to the vertical position . Measures were repeated with binocular and monocular vision and with the head upright or tilted to the right or left . Results — SVV was abnormally deviated in 23 of 40 patients ( 57 % ) . The deviation was significantly greater among patients with a right or left hemispheric lesion than among healthy controls ( −2.2 ° and 1.5 ° versus 0.2 ° ) ; the same applied to the range of uncertainty ( 7.6 ° and 4.7 ° versus 1.9 ° ) . SVV deviation was not significantly related to the location of the lesion but was closely related to visuospatial neglect . The “ E ” effect observed in controls with the head tilted , ie , an SVV shift in the direction opposite to the head tilt , was not observed in hemiplegic patients with the head tilted toward the nonparetic side . Conclusions — Recent hemispheric stroke affects SVV perception , which is closely correlated to visuospatial neglect . It is suggested that the E effect might be mediated by the stretching of the somatosensory structure of the neck BACKGROUND AND PURPOSE Of all stroke survivors , 30 % to 66 % are unable to use their affected arm in performing activities of daily living . Although forced use therapy appears to improve arm function in chronic stroke patients , there is no conclusive evidence . This study evaluates the effectiveness of forced use therapy . METHODS In an observer-blinded r and omized clinical trial , 66 chronic stroke patients were allocated to either forced use therapy ( immobilization of the unaffected arm combined with intensive training ) or a reference therapy of equally intensive bimanual training , based on Neuro-Developmental Treatment , for a period of 2 weeks . Outcomes were evaluated on the basis of the Rehabilitation Activities Profile ( activities ) , the Action Research Arm ( ARA ) test ( dexterity ) , the upper extremity section of the Fugl-Meyer Assessment scale , the Motor Activity Log ( MAL ) , and a Problem Score . The minimal clinical ly important difference ( MCID ) was determined at the onset of the study . RESULTS One week after the last treatment session , a significant difference in effectiveness in favor of the forced use group compared with the bimanual group ( corrected for baseline differences ) was found for the ARA score ( 3.0 points ; 95 % CI , 1.3 to 4.8 ; MCID , 5.7 points ) and the MAL amount of use score ( 0.52 points ; 95 % CI , 0.11 to 0.93 ; MCID , 0.50 ) . The other parameters revealed no significant differential effects . One-year follow-up effects were observed only for the ARA . The differences in treatment effect for the ARA and the MAL amount of use scores were clinical ly relevant for patients with sensory disorders and hemineglect , respectively . CONCLUSIONS The present study showed a small but lasting effect of forced use therapy on the dexterity of the affected arm ( ARA ) and a temporary clinical ly relevant effect on the amount of use of the affected arm during activities of daily living ( MAL amount of use ) . The effect of forced use therapy was clinical ly relevant in the subgroups of patients with sensory disorders and hemineglect , respectively 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 In a recent study , De Haart et al. ( Arch Phys Med Rehabil 85:886–895 , 2004 ) investigated the recovery of balance in stroke patients using traditional analyses of center-of-pressure ( COP ) trajectories to assess the effects of health status , rehabilitation , and task conditions like  st and ing with eyes open or closed and st and ing while performing a cognitive dual task .  To unravel the underlying control processes , we reanalyzed these data in terms of stochastic dynamics using more advanced analyses . Dimensionality , local stability , regularity , and scaling behavior of COP trajectories were determined and compared with shuffled and phase-r and omized surrogate data . The presence of long-range correlations discarded the possibility that the COP trajectories were purely r and om . Compared to the healthy controls , the COP trajectories of the stroke patients were characterized by increased dimensionality and instability , but greater regularity in the frontal plane . These findings were taken to imply that the stroke patients actively ( i.e. , cognitively ) coped with the stroke-induced impairment of posture , as reflected in the increased regularity and decreased local stability , by recruiting additional control processes ( i.e. , more degrees of freedom ) and /or by tightening the present control structure while releasing non-essential degrees of freedom from postural control . In the course of rehabilitation , dimensionality stayed fairly constant , whereas local stability increased and regularity decreased . The progressively less regular COP trajectories were interpreted to indicate a reduction of cognitive involvement in postural control as recovery from stroke progressed . Consistent with this interpretation , the dual task condition result ed in less regular COP trajectories of greater dimensionality , reflecting a task-related decrease of active , cognitive contributions to postural control . In comparison with conventional posturography , our results show a clear surplus value of dynamical measures in study ing postural control Objectives . Determine whether a rehabilitation program targeting functional motor recovery of persons with poststroke hemiparesis improved motor coordination . Methods . A subgroup of 20 persons with poststroke hemiparesis ( n = 11 in intervention and n = 9incontrol group ) was investigated from within a larger r and omized controlled single-blind clinical trial of 100 patients .  Motor coordination was measured using a pedaling task , and subjects in the intervention group pedaled during an intensive broad-based home exercise program that targeted flexibility , strength , balance , and endurance . Coordination variables based on paretic leg pedal forces and EMG of 4 thigh muscles were measured while pedaling pre- and postintervention . Results . Despite extensive pedaling practice , up to 30 half-hour sessions that were progressively more intense , there was no effect ( P > 0.05 ) of the intervention on percent of total work done by the paretic leg , quantitative measures of EMG , or pedaling speed . However , walking speed was improved and pedaling and walking faster were associated after the intervention . Conclusions . There is no evidence of improved locomotor coordination postintervention . The increased walking and pedaling speed was likely achieved by a more proficient use of the same impaired pattern without EMG timing changes , likely because of increased strength and endurance postintervention . A more task-specific intervention may be required to improve coordination , consistent with principles of use-dependent plasticity 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 BACKGROUND AND PURPOSE Many patients have impaired arm function after stroke , for which they receive physiotherapy . The aim of the study was to determine whether increasing the amount of physiotherapy early after stroke improved the recovery of arm function and to compare the effects of this therapy when administered by a qualified therapist or a trained , supervised assistant . The physiotherapy followed a typical British approach , which is Bobath derived . Ten hours of additional therapy were given over a 5-week period . METHODS The study design was a single-blind , r and omized , controlled trial . Stroke patients were recruited from those admitted to the hospital in the 5 weeks after stroke . They were r and omly allocated to routine physiotherapy , additional treatment by a qualified physiotherapist , or additional treatment by a physiotherapy assistant . Outcome was assessed after 5 weeks of treatment and at 3 and 6 months after stroke on measures of arm function and of independence in activities of daily living . RESULTS There were 282 patients recruited to the study . The median initial Barthel score was 6.5 , and the median age of the patients was 73 years . The median initial Rivermead Motor Assessment Arm score was 1 . There were no significant differences between the groups at r and omization or on any of the outcome measures . Only half of the patients allocated to the 2 additional-therapy groups completed the program . CONCLUSIONS This increase in the amount of physiotherapy for arm impairment with a typical British approach given early after stroke did not significantly improve the recovery of arm function in the patients studied . A number of other studies of interventions aim ed at rehabilitation of arm function have reported positive results . Such findings may have been due to the content of these interventions , to the greater intensity of the interventions , or to the selection of patients to whom the treatments were applied BACKGROUND AND PURPOSE Cognitive deficits after stroke are common and interfere with recovery . One purpose of this study was to determine whether the motor abilities of subjects who have poststroke cognitive deficits and who have received problem-oriented willed-movement ( POWM ) therapy  will improve more than the motor abilities of subjects in the reference group who have received neurodevelopmental treatment ( NDT ) . Another purpose of this study was to identify the relationship between cognitive function and motor abilities for both groups . SUBJECTS The subjects recruited for this study were 36 men and 11 women with various degrees of poststroke cognitive deficits . METHODS A r and omized block design was used to assign the subjects to 2 groups . Cognitive function and motor ability were evaluated with the  Mini-Mental State Examination  and the  Stroke Rehabilitation Assessment of Movement ( STREAM ) .  Both groups received physical therapy 5 or 6 times per week in 50-minute sessions . RESULTS The STREAM scores improved after treatment in both groups . Main group effects were found for the lower-extremity ( F=4.58 , P < .05 ) and basic mobility ( F=27.49 , P < .01 ) subscales of the STREAM . Pretest cognitive function showed a positive relationship with posttest motor ability in the NDT group ( r = .446 , P < .05 ) . However , the relationship between pretest cognitive function and posttest motor ability had no statistical significance in the POWM group ( r = .101 , P= .630 ) . DISCUSSION AND CONCLUSION These findings suggest that , regardless of a person 's cognitive function , POWM intervention is effective in improving lower-extremity and basic mobilities and indicates the need to use relatively intact cognitive function or perceptual function , or both , to improve motor rehabilitation for people with cognitive function deficits OBJECTIVE To establish whether functional recovery of gait in patients with post-stroke hemiparesis coincides with changes in the temporal patterning of lower extremity muscle activity and coactivity during treadmill walking . METHODS  Electromyographic ( EMG ) data from both legs , maximum walking speed , the amount of swing phase asymmetry and clinical measures were obtained from a group of post-acute patients with hemiparesis , as early as possible after admission in a rehabilitation centre ( mean time post-stroke 35 days ) and 1 , 3 , 6 , and 10 weeks later , while all patients participated in a regular rehabilitation program .  EMG data from the first assessment were compared to those obtained from a group of healthy controls to identify abnormalities in the temporal patterning of muscle activity . Within subject comparisons of patient data were made over time to investigate whether functional gait recovery was accompanied by changes in the temporal patterns muscle (co-)activity . RESULTS EMG patterns during the first assessment showed a number of abnormalities on the paretic side , namely abnormally long duration s of activity in biceps femoris ( BF ) during the single support ( SS ) phase and in gastrocnemius medialis ( GM ) during the first double support phase ( DS1 ) . Furthermore , in both legs a prolongation of the activity was seen in the rectus femoris ( RF ) during the SS phase . In addition , the duration of BF-RF coactivation was longer on the paretic side than it was in controls . Over time , the level of ambulatory independence , body mobility , and maximum walking speed increased significantly , indicating that substantial improvements in gait ability occurred . Despite these improvements , duration s of muscle ( co- ) activity and the level of swing phase asymmetry did not change during rehabilitation . More specifically , timing abnormalities in muscle (co-)activity that were found during the first assessment did not change significantly , indicating that these aberrations were not an impediment for functional gait improvements . CONCLUSIONS Normalization of the temporal patterning of gait related muscle activity in the lower extremities is not a prerequisite for functional recovery of gait in patients with post-stroke hemiparesis . Apparently , physiological processes other than improved temporal muscular coordination must be important determinants of the restoration of ambulatory capacity after stroke . SIGNIFICANCE Recovery of walking ability in post-stroke hemiparesis is not necessarily associated with , or dependent on , reorganization in the temporal control of gait related muscle activity . Normalization of the temporal coordination of muscle activity during gait may not be an important clinical goal during post-acute rehabilitation Abstract In a sample of 28 subacute anterior circulation ischemic stroke patients with severe arm paresis , reduced motor cortex excitability ( increased motor thresholds , reduced MEP amplitudes , reduced number of active points ) and a reduced conduction velocity in the corticospinal system were found in the affected hemisphere . At the same time motor cortex topology for the abductor pollicis brevis ( APB ) representation was comparable for the affected and non – affected hemisphere . Considerable arm motor recovery ( Fugl – Meyer test ) was observed when assessed four weeks later after a period of rehabilitation intervention . Motor cortex excitability and conduction velocity in the corticospinal system improved in the affected hemisphere . In addition , APB representation showed a medial shift in patients with such a representation at pre test ( n = 14 ) . Multiple stepwise regression indicated that of all transcranial magnetic stimulation ( TMS ) parameters only the medial shift of the motor cortex map predicted motor recovery . Assessing the effect of training time ( nonintensified vs. intensified therapy ) and type of arm training ( Bobath approach vs. Arm BASIS training ) with a r and omised controlled design revealed that the impairment – oriented Arm BASIS training improved motor control more than the control conditions . In addition , patients of the group receiving the Arm BASIS training with an APB representation at pre test showed a medial shift of the motor cortex map and improved conduction times . In conclusion , changes in motor cortex topology were likely to be relevant for motor recovery and might have been induced by the impairment – oriented training In a prospect i ve , r and omized , controlled trial we compared the clinical outcome for 65 acute stroke patients where 31 were treated in a stroke unit and 34 in general medical units . In the stroke unit the treatment principles of Bobath were used , and teamwork was essential in the treatment . The inclusion period was nine months . Patients were followed up at a control six months after hospital discharge . The two groups were comparable as concerned age , sex , number of patients > or = 75 years and functional impairment at hospital admission . The mortality was similar in the two groups of patients . Significantly fewer patients from the stroke unit group were referred to nursing homes , when the patients in function group five ( those most severely ill ) were excluded . The functional status at the six months post discharge control was similar in the two groups . The in-patient time was without significant difference between the two groups when patients referred to nursing homes were excluded . The need for primary nursing after discharge was similar in the two groups . We conclude from our pilot study that better organisation in a general medical ward would in some aspects improve the prognosis of a major proportion of stroke patients 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 OBJECTIVES To study electromyographic characteristics of anticipatory postural adjustment in axial and lateral , posterior and anterior trunk muscles during the performance of upper- and lower-limb flexion tasks , in subjects with hemiparesis after stroke and to determine the relationship between anticipatory activity and subjects ' motor and functional status . DESIGN A nonr and omized control study . SETTING Geriatric rehabilitation center in Israel . PARTICIPANTS Fifty poststroke hemiparetic patients and 30 healthy control subjects . INTERVENTION  Electromyographic activity of the lumbar erector spinae and of the latissimus dorsi muscles was recorded bilaterally during flexion of either arm and from the 2 rectus abdominis and obliquus externus muscles during flexion of either hip . MAIN OUTCOME MEASURES Muscles ' onset latency , cross-correlation values between the temporal activation profile of corresponding pairs and between ipsilateral muscular pairs , symmetry in activation magnitude of corresponding muscles , and relation between electromyographic activity and motor and functional performance RESULTS Onset latencies of trunk muscles were partially delayed in the patients with longest hindrance displayed by the erector spinae ipsilateral to the flexing arm ( P<.04 ) . Temporal synchronization between pertinent muscular pairs was lower in the patients than in the healthy subjects , with significant group differences ( P<.05 or lower ) in the correlations between ipsilateral pairs of trunk muscles . Activation of the corresponding lateral trunk muscles in the patients was significantly less symmetrical than in the controls ( P<.03 or lower ) because of reduced activity on the paretic body side , especially on flexing of the paretic limbs . Conversely , in the controls as well as on the nonparetic side of the patients , limb flexion was associated with increased activity in the ipsilateral lateral trunk muscle . The erector spinae muscle in both groups and on both sides was more active on the contralateral side than on the ipsilateral side to the flexing arm . The reduced activity level in trunk muscles on the paretic body side was associated with deficiencies in motor and functional abilities . CONCLUSIONS Major impairments in the activity of trunk muscles in hemiparetic subjects were manifested in the reduced activity level of the lateral trunk muscles , in delayed onset , and in reduced synchronization between activation of pertinent muscular pairs . These problems were associated with motor and functional deficits and warrant specific consideration during physical rehabilitation of post stroke hemiparetic patients Objective : To determine ( 1 ) the most effective of three treatment approaches to retrain seated weight distribution long-term after stroke and ( 2 ) whether improvements could be generalized to weight distribution in st and ing . Setting : Inpatient rehabilitation unit . Design : Forty asymmetrical acute stroke subjects were r and omly allocated to one of four groups in this pilot study . Changes in weight distribution were compared between the 10 subjects of each of three treatment groups ( task-specific reach , Bobath , or Balance Performance Monitor [ BPM ] feedback training ) and a no specific treatment control group . One week of measurement only was followed by two weeks of daily training sessions with the treatment to which the subject was r and omly allocated . Measurements were performed using the BPM daily before treatment sessions , two weeks after cessation of treatment and 12 weeks post study . Weight distribution was calculated in terms of mean balance ( percentage of total body weight ) or the mean of 300 balance points over a 30-s data run . Results : In the short term , the Bobath approach was the most effective treatment for retraining sitting symmetry after stroke ( p = 0.004 ) . Training with the BPM and no training were also significant ( p = 0.038 and p = 0.035 respectively ) and task-specific reach training failed to reach significance ( p = 0.26 ) . At 12 weeks post study 83 % of the BPM training group , 38 % of the task-specific reach group , 29 % of the Bobath group and 0 % of the untrained group were found to be distributing their weight to both sides . Some generalization of symmetry training in sitting to st and ing was noted in the BPM training group which appeared to persist long term . Conclusions : Results should be treated with caution due to the small group sizes . However , these preliminary endings suggest that it might be possible to restore postural symmetry in sitting in the early stages of rehabilitation with therapy that focuses on creating an awareness of body position Objective : To evaluate the immediate and long-term effects of aerobic treadmill plus Bobath walking training in subacute stroke survivors compared with Bobath walking training alone . Design : R and omized controlled trial . Setting : Rehabilitation unit . Subjects : Fifty patients , first-time supratentorial stroke , stroke interval less than six weeks , Barthel Index ( 0 / 100 ) from 50 to 80 , able to walk a minimum distance of 12 m with either intermittent help or st and -by while walking , cardiovascular stable , minimum 50 W in the bicycle ergometry , r and omly allocated to two groups , A and B. Interventions : Group A 30 min of treadmill training , harness secured and minimally supported according to patients ' needs , and 30 min of physiotherapy , every workday for six weeks , speed and inclination of the treadmill were adjusted to achieve a heart rate of HR : ( Hrmax / HRrest)*0.6 / HRrest ; in group B 60 min of daily physiotherapy for six weeks . Main outcome measures : Primary outcome variables were the absolute improvement of walking velocity ( m/s ) and capacity ( m ) , secondary were gross motor function including walking ability ( score out of 13 ) and walking quality ( score out of 41 ) , blindly assessed before and after the intervention , and at follow-up three months later . Results : Patients tolerated the aerobic training well with no side-effects , significantly greater improvement of walking velocity and capacity both at study end ( p / 0.001 versus p / 0.002 ) and at follow-up ( p < 0.001 versus p<0.001 ) in the experimental group . Between weeks 0 and 6 , the experimental group improved walking speed and capacity by a mean of.31 m/s and 91 m , the control group by a mean of 0.16 m/s and 56 m. Between weeks 0 and 18 , the experimental group improved walking speed and capacity by a mean of 0.36 m/s and 111 m , the control group by a mean of 0.15 m/s and 57 m. Gross motor function and walking quality did not differ at any time . Conclusions : Aerobic treadmill plus Bobath walking training in moderately affected stroke patients was better than Bobath walking training alone with respect to the improvement of walking velocity and capacity . The treatment approach is recommended in patients meeting the inclusion criteria . A multicentre trial should follow to strengthen the evidence OBJECTIVE To investigate the effects of early rehabilitation on activities of daily living ( ADL ) and complications in patients within 1 month after a first stroke . METHODS 57 stroke patients were r and omly divided into rehabilitation group ( 30 cases ) and control group ( 27 cases ) . Patients in rehabilitation group received rehabilitation intervention ( the main methods were therapeutic exercises , especially Bobath method ) starting on average ( 15+/-4 ) days after stroke . Patients in both groups received the similar pharmological treatments . The demographic information was similar in both groups . Using the degree of deficit of neural function ( DDNF , Chinese version ) , Barthel index and Fugl-Meyer Assessment ( FMA ) scale to assess all patients in pre-therapy stage and post-therapy stage . RESULTS The scores of DDNF , FMA and Barthel index except for the grooming item ( P=0.04 , it is higher in rehabilitation group than in control group ) in the 2 groups were similar at the pre-therapy stage ( P>0.05 ) . At the post-therapy stage , there was no significant difference in the difference values in the grooming item between the pre- and post-stages in the 2 groups . There were significant differences in the difference values between the pre- and post-stages in the 2 groups in eating , bed-chair transfer and short distance walking activities items put together(P=0.05 ) . The differences between the pre- and post-stages in both groups in Barthel index items except the control of feces and urine , and bath items were significant ( P</=0.01 ) . The effects on complications were as follows : At the pre-therapy stage , the number of shoulder h and syndrome in rehabilitation group was higher than the one in control group ( P=0.11 ) , it was lower in rehabilitation group than in control group ( P=0.09 ) at the post-therapy stage . There were no significant differences about drop foot , interior deviation foot and ankle joint contracture conditions between the 2 groups at the pre-therapy stage , but there were significant differences about the 3 conditions at the post-therapy stage ( P</=0.01 ) , and the number of 3 complications was lower in rehabilitation group than in control group . There was no significant difference in shoulder subluxation at the pre- and post-therapy stages between the 2 groups . CONCLUSION Early rehabilitation can effectively improve stroke patients ' ADL , especially in eating , bed-chair transfer and short distance walking activities , and decrease the rate of complications ' incidence within one month after stroke During stroke recovery , restoration of the paretic ankle and compensation in the non-paretic ankle may contribute to improved balance maintenance . We examine a new approach to disentangle these recovery mechanisms by objective ly quantifying the contribution of each ankle to balance maintenance .  Eight chronic hemiparetic patients were included .  Balance responses were elicited by continuous r and om platform movements . We measured body sway and ground reaction forces below each foot to calculate corrective ankle torques in each leg . These measurements yielded the Frequency Response Function ( FRF ) of the stabilizing mechanisms , which expresses the amount and timing of the generated corrective torque in response to sway at the specified frequencies . The FRFs were used to calculate the relative contribution of the paretic and non-paretic ankle to the total amount of generated corrective torque to correct sway . All patients showed a clear asymmetry in the balance contribution in favor of the non-paretic ankle . Paretic balance contribution was significantly smaller than the contribution of the paretic leg to weight bearing , and did not show a clear relation with the contribution to weight bearing . In contrast , a group of healthy subjects instructed to distribute their weight asymmetrically showed a one-on-one relation between the contribution to weight bearing and to balance . We conclude that the presented approach objective ly quantifies the contribution of each ankle to balance maintenance . Application of this method in longitudinal surveys of balance rehabilitation makes it possible to disentangle the different recovery mechanisms . Such insights will be critical for the development and evaluation of rehabilitation strategies BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To examine the extent to which recovery of functional balance and mobility is accompanied by change in a few specific physiologic measures of postural control . DESIGN Longitudinal prospect i ve study . SETTING Laboratory setting in Ontario . PARTICIPANTS Twenty-seven volunteers ( age , 64.2+/-13.7y ) undergoing 4 weeks of rehabilitation after stroke participated . At initial testing , patients were 32.7+/-18.4 days poststroke and exhibited a moderate level of motor recovery ( lower-extremity and postural control , stages 3 - 4 on the Chedoke-McMaster Stroke Assessment Impairment Inventory ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Three functional measures ( Berg Balance Scale , Clinical Outcome Variables Scale , gait speed ) were assessed . Three physiologic measures ( electromyographic data of hamstrings and soleus muscles bilaterally , postural sway , arm acceleration )  were taken while subjects stood quietly on a force platform and while they performed a rapid shoulder flexion movement of the nonparetic upper extremity . RESULTS After 1 month of rehabilitation , there was an overall significant improvement in all outcome measures ( functional , physiologic ) . However , 10 patients failed to show any improvement in the electromyographic activation of hamstrings muscle on the paretic side in response to the rapid arm movement . These patients compensated by increasing the anticipatory activation of the nonparetic hamstrings . CONCLUSION After stroke , patients showed improvement in both physiologic and functional measures of balance and mobility over a 1-month period . We have identified some patients who may be using compensatory strategies to increase function . The factors that may predict those patients who are likely to use compensatory strategies awaits further study 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 To determine the efficacy , safety , and compliance with forced-use therapy ( FUT ) applied without additional " shaping " therapy during the rehabilitation phase of stroke . DESIGN Prospect i ve , r and omized controlled trial . SETTING Tertiary mixed rehabilitation center . PARTICIPANTS Consecutive sample of 30 in patients or out patients with first stroke showing minimal movement of the arm and h and . Subjects who scored below 26 on the Mini-Mental State Examination were excluded . Seven subjects either did not provide consent or withdrew from the study . The remaining subjects were r and omized into the  control group ( n=13 ) and the FUT group ( n=10 ) . INTERVENTION FUT involved wearing a thick constraint mitten on the sound arm for as many as 6 hours a day . MAIN OUTCOME MEASURES The Chedoke McMaster Impairment Inventory for arm , h and , postural control , and shoulder pain ; Action Research Arm Test ; grip strength ; and FIM instrument . RESULTS FUT subjects experienced 20 % more recovery of the arm than did control subjects and more recovery of postural control ( P=.04 ) . Men benefited most from the program , and there was a tendency for FUT subjects to have more shoulder pain . Compliance was related to cognitive status . CONCLUSIONS FUT , without shaping therapy , appears to augment arm recovery , but a larger sample is required to confirm these findings . The FUT mitten was safe and well tolerated ; however , more research is needed to determine the relation between FUT and hemiplegic shoulder pain Objective : To study the effects of augmented exercise therapy time for arm rehabilitation as either Bobath therapy or the impairment-oriented training ( Arm BASIS training ) in stroke patients with arm severe paresis . Design : Single blind , multicentre r and omized control trial . Setting : Three inpatient neurorehabilitation centres . Subjects : Sixty-two anterior circulation ischaemic stroke patients . Interventions : R and om assignment to three group : ( A ) no augmented exercise therapy time , ( B ) augmented exercise therapy time as Bobath therapy and ( C ) augmented exercise therapy time as Arm BASIS training . Main measures : Main outcome measure : Fugl-Meyer arm motor score . Secondary measure : Action Research Arm Test ( ARA ) . Ancillary measures : Fugl-Meyer arm sensation and joint motion/pain scores and the Ashworth Scale ( elbow flexors ) . Results : An overall effect of  augmented exercise therapy  time on Fugl-Meyer scores after four weeks was not corroborated ( mean and 95 % confidence interval ( CI ) of change scores : no augmented exercise therapy time ( n = 20 ) 8.8 , 5.2–12.3 ; augmented exercise therapy time ( n = 40 ) 9.9 , 6.8 - 13.9 ; p = 0.2657 ) . The group who received the augmented exercise therapy time as Arm BASIS training ( n = 20 ) had , however , higher gains than the group receiving the  augmented exercise therapy time as Bobath therapy  ( n = 20 ) ( mean and 95 % CI of change scores : Bobath 7.2 , 2.6 - 11.8 ; BASIS 12.6 , 8.4 - 16.8 ; p = 0.0432 ) . Passive joint motion/pain deteriorated less in the group who received BASIS training ( mean and 95 % CI of change scores : Bobath -3.2 , -5.2 to -1.1 ; BASIS 0.1 , -1.8 - 2.0 ; p = 0.0090 ) . ARA , Fugl-Meyer arm sensation , and Ashworth Scale scores were not differentially affected . Conclusions : The augmented exercise therapy time as Arm BASIS training enhanced selective motor control . Type of training was more relevant for recovery of motor control than therapeutic time spent OBJECTIVES To determine the test-retest reliability over 2 separate days for weight-bearing ability during st and ing tasks in individuals with chronic stroke and to compare the weight-bearing ability among 5 st and ing tasks for the paretic and nonparetic limbs . DESIGN Prospect i ve study using a convenient sample . SETTING Free-st and ing tertiary rehabilitation center . PARTICIPANTS Fifteen community-dwelling stroke individuals with moderate motor deficits ; volunteer sample . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Weight-bearing ability as measured by the vertical ground reaction force during 5 st and ing tasks ( rising from a chair , quiet st and ing , weight-shifting forward , backward , laterally ) . RESULTS The weight-bearing ability was less for the paretic limb compared with the nonparetic limb , but the intraclass correlation coefficients were high ( .95-.99 ) for both limbs between the 2 sessions for all 5 tasks . The forward weight-shifting ability was particularly low in magnitude on the paretic side compared with the other weight-shifting tasks . In addition , the forward weight-shift ability of the nonparetic limb was also impaired but to a lesser extent . Large asymmetry was evident when rising from a chair , with the paretic limb bearing a mean 296N and the nonparetic side bearing a mean 458N . The weight-bearing ability during all 5 tasks correlated with one another ( r range,.56-.94 ) . CONCLUSIONS Weight-bearing ability can be reliably measured and may serve as a useful outcome measure in individuals with stroke . We suggest that impairments of the hemiparetic side during forward weight shifting and sit-to-st and tasks presents a challenge to the motor systems of individuals with stroke , which may account for the poor balance that is often observed in these individuals AIM To verify whether a shoulder exercises program according to Bobath reduced the shoulder pain in hemiplegic patients . METHODS We studied a total of 20 patients with pain shoulder . Ten patients are assigned to group R ( su bmi tted to rehabilitation ) and ten to group R+E ( su bmi tted to rehabilitation and shoulder exercises program according to Bobath ) . Shoulder exercises program was self-performed by the patients after training in occupational rehabilitation unit . The assessment of patients was performed at admission to hospital , at discharge and three months after discharge . Shoulder pain ( VAS ) , shoulder range of motion , disability ( FIM ) , motor function ( Fugl-Meyer scale ) and spasticity ( Ashworth scale ) of paretic arm were evaluated in all patients . RESULTS VAS was similar in both groups at admission and decreased in group R+E at discharge without reaching significant differences ( p=0.253 ) . On the contrary , VAS and Shoulder range of motion improved statistically in group R+E ( p=0.0001 , p<0.04 respectively ) after three months . The others variables measured did not change . CONCLUSIONS This study showed that a shoulder exercises program according to Bobath reduces shoulder pain of patients with hemiplegia if it is performed daily and for a long period of time This was a controlled study of the efficacy of two forms of therapy on upper limb functions of hemiparetic patients --one  heavily behavioral and the other based on Bobath therapeutic exercises . It arose from an earlier pilot study comparing EMG biofeedback with physical therapy from which it was concluded that both the elapsed time since the acute stroke and the severity of residual disability were particularly important factors . Of 29 patients included and r and omly assigned to one or the other heavily systematized therapies  , 18 were classified as having early-severe and 11 as late-mild conditions . Multiple function tests by a " blinded " special technician in another location revealed that overall both forms of therapy obtained worthwhile clinical and statistical improvement , which was maintained at nine-month recheck testing ; but there was no statistically significant superiority of one therapy over the other under the very specific circumstances of the research design . Ease of delivering care and other socioeconomic considerations become important factors in choosing either or both of these methods OBJECTIVE To investigate whether body weight-supported treadmill training ( BWSTT ) is of long-term benefit for patients with Parkinson 's disease ( PD ) . DESIGN R and omized controlled trial . SETTING Inpatient rehabilitation unit for neurologic diseases in Japan . PARTICIPANTS Twenty-four patients ( Hoehn and Yahr stages 2.5 or 3 ) who were not demented ( Mini-Mental State Examination score , > 27 ) . INTERVENTIONS Patients were r and omized to receive either a 45-minute session of BWSTT ( up to 20 % of body weight supported ) or conventional physical therapy ( PT ) for 3 days a week for 1 month . MAIN OUTCOME MEASURES Outcome measures were evaluated at baseline and at 1 , 2 , 3 , and 6 months . Measures included the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , ambulation speed ( s/10 m ) , and number of steps taken for a 10-m walk as a parameter for stride length . RESULTS Four patients needed modification of medications in the follow-up period . Twenty patients ( BWSTT , n=11 ; PT , n=9 ) without modified medications were analyzed for functional outcome . Age , duration of PD , gender , and doses of medications were comparable . There was no difference in the baseline UPDRS ( BWSTT=33.3 ; PT=32.6 ) , speed ( BWSTT=10.8 ; PT=11.5 ) , and steps ( BWSTT=23.4 ; PT=22.8 ) . The BWSTT group had significantly greater improvement than the PT group ( Mann-Whitney U test , Bonferroni adjustment for multiple comparison ) in ambulation speed at 1 month ( BWSTT=8.5 ; PT=10.8 ; P<.005 ) ; and in the number of steps at 1 ( BWSTT=20.0 ; PT=22.7 ; P<.005 ) , 2 ( BWSTT=19.5 ; PT=22.4 ; P<.005 ) , 3 ( BWSTT=20.1 ; PT=23.1 ; P<.005 ) , and 4 months ( BWSTT=21.0 ; PT=23.0 ; P=.006 ) . CONCLUSIONS BWSTT has a lasting effect specifically on short-step gait in PD 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 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 Background . Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking . Objective . The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles in hemiplegic gait and improvement in walking ability after stroke . Methods . Thirteen patients diagnosed with a first unilateral ischemic stroke had their recovery of walking measured by the Rivermead Mobility Index , Functional Ambulation Categories , Barthel Index , Trunk Control Test , Motricity Index , and comfortable walking speed . Surface electromyography ( SEMG )  of the erector spinae , gluteus maximus , gluteus medius , rectus femoris , vastus lateralis , semitendinosus , gastrocnemius , and tibialis anterior muscles of both legs was used to quantify coordination patterns in comfortable walking mode . All clinical and electromyography-related measurements were taken at 3 , 6 , 9 , 12 , and 24 weeks poststroke . Timing parameters of the SEMG patterns were calculated , using an objective burst detection algorithm , and analyzed with the measures of functional recovery . Results . All functional measures , except Trunk Control Test , showed statistically significant improvement over time , whereas SEMG patterns did not change significantly over time . Conclusion . The lack of significant change in SEMG patterns over time suggests that functional gait improvements may be more related to compensatory strategies in muscle activation of the unaffected leg and biomechanical changes than by restitution of muscle coordination patterns in the affected leg BACKGROUND AND PURPOSE The effects of different duration s of rehabilitation sessions for the upper extremities ( UEs ) and lower extremities ( LEs ) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated . SUBJECTS AND METHODS Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with ( 1 ) an emphasis on the LEs , ( 2 ) an emphasis on the paretic UE , or ( 3 ) a condition in which the paretic arm ( UE ) and leg ( LE ) were immobilized with an inflatable pressure splint ( control treatment ) . The 3 treatment regimens were applied for 30 minutes , 5 days a week , during the first 20 weeks after onset of stroke . All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 11/2-hour session of training in activities of daily living . A repeated- measures design was used . Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds . In addition , mean continuous relative phase ( CRP ) between paretic arm and leg ( PAL ) movements and nonparetic arm and leg ( NAL ) movements and st and ard deviations of CRP of both limb pairs as a measurement of stability ( variability ) were evaluated . RESULTS Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment . No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the st and ard deviation of CRP of both limb pairs . DISCUSSION AND CONCLUSION With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions , no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found . Increasing walking speed , however , result ed in a larger mean CRP for both limb pairs , with increased stability and asymmetry of walking , indicating that walking speed influences interlimb coordination in hemiplegic gait
BACKGROUND AND PURPOSE In the Western world , the Bobath Concept or neurodevelopmental treatment is the most popular treatment approach used in stroke rehabilitation , yet the superiority of the Bobath Concept as the optimal type of treatment has not been established .
This systematic review of r and omized , controlled trials aim ed to evaluate the available evidence for the effectiveness of the Bobath Concept in stroke rehabilitation .