''Playstation eyetoy games'' improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial. Botulinum Toxin for the Upper Limb After Stroke (BoTULS) Trial: Effect on Impairment, Activity Limitation, and Pain Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. Assessing Wolf Motor Function Test as Outcome Measure for Research in Patients After Stroke Does low-dose botulinum toxin help the recovery of arm function when given early after stroke? A phase II randomized controlled pilot study to estimate effect size Assessing the Motor Status Score: A Scale for the Evaluation of Upper Limb Motor Outcomes in Patients after Stroke AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Sensorimotor Training in a Virtual Reality Environment: Does It Improve Functional Recovery Poststroke? Multisensory Stimulation in Stroke Rehabilitation The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Modified constraint induced therapy: a randomized feasibility and efficacy study. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. The Purdue Pegboard Test: normative data for people aged 60 and over. The Role of Caregiver Involvement in Upper-Limb Treatment in Individuals With Subacute Stroke Reporting of interventions in randomised trials: an audit of journal Instructions to Authors Effectiveness of Virtual Reality Using Wii Gaming Technology in Stroke Rehabilitation: A Pilot Randomized Clinical Trial and Proof of Principle Priming the motor system enhances the effects of upper limb therapy in chronic stroke. Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke? Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke. Mental Practice in Chronic Stroke: Results of a Randomized, Placebo-Controlled Trial Contribution of the shaping and restraint components of Constraint-Induced Movement therapy to treatment outcome. Assessment of the risk of bias in rehabilitation reviews Modification of motor control of wrist extension by mesh-glove electrical afferent stimulation in stroke patients. Effects of Splinting on Wrist Contracture After Stroke: A Randomized Controlled Trial Reliability of the PEDro scale for rating quality of randomized controlled trials. Functional electrical stimulation by means of the ‘Ness Handmaster Orthosis’ in chronic stroke patients: an exploratory study Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Dose–Response Study of Mobilisation and Tactile Stimulation Therapy for the Upper Extremity Early After Stroke Translating Animal Doses of Task-Specific Training to People With Chronic Stroke in 1-Hour Therapy Sessions: A Proof-of-Concept Study The effectiveness of EMG biofeedback in the treatment of arm function after stroke. Description and validation of a test of motor function and activities in stroke patients. The Sødring Motor Evaluation of Stroke Patients. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Modified Constraint-Induced Therapy after Subacute Stroke: A Preliminary Study Motor Recovery and Cortical Reorganization After Mirror Therapy in Chronic Stroke Patients
AIM To evaluate the effects of ' ' Playstation EyeToy Games ' ' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke . METHODS The authors design ed a r and omized , controlled , assessor-blinded , 4-week trial , with follow-up at 3 months . A total of 20 hemiparetic in patients ( mean age 61.1 years ) , all within 12 months post-stroke , received 30 minutes of treatment with ' ' Playstation EyeToy Games ' ' per day , consisting of flexion and extension of the paretic shoulder , elbow and wrist as well as abduction of the paretic shoulder or placebo therapy ( watching the games for the same duration without physical involvement into the games ) in addition to conventional program , 5 days a week , 2 - 5 hours/day for 4 weeks . Brunnstrom 's staging and self-care sub-items of the functional independence measure ( FIM ) were performed at 0 month ( baseline ) , 4 weeks ( post-treatment ) , and 3 months ( follow-up ) after the treatment . RESULTS The mean change score ( 95 % confidence interval ) of the FIM self-care score ( 5.5 [ 2.9 - 8.0 ] vs 1.8 [ 0.1 - 3.7 ] , P=0.018 ) showed significantly more improvement in the EyeToy group compared to the control group . No significant differences were found between the groups for the Brunnstrom stages for h and and upper extremity . CONCLUSION ' ' Playstation EyeToy Games ' ' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients Background and Purpose — Botulinum toxin is increasingly used to treat upper limb spasticity due to stroke , but its impact on arm function is unclear . We evaluated botulinum toxin for upper limb spasticity and function poststroke . Methods — Three hundred thirty-three patients with stroke with upper limb spasticity and reduced arm function participated in a multicenter r and omized controlled trial . The intervention group received botulinum toxin type A injection(s ) plus a 4-week therapy program . The control group received the therapy program alone . Repeat injection(s ) and therapy were available at 3 , 6 , and 9 months . The primary outcome was upper limb function at 1 month ( Action Research Arm Test ) . Secondary outcomes included measures of impairment , activity limitation , and pain at 1 , 3 , and 12 months . Outcome assessment s were blinded and analysis was by intention to treat . Results — There was no significant difference in achievement of improved arm function ( Action Research Arm Test ) at 1 month ( intervention group : 42 of 167 [ 25.1 % ] , control group 30 of 154 [ 19.5 % ] ; P=0.232 ) . Significant differences in favor of the intervention group were seen in muscle tone at 1 month ; upper limb strength at 3 months ; basic arm functional tasks ( h and hygiene , facilitation of dressing ) at 1 , 3 , and 12 months ; and pain at 12 months . Conclusions — Botulinum toxin type A is unlikely to be useful for improving active upper limb function ( eg , reaching and grasping ) in the majority of patients with spasticity after stroke , but it may improve basic upper limb tasks ( h and hygiene , facilitation of dressing ) and pain CONTEXT Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % ] ; P<.001 ) and in the MAL Amount of Use ( on a 0 - 5 scale , increase from 1.21 to 2.13 vs from 1.15 to 1.65 ; between-group difference , 0.43 [ 95 % CI , 0.05 - 0.80 ] ; P<.001 ) and MAL Quality of Movement ( on a 0 - 5 scale , increase from 1.26 to 2.23 vs 1.18 to 1.66 ; between-group difference , 0.48 [ 95 % CI , 0.13 - 0.84 ] ; P<.001 ) . The CIMT group achieved a decrease of 19.5 in self-perceived h and function difficulty ( Stroke Impact Scale h and domain ) vs a decrease of 10.1 for the control group ( between-group difference , 9.42 [ 95 % CI , 0.27 - 18.57 ] ; P=.05 ) . CONCLUSION Among patients who had a stroke within the previous 3 to 9 months , CIMT produced statistically significant and clinical ly relevant improvements in arm motor function that persisted for at least 1 year . Trial Registration clinical trials.gov Identifier : NCT00057018 Background and Purpose — The Wolf Motor Function Test ( WMFT ) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements . This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population . Methods — Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment . Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment ( FMA ) on 2 occasions ( 12 to 16 days apart ) , with scoring performed independently by 2 r and om raters . Results — The  WMFT and FMA demonstrated agreement ( P < 0.0001 ) between raters at each session .  WMFT  scores for the dominant and nondominant extremities of individuals without impairment were different ( P ≤0.05 ) from the more and less affected extremities of subjects after stroke . The FMA score for the more affected extremity of subjects after stroke was different ( P ≤0.05 ) from the dominant and nondominant extremities . However , the FMA score for the less affected upper extremity of individuals after stroke was not different ( P > 0.05 ) from the dominant and nondominant extremities of individuals without impairment . The WMFT and FMA scores were related ( P < 0.02 ) for the more affected extremity in individuals after stroke . Conclusions — The interrater reliability , construct validity , and criterion validity of the WMFT , as used in these subject sample s , are supported Objective : Spasticity after stroke may be associated with worse functional outcome . Our study aim is to establish whether a low dose of botulinum toxin , given early post stroke before clinical ly evident spasticity warrants treatment , will improve recovery of arm function . Design : A double-blind r and omized placebo-controlled trial . Setting : An acute stroke unit . Subjects : Individuals recruited within three weeks of stroke onset with severe arm function deficits . Interventions : Injections of quarter and half st and ard dose botulinum toxin A to the upper limb , with a control of normal saline injections . Main measures : Arm function , active and passive movement , and spasticity at elbow and wrist were recorded at baseline , and at 4 , 8 , 12 and 20 weeks post intervention . A pre-planned subgroup analysis included only subjects with no arm function at baseline ( Action Research Arm Test score = 0 ) . Results : Thirty subjects were recruited , and 21 completed all assessment s. Arm function scores improved in all three groups between baseline and week 20 . There was no benefit for active treatment over control in the whole group analysis . In the subgroup analysis the active groups improved when compared with the control group and effect sizes for improvement in this subgroup were 0.6 and 0.5 for the quarter dose and half dose groups respectively . Conclusions : Individuals with no arm function within three weeks of stroke may benefit functionally from botulinum toxin . Using the effect size of 0.5 , further studies would need a minimum of 101 participants in each group to confirm this finding The  Motor Status Scale ( MSS ) measures shoulder , elbow ( maximum score = 40 ) , wrist , h and , and finger movements ( maximum score = 42 ) , and exp and s the measurement of upper extremity impairment and disability provided by the Fugl-Meyer ( FM ) score . This work examines the interrater reliability and criterion validity of the MSS performed in patients admitted to a rehabilitation hospital 21 ± 4 days after stroke . Using the MSS and the FM , 7 occupational therapists masked to each other ’s judgments , evaluated 12 consecutive patients with stroke . Two therapists evaluated 6 additional patients on consecutive days . Intraclass correlation coefficients were significant for each group of raters for the shoulder/elbow and for the wrist/h and ( P < 0.0001 ) ; test-retest measures were also significant for the shoulder/elbow ( Pearson correlation coefficient r = 0.99 , P < 0.004 ) and for the wrist/h and ( Pearson correlation coefficient r = 0.99 , P < 0.003 ) . The internal item consistency for the overall MSS was significant ( Cronbach alpha = 0.98 , P < 0.0001 ) . Finally the correlation between the MSS and the FM ( R 2 = 0.964 ) was significant ( P < 0.0001 ) . The MSS affords a reliable and valid assessment of upper limb impairment and disability following stroke OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review Objective . To investigate the effectiveness of computerized virtual reality ( VR ) training of the hemiparetic h and of patients poststroke using a system that provides repetitive motor reeducation and skill reacquisition . Methods . Eight subjects in the chronic phase poststroke participated in a 3-week program using their hemiparetic h and in a series of interactive computer games for 13 days of training , weekend breaks , and pretests and posttests . Each subject trained for about 2 to 2.5 h per day . Outcome measures consisted of changes in the computerized measures of thumb and finger range of motion , thumb and finger velocity , fractionation ( the ability to move fingers independently ) , thumb and finger strength , the Jebsen Test of H and Function , and a Kinematic reach to grasp test . Results . Subjects as a group improved in fractionation of the fingers , thumb and finger range of motion , and thumb and finger speed , retaining those gains at the 1-week retention test . Transfer of these improvements was demonstrated through changes in the Jebsen Test of H and Function and a decrease after the therapy in the overall time from h and peak velocity to the moment when an object was lifted from the table . Conclusions . It is difficult in current service delivery models to provide the intensity of practice that appears to be needed to effect neural reorganization and functional changes poststroke . Computerized exercise systems may be a way to maximize both the patients ’ and the clinicians ’ time . The data in this study add support to the proposal to explore novel technologies for incorporation into current practice The brain has a large capacity for automatic simultaneous processing and integration of sensory information . Combining information from different sensory modalities facilitates our ability to detect , discriminate , and recognize sensory stimuli , and learning is often optimal in a multisensory environment . Currently used multisensory stimulation methods in stroke rehabilitation include motor imagery , action observation , training with a mirror or in a virtual environment , and various kinds of music therapy . Non-invasive brain stimulation has showed promising preliminary results in aphasia and neglect . Patient heterogeneity and the interaction of age , gender , genes , and environment are discussed . R and omized controlled longitudinal trials starting earlier post-stroke are needed . The advance in brain network science and neuroimaging enabling longitudinal studies of structural and functional networks are likely to have an important impact on patient selection for specific interventions in future stroke rehabilitation . It is proposed that we should pay more attention to age , gender , and laterality in clinical studies BACKGROUND AND PURPOSE To be useful for clinical research , an outcome measure must be feasible to administer and have sound psychometric attributes , including reliability , validity , and sensitivity to change . This study characterizes the psychometric properties of the Stroke Impact Scale ( SIS ) Version 2.0 . METHODS Version 2.0 of the SIS is a self-report measure that includes 64 items and assesses 8 domains ( strength , h and function , ADL/IADL , mobility , communication , emotion , memory and thinking , and participation ) . Subjects with mild and moderate strokes completed the SIS at 1 month ( n=91 ) , at 3 months ( n=80 ) , and at 6 months after stroke ( n=69 ) . Twenty-five subjects had a replicate administration of the SIS 1 week after the 3-month or 6-month test . We evaluated internal consistency and test-retest reliability . The validity of the SIS domains was examined by comparing the SIS to existing stroke measures and by comparing differences in SIS scores across Rankin scale levels . The mixed model procedure was used to evaluate responsiveness of the SIS domain scores to change . RESULTS Each of the 8 domains met or approached the st and ard of 0.9 alpha-coefficient for comparing the same patients across time . The intraclass correlation coefficients for test-retest reliability of SIS domains ranged from 0.70 to 0.92 , except for the emotion domain ( 0.57 ) . When the domains were compared with established outcome measures , the correlations were moderate to strong ( 0.44 to 0.84 ) . The participation domain was most strongly associated with SF-36 social role function . SIS domain scores discriminated across 4 Rankin levels . SIS domains are responsive to change due to ongoing recovery . Responsiveness to change is affected by stroke severity and time since stroke . CONCLUSIONS This new , stroke-specific outcome measure is reliable , valid , and sensitive to change . We are optimistic about the utility of measure . More studies are required to evaluate the SIS in larger and more heterogeneous population s and to evaluate the feasibility and validity of proxy responses for the most severely impaired patients This case series examined the feasibility and efficacy of a modified constraint induced therapy ( CIT ) protocol administered on an outpatient basis . The Fugl-Meyer Assessment of Motor Recovery After Stroke ( Fugl ) , Action Research Arm Test ( ARA ) , Wolf Motor Function Test ( WMFT ) , and  Motor Activity Log  ( MAL ) were administered to six patients between 2 and 6 months poststroke ( CVA ) exhibiting stable motor deficits and learned nonuse of the affected limb . Two patients then participated in half-hour physical and occupational therapy sessions three times/week for 10 weeks . During the same period , their unaffected arms and h and s were restrained 5 days/week during 5 hours identified as times of frequent use . Two other patients received regular therapy and two control patients received no therapy . The ARA , Fugl , WMFT , and MAL were again administered after 10 weeks . Patients receiving modified CIT exhibited substantial improvements on the Fugl , ARA , and WMFT , as well as increases in amount and quality of use of the limb using the MAL . Patients receiving traditional or no therapy exhibited no improvements . Results suggest that modified CIT may be an efficacious method of improving function and use of the affected arms of patients exhibiting learned nonuse BACKGROUND AND PURPOSE To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm , the effects of change in motor function over time on the accuracy of prediction were evaluated , and a prediction model for the probability of regaining dexterity at 6 months was developed . METHODS In 102 stroke patients , dexterity and paresis were measured with the  Action Research Arm Test , Motricity Index , and Fugl-Meyer motor evaluation .  For model development , 23 c and i date determinants were selected . Logistic regression analysis was used for prognostic factors and model development . RESULTS At 6 months , some dexterity in the paretic arm was found in 38 % , and complete functional recovery was seen in 11.6 % of the patients . Total anterior circulation infa rcts , right hemisphere strokes , homonymous hemianopia , visual gaze deficit , visual inattention , and paresis were statistically significant related to a poor arm function . Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity ( Action Research Arm Test > or=10 points ) from 74 % ( positive predictive value [ PPV ] , 0.74 ; 95 % confidence interval [ CI ] , 0.63 to 0.86 ) to 94 % ( PPV , 0.83 ; 95 % CI , 0.76 to 0.91 ) at 6 months . No change in probabilities of prediction dexterity was found after 4 weeks . CONCLUSIONS Based on the Fugl-Meyer scores of the flaccid arm , optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset . Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months Manual dexterity is frequently evaluated in rehabilitation services to estimate h and function . Several tests have been developed for this purpose , including the Purdue Pegboard , which measures fine manual dexterity . The goals of the study were to verify the test-retest reliability with subjects aged 60 and over without upper limb impairment , and to develop normative data based on a r and om sample of healthy older community-living individuals . The results show that the test-retest reliability is good ( intra-class correlation coefficients from 0.66 to 0.90 , depending on the subtest ) . Norms are presented to help clinicians involved in rehabilitation services to better differentiate real dexterity deficits from those that may be attributed to normal ageing Background Initial severity of upper-limb motor impairment and exercise intensity are important predictors of improved upper-limb function during stroke rehabilitation . Initial severity of motor impairment , however , is not modifiable by rehabilitation , and increased one-on-one treatment is not always feasible . Alternative methods to increase intensity and improve upper-limb function are needed . Objective The purpose of this study was to examine  caregiver involvement in upper-limb treatment as a method to improve upper-limb function . Design This study was a secondary analysis of a multi-site r and omized controlled trial for upper-limb recovery during subacute inpatient stroke rehabilitation . Methods Data from 50 individuals with subacute stroke who were r and omly assigned to the experimental group ( upper-limb exercise )  were used for the analysis . Outcome variables were measured at baseline and at completion of the 4-week intervention . Group comparisons between participants with caregiver support and participants without caregiver support were done using an analysis of variance . Using the Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment ( intensity ) as covariates , a multivariate regression analysis was performed to determine the additive value of caregiver support on upper-limb function , as measured by change scores on the Chedoke Arm and H and Activity Inventory and the Motor Activity Log . Results Group comparisons revealed that participants with caregiver support had improved upper-limb function compared with those without caregiver support and were more likely to increase the amount of time spent doing exercise . The multiple regression analysis showed that Fugl-Meyer score , treatment intensity , and caregiver support were significant predictors of upper-limb improvement ( R2=.240–.292 ) . In the regression models , caregiver support accounted for 5 % to 9 % of upper-limb improvement . Limitations Support was coded as a dichotomous variable , and thus the degree of support or qualitative nature of support was not captured . Conclusions Involvement of caregivers was a determinant of improved upper-limb function over and above initial severity of motor impairment and exercise intensity . Further research is needed to determine the optimal qualitative and quantitative elements of caregiver involvement in stroke rehabilitation in order to maximize results Background A complete description of the intervention in a published trial report is necessary for readers to be able to use the intervention , yet the completeness of intervention descriptions in trials is very poor . Low awareness of the issue by authors , review ers , and editors is part of the cause and providing specific instructions about intervention reporting to authors and encouraging full sharing of intervention material s is important . We assessed the extent to which : 1 ) journals ’ Instructions to Authors provide instructions about how interventions that have been evaluated in a r and omised controlled trial ( RCT ) should be reported in the paper ; and 2 ) journals offer the option of authors providing online supplementary material s. Methods We examined the web-based Instructions to  Authors  of  106 journals ( the six leading general medical journals , 50 r and omly selected journals from the National Library of Medicine ’s Core Clinical Journals , and 50 r and omly selected journals from the remainder of the journal collection indexed by PubMed ) . To be eligible , each journal must have published at least one r and omised trial involving human participants each year from 2008 to 2012 . We extracted all information related to the reporting of interventions , reporting of r and omised trials in general , and online supplementary material s. Results Of the 106 journals ’ Instructions to Authors , only 15 ( 14 % ) specifically mentioned the reporting of interventions and most of these provided non-specific advice such as ‘ describe essential features ’ . Just over half ( 62 , 58 % ) of the journals mentioned the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement in their author instructions . Seventy-eight ( 74 % ) of the journals ’ instructions mentioned the option of providing supplementary content online as part of the paper ; however , only four of these journals explicitly encouraged or m and ated use of this option for providing intervention information or material s. Conclusions Most journals ’ Instructions to Authors do not provide any specific instructions regarding reporting of interventions or encourage authors to provide online supplementary material s to enhance intervention reporting . Journals can help to improve the problem of incomplete intervention reporting by providing specific instructions to authors and peer review ers about intervention reporting and requiring full intervention descriptions to be provided Background and Purpose — Hemiparesis result ing in functional limitation of an upper extremity is common among stroke survivors . Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery , limited evidence is available on the efficacy of virtual reality for stroke rehabilitation . Methods — In this pilot , r and omized , single-blinded clinical trial with 2 parallel groups involving stroke patients within 2 months , we compared the feasibility , safety , and efficacy of virtual reality using the Nintendo Wii gaming system ( VRWii ) versus recreational therapy ( playing cards , bingo , or “ Jenga ” ) among those receiving st and ard rehabilitation to evaluate arm motor improvement . The primary feasibility outcome was the total time receiving the intervention . The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period . Efficacy , a secondary outcome measure , was evaluated with the Wolf Motor Function Test , Box and Block Test , and Stroke Impact Scale at 4 weeks after intervention . Results — Overall , 22 of 110 ( 20 % ) of screened patients were r and omized . The mean age ( range ) was 61.3 ( 41 to 83 ) years . Two participants dropped out after a training session . The interventions were successfully delivered in 9 of 10 participants in the VRWii and 8 of 10 in the recreational therapy arm . The mean total session time was 388 minutes in the recreational therapy group compared with 364 minutes in the VRWii group ( P=0.75 ) . There were no serious adverse events in any group . Relative to the recreational therapy group , participants in the VRWii arm had a significant improvement in mean motor function of 7 seconds ( Wolf Motor Function Test , 7.4 seconds ; 95 % CI , −14.5 , −0.2 ) after adjustment for age , baseline functional status ( Wolf Motor Function Test ) , and stroke severity . Conclusions — VRWii gaming technology represents a safe , feasible , and potentially effective alternative to facilitate rehabilitation therapy and promote motor recovery after stroke After stroke , the function of primary motor cortex ( M1 ) between the hemispheres may become unbalanced . Techniques that promote a re-balancing of M1 excitability may prime the brain to be more responsive to rehabilitation therapies and lead to improved functional outcomes . The present study examined the effects of Active-Passive Bilateral Therapy ( APBT ) , a putative movement-based priming strategy design ed to reduce intracortical inhibition and increase excitability within the ipsilesional M1 . Thirty-two patients with upper limb weakness at least 6 months after stroke were r and omized to a 1-month intervention of self-directed motor practice with their affected upper limb ( control group ) or to APBT for 10 - 15 min prior to the same motor practice ( APBT group ) . A blinded clinical rater assessed upper limb function at baseline , and immediately and 1 month after the intervention . Transcranial magnetic stimulation was used to assess M1 excitability . Immediately after the intervention , motor function of the affected upper limb improved in both groups ( P < 0.005 ) . One month after the intervention , the APBT group had better upper limb motor function than control patients ( P < 0.05 ) . The APBT group had increased ipsilesional M1 excitability ( P < 0.025 ) , increased transcallosal inhibition from ipsilesional to contralesional M1 ( P < 0.01 ) and increased intracortical inhibition within contralesional M1 ( P < 0.005 ) . None of these changes were found in the control group . APBT produced sustained improvements in upper limb motor function in chronic stroke patients and induced specific and sustained changes in motor cortex inhibitory function . We speculate that APBT may have facilitated plastic reorganization in the brain in response to motor therapy . The utility of APBT as an adjuvant to physical therapy warrants further consideration Normalization of upper limb movement remains a difficult problem for a significant sub population of hemiplegic stroke patients . Clinical observations prompted investigation of a novel approach using simultaneous identical bilateral movements performed independently . We briefly report 12 controlled single-case experiments using multiple-baseline design s across three separate grasp/reach activities . Unilateral performance tests with the hemiplegic arm using the bilaterally trained actions demonstrated clinical ly and statistically significant improvements in movement patterns . These improvements were specific to the trained movement and well maintained . Using recent literature we develop a theoretical model proposing that bilateral simultaneous movement promotes interhemispheric disinhibition likely to allow reorganization by sharing of normal movement comm and s from the undamaged hemisphere . Disinhibition may also encourage recruitment of undamaged neurones to construct new task-relevant neural networks . The potential contribution of spared ipsilateral pathways in the damaged hemisphere , indirect corticospinal pathways and ipsilateral pathways from the undamaged hemisphere is discussed Stroke is a leading cause of adult motor disability . Despite recent progress , recovery of motor function after stroke is usually incomplete . This double blind , Sham-controlled , crossover study was design ed to test the hypothesis that non-invasive stimulation of the motor cortex could improve motor function in the paretic h and of patients with chronic stroke .  H and function was measured using the Jebsen-Taylor H and Function Test ( JTT ) , a widely used , well vali date d test for functional motor assessment that reflects activities of daily living . JTT measured in the paretic h and improved significantly with non-invasive transcranial direct current stimulation ( tDCS ) , but not with Sham , an effect that outlasted the stimulation period , was present in every single patient tested and that correlated with an increment in motor cortical excitability within the affected hemisphere , expressed as increased recruitment curves ( RC ) and reduced short-interval intracortical inhibition . These results document a beneficial effect of non-invasive cortical stimulation on a set of h and functions that mimic activities of daily living in the paretic h and of patients with chronic stroke , and suggest that this interventional strategy in combination with customary rehabilitative treatments may play an adjuvant role in neurorehabilitation Background and Purpose — Mental practice ( MP ) of a particular motor skill has repeatedly been shown to activate the same musculature and neural areas as physical practice of the skill . Pilot study results suggest that a rehabilitation program incorporating MP of valued motor skills in chronic stroke patients provides sufficient repetitive practice to increase affected arm use and function . This Phase 2 study compared efficacy of a rehabilitation program incorporating MP of specific arm movements to a placebo condition using r and omized controlled methods and an appropriate sample size . Method — Thirty-two chronic stroke patients ( mean=3.6 years ) with moderate motor deficits received 30-minute therapy sessions occurring 2 days/week for 6 weeks , and emphasizing activities of daily living . Subjects r and omly assigned to the experimental condition also received 30-minute MP sessions provided directly after therapy requiring daily MP of the activities of daily living ; subjects assigned to the control group received the same amount of therapist interaction as the experimental group , and a sham intervention directly after therapy , consisting of relaxation . Outcomes were evaluated by a blinded rater using the Action Research Arm test and the upper extremity section of the Fugl-Meyer Assessment . Results — No pre-existing group differences were found on any demographic variable or movement scale . Subjects receiving MP showed significant reductions in affected arm impairment and significant increases in daily arm function ( both at the P<0.0001 level ) . Only patients in the group receiving MP exhibited new ability to perform valued activities . Conclusions — The results support the efficacy of programs incorporating mental practice for rehabilitating affected arm motor function in patients with chronic stroke . These changes are clinical ly significant Two important components of Constraint-Induced Movement therapy are thought to be intense training of the more-impaired arm and physical restraint of the less-impaired arm . This preliminary study examined the effects of type of training ( task- practice , shaping ) and restraint ( sling , half-glove , no restraint ) on treatment outcomes . Seventeen individuals at least 1-year post-stroke with mild/moderate upper extremity motor deficit were consecutively assigned to Sling and Task- practice , Sling and Shaping , Half-glove and Shaping , and Shaping Only groups . Task- practice involved repetitive more-impaired arm training on functional tasks for 6 hr/day for 10 consecutive weekdays . Shaping differed from task- practice in that task dem and s were progressively increased and immediate performance feedback was provided frequently and systematic ally . " Sling " groups placed the less-impaired arm in a resting h and -splint/sling assembly for most waking hours over the 2-week intervention , while the " Half-glove " group wore a modified gardening glove as a reminder not to use the more affected arm in the life situation . There were no between-group differences in outcome at post-treatment , although two-years afterwards Sling & Task- practice and Half-glove & Shaping participants showed larger and smaller retention of gains , respectively , than those in the Sling & Shaping group . Thus , long-term outcomes may have been affected by type of more-impaired arm motor training and less-impaired arm restraint . These variables , however , were confounded with between-group differences in training intensity , limiting confidence in this conclusion Systematic review s are used to inform practice , and develop guidelines and protocol s. A question naire to quantify the risk of bias in systematic review s , the review paper assessment ( RPA ) tool , was developed and tested . A search of electronic data bases provided a data set of review articles that were then independently review ed by two assessors using the RPA . The inter-rater reliability was between moderate and good ( & kgr ; scores 0.46–0.95 ) . Many review s did not describe the purpose in terms of population , intervention , comparator and outcome measure ( i.e. PICO format ) , making inter-rater agreement on this question difficult . The RPA discriminated between high- quality review s and those with a risk of bias ( e.g. inadequate reporting of search terms , lack of independent review ing or inclusion of non-r and omized-controlled trials ) . The RPA question naire was revised to ensure that questions ( on the basis of clarity of purpose , extent of search , independence of review ers , r and omized-controlled trial inclusion and availability of data ) had dichotomous answers so that the positive responses scored one . The risk of bias increases as the score reduces . Anh and von systematischen Prüfungen werden die Praxis informiert und Richtlinien und Protokolle entwickelt . Ein Fragebogen zur Quantifizierung des statistischen Verzerrungsrisikos ( Bias-Risikos ) bei systematischen Prüfungen - das RPA-Tool ( Review Paper Assessment )  - wurde entwickelt und getestet . Recherchen in elektronischen Date nbanken förderten Date nsätze von Übersichtsartikeln zutage , die mit Hilfe des RPA-Tools von zwei unabhängigen Assessoren geprüft wurden . Die Inter-Rater-Reliabilität lag bei mittelmäßig bis gut ( & kgr;-Scores 0.46–0.95 ) . Viele Prüfungen beschrieben nicht ihren Zweck hinsichtlich Population , Intervention , Vergleich und Zielgröße ( d. h. PICO-Format ) , wodurch Inter-Rater-Übereinstimmungen bei dieser Frage sich als schwer erwiesen . Das RPA-Tool unterschied zwischen hochwertigen Prüfungen und solchen , die ein Bias-Risiko in sich trugen ( z. B. unangemessene Berichterstattung zu den Suchkriterien , mangelnde unabhängige Prüfung oder Einschluss von nicht-r and omisierten Kontrollstudien ) . Der RPA-Fragebogen wurde einer Prüfung unterzogen , um so sicherzustellen , dass die Fragen ( auf der Grundlage von klaren Zielvorgaben , Ausmaß der Recherche , Unabhängigkeit der Prüfer , Einschluss in r and omisierte Kontrollstudien und Verfügbarkeit von Date n ) dichotom beantwortet wurden , damit die positiven Antworten eine Wertung ergaben . Das Bias-Risiko steigt mit abnehmendem Score . Las revisiones sistemáticas se utilizan para fundamentar la práctica y elaborar directrices y protocol os . Se creó y se evaluó un cuestionario , la herramienta de evaluación de revisiones ( RPA ) ( review paper assessment ) para cuantificar el riesgo de sesgo en las revisiones sistemáticas . Tras realizar una búsqueda en una serie de bases de datos electrónicas , se obtuvo un conjunto de datos sobre artículos que habían sido revisados de forma independiente por dos revisores utiliz and o la herramienta RPA . Se obtuvo una fiabilidad interclasificadores entre moderada y buena ( puntuaciones & kgr ; del 0.46–0.95 ) . Muchas de las revisiones no describían el objetivo en términos de población , intervención , grupo control y result ados de las mediciones , dificult and o por tanto el acuerdo sobre la fiabilidad interclasificadores . La herramienta RPA distinguió entre revisiones de alta calidad y revisiones con riesgo de sesgo ( por ejemplo , revisiones que incluían información inadecuada sobre los términos de búsqueda , que no habían sido revisadas de forma independiente o que incorporaban ensayos controlados no aleatorios ) . El cuestionario RPA se revisó con el objetivo de garantizar que todas las preguntas obtuvieran respuestas dicotómicas ( partiendo de aspectos tales como la claridad del objetivo , el grado de búsqueda , la independencia de los revisores , la incorporación de un ensayo controlado aleatorio y la disponibilidad de datos ) , de modo que a cada respuesta positiva se le asignaba un punto . El riesgo de sesgo aumenta conforme disminuye la puntuación . Des examens systématiques sont utilisés pour éclairer les pratiques et élaborer des lignes directrices et des protocol es . Un question naire pour quantifier le risque de biais dans les examens systématiques , l'outil document de synthèse d'évaluation ( RPA ) , a été développé et testé . Une recherche dans les bases de données électroniques a permis de dégager un jeu d'articles de synthèse qui ont ensuite été indépendamment examinés par deux évaluateurs utilisant le RPA . La fiabilité inter-évaluateurs se situait entre modérée et bonne ( scores & kgr ; 0.46 - 0.95 ) . Nombre d'évaluations ne décrivent pas les objectifs en termes de population , d'intervention , de comparateur et de mesure des résultats ( par exemple , format PICO ) , ce qui rend difficile un accord entre les évaluateurs sur ces points . Le RPA fait la distinction entre les commentaires de haute qualité et ceux qui présentent un risque de biais ( par exemple communication inadéquate des termes de recherche , manque d'examen indépendant ou inclusion d'essais non-contrôlés et r and omisés ) . Le question naire RPA a été révisé pour s'assurer que les questions ( en termes de clarté des objectifs , de portée de la recherche , d'indépendance des évaluateurs , d ' inclusion d'essai r and omisés-contrôlés et de disponibilité des données ) reçoivent des réponses dichotomiques de sorte que les réponses positives se voient attribué un score de un . Le risque de partialité augmente à mesure que le score diminue OBJECTIVE To study the effect of mesh-glove afferent stimulation on motor control of voluntary wrist movement in stroke patients who have chronic neurological deficits . DESIGN Case series . Motor control was evaluated by surface EMG of the arm muscles and kinematics of voluntary wrist movements on 3 occasions : before and immediately after the initial session of mesh-glove stimulation , and then after a daily mesh-glove stimulation program conducted over several months . SETTING Tertiary care center . PATIENTS The inclusion criteria were : a history of stroke lasting longer than 6 months ; completion of a rehabilitation program during early recovery ; and preserved cognitive and communicative ability . Fourteen referred patients ( age 63 + /- 9yr ; time since stroke 31 + /- 22mo ) fulfilled the criteria and completed the daily stimulation program . INTERVENTION A single initial and then daily mesh-glove electrical afferent stimulation was applied to the h and of the involved upper limb for 20 to 30min . MAIN OUTCOME MEASURES Surface EMGs from the affected biceps brachii and wrist extensor muscles and amplitudes of wrist movements were analyzed . RESULTS The single , initial mesh-glove application had no effect on outcome measures . Following a daily mesh-glove stimulation program , however , both the amplitude of wrist extension movement and wrist extensor integrated EMG were significantly increased while coactivation of biceps brachii decreased . These findings were most prominent in subjects with partially preserved voluntary wrist movements . CONCLUSION We conclude that daily mesh-glove stimulation can modify altered motor control and improve voluntary wrist extension movement in stroke subjects with chronic neurological deficits Background and Purpose — Splints are commonly applied to the wrist and h and to prevent and treat contracture after stroke . However , there have been few r and omized trials of this intervention . We sought to determine whether wearing a h and splint , which positions the wrist in either a neutral or an extended position , reduces wrist contracture in adults with hemiplegia after stroke . Methods — Sixty-three adults who had experienced a stroke within the preceding 8 weeks participated . They were r and omized to either a control group ( routine therapy ) or 1 of 2 intervention groups ( routine therapy plus splint in either a neutral or an extended wrist position ) . Splints were worn overnight for , on average , between 9 and 12 hours , for 4 weeks . The primary outcome , measured by a blinded assessor , was extensibility of the wrist and long finger flexor muscles ( angle of wrist extension at a st and ardized torque ) . Results — Neither splint appreciably increased extensibility of the wrist and long finger flexor muscles . After 4 weeks , the effect of neutral wrist splinting was to increase wrist extensibility by a mean of 1.4 ° ( 95 % CI , −5.4 ° to 8.2 ° ) , and splinting the wrist in extension reduced wrist extensibility by a mean of 1.3 ° ( 95 % CI , −4.9 ° to 2.4 ° ) compared with the control condition . Conclusions — Splinting the wrist in either the neutral or extended wrist position for 4 weeks did not reduce wrist contracture after stroke . These findings suggest that the practice of routine wrist splinting soon after stroke should be discontinued 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 gain experience with ‘ Ness H and master Orthosis ’ treatment in chronic stroke patients , to identify suitable patients , and to study the effects of treatment . Design : Exploratory , uncontrolled trial with measurement of motor functions and muscle tone of the upper extremity prior to , during , upon completion , and six weeks after a treatment period . Setting : A rehabilitation centre in the Netherl and s. Subjects : Eighteen chronic stroke patients ( more than six months post stroke ) , who exhibited upper extremity dysfunction due to spastic paresis . Intervention : A 10-week therapy programme of functional electrical stimulation by means of the ‘ Ness H and master Orthosis ’ . Results : The results of 15 patients were available for analysis . The differences in motor score and muscle tone before and at the end of treatment were statistically significant ( p = 0.008 and 0.021 , respectively ) . The follow-up measurements showed that the effects on motor functions and muscle tone decreased after therapy completion . Stratification of the patients in two subgroups indicated that patients with initial high motor scores benefited most during the intervention period . Conclusion : The present study suggests that H and master treatment possesses therapeutic opportunities in chronic stroke patients with spastic paresis of the upper extremity Purpose : This study examined the role of anxiety and upper limb dysfunction , amongst other variables , as predictors of health related quality of life ( HRQOL ) 6 months after stroke . Method : Participants : Stroke survivors ( n = 85 ) who had previously participated in a r and omised controlled trial of a physiotherapy intervention .  Dependent variable : HRQOL – Nottingham Health Profile ( NHP ) . Predictor variables : Mood – Hospital Depression and Anxiety Scale ; Upper Limb Functioning - Action Research Arm Test ; Rivermead Motor Assessment ; Activities of Daily Living – Modified Barthel Index ; Clinical and demographic factors . Results : Anxiety and depression significantly predicted 49 % of variance in overall HRQOL ( p < 0.05 ) , but only anxiety significantly predicted NHP pain ( 13 % variance , p < 0.001 ) , emotional reactions ( 41 % variance , p < 0.001 ) , sleep ( 19 % variance , p = 0.02 ) and social isolation ( 23 % variance , p = 0.02 ) . Depression and anxiety together significantly predicted 30 % variance in energy level ( p < 0.001 ) . UL motor impairment and activities of daily living predicted 36 % of variance in NHP physical activity score ( p < 0.001 ) . Conclusions : This study indicates that where anxiety is assessed , it appears more important in determining HRQOL than depression . UL impairment and ADL independence predicted perceived physical activity . Management strategies for anxiety and therapy for UL recovery long after stroke onset are likely to benefit perceived HRQOL . Implication s for Rehabilitation Anxiety is a major predictor of quality of life six months after stroke . Post-stroke anxiety should be routinely assessed in rehabilitation . Appropriate management strategies for anxiety should occur during rehabilitation with follow-up into the chronic post-stroke period . Upper limb impairment is a stronger predictor of perceptions of physical activity than independence in activities daily living six months after stroke . Rehabilitation of the upper limb should continue into the chronic post-stroke period Manual dexterity is a skill frequently evaluated in rehabilitation to estimate h and function . Several tests have been developed for this purpose , including the Box and Block Test ( BBT ) that measures gross manual dexterity . The goal of the present study was to verify the test-retest reliability and construct validity of the BBT with subjects aged 60 and over with upper limb impairment . The second objective of this research was to develop normative data based on a r and om sample of healthy elderly community-living individuals . The results show that the test-retest reliability is high ( intraclass correlations coefficients of 0.89 to 0.97 ) and the validity of the test is shown by significant correlations between the BBT , an upper limb performance measurement and a functional independence measurement . The norms will help rehabilitation clinicians to differentiate better between real difficulties and those that may be attributed to normal aging Background . Physical therapy doses may need to be higher than provided in current clinical practice , especially for patients with severe paresis . The authors aim ed to find the most effective and feasible dose of Mobilisation and Tactile Stimulation ( MTS ) , which includes joint and soft-tissue mobilization and passive or active-assisted movement to enhance voluntary muscle contraction . Methods . This 2-center , r and omized , controlled , observer-blinded feasibility trial compared conventional rehabilitation but no extra therapy ( group 1 ) with conventional therapy plus 1 of 3 daily doses of MTS , up to 30 ( group 2 ) , 60 ( group 3 ) , or 120 ( group 4 ) minutes for 14 days . The 76 participants had substantial paresis ( Motricity Index [ MI ] < 61 ) a mean of 30 days ( st and ard deviation [ SD ] = 20 days ) after anterior circulation stroke .  MTS was delivered using a st and ardized schedule of techniques ( eg , sensory input , active-assisted movement ) . The primary outcome was the Motricity Index ( MI ) and secondary outcome was the Action Research Arm Test ( ARAT ) tested on day 16 . Adverse events were monitored daily . Results . No difference was found in the change in control group MI compared with each of the 3 intervention groups ( P = .593 ) or in the ARAT . Mean actual daily treatment time for all MTS groups was less than expected . The attrition rate was 1.3 % . No adverse events related to overuse occurred . Conclusion . The authors were not able to deliver a maximum dose of 120 minutes of daily therapy each day . The mean daily dose of MTS feasible for subsequent evaluation is between 37 and 66 minutes Objective . The purpose s of this study were to ( 1 ) examine the feasibility of translating high-repetition doses of upper-extremity ( UE ) task-specific training to people with stroke within the confines of the current outpatient delivery system of 1-hour therapy sessions and ( 2 ) to gather preliminary data regarding the potential benefit of this intensity of training . Methods . A total of 15 patients with chronic ( > 6 months ) UE paresis caused by stroke underwent 3 weeks of baseline assessment s followed by 6 weeks of the high-repetition intervention ( 3 sessions/wk for 6 weeks ) . During each 1-hour session , participants were challenged to complete 300 or more repetitions of UE functional task training ( 3 tasks × 100 repetitions ) . Assessment s during and after the intervention were used to measure feasibility and potential benefit . Results . For the 13 participants completing the intervention , the average number of repetitions per session was 322 . The percentage of sessions attended was 97 % . Participant ratings of pain and fatigue were low . Action Research Arm test scores improved an average of 8 points during the intervention and were maintained at the 1-month follow-up . Secondary measures of activity and participation increased , but the measure of impairment did not . Conclusions . It is feasible to deliver hundreds of repetitions of task-specific training to people with stroke in 1-hour therapy sessions . Preliminary outcome data suggest that this intervention may be beneficial for some people with stroke The study was design ed to evaluate the effect of electromyographic ( EMG ) biofeedback on the recovery of arm function after stroke . Patients who had impaired arm function and were between 2 and 8 weeks after stroke were r and omly allocated to receive either treatment incorporating EMG biofeedback or a control treatment in addition to their routine physiotherapy . The two groups of 20 patients were compared before and after 6 weeks of treatment and at follow-up 6 weeks later . There were no significant differences between the groups before treatment or at follow-up , but at the end of treatment those who received EMG biofeedback scored significantly higher on tests of arm function .  Patients with severe impairment were shown to benefit most from EMG biofeedback but there was no difference in response to treatment according to patient 's age or side of stroke . Men had higher arm function scores than women before and at the end of treatment , but not at follow-up A new method ( The Sødring Motor Evaluation of Stroke Patients ) has been developed for physiotherapists to evaluate motor function and activities in stroke patients . Its main characteristics are the assessment of motor activity without assisting the patient , and the use of a rating which reflects quantity as well as quality in motor performance . A hospitalised group of stroke patients ( n = 93 ) was assessed three times after the acute event , by means of SMES . The data were analysed regarding construct validity as well as concurrent validity against another assessment method . Factor analyses showed a reasonably stable three-factor pattern ( " arm " , " gross motor function " , and " leg " ) which explained 84 , 89 and 90 % , respectively , of the variance at the three study points , with Factor 1 ( " arm " ) as the dominant factor . The ordinality of the rating scale was assessed by means of linear regression analysis and found to be acceptable . The correlation coefficients were high between comparable parts of the new and the reference methods 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 determine the efficacy of a modified constraint-induced therapy ( mCIT ) administered to patients with subacute stroke . Design : Prospect i ve , multiple-baseline , before-after , r and omized clinical trial . Setting : Subacute outpatient clinic . Subjects : Fourteen patients with subacute stroke who exhibited learned nonuse and stable motor deficits in their affected upper limbs . Intervention : Four patients participated in half-hour , structured physical and occupational therapy sessions that emphasized affected arm use in valued functional activities , 3 times per week for 10 weeks . Their less affected upper limbs were restrained 5 days per week during 5 hours identified as times of frequent use ( mCIT ) . Five patients received regular therapy ( TR ) with similar therapeutic contact time to mCIT , and 5 patients received no therapy ( CON ) . Main Outcome Measures : The Fugl-Meyer Assessment of Motor Recovery ( Fugl ) , Action Research Arm ( ARA ) test , and Motor Activity Log ( MAL ) . Results : After intervention , Fugl , ARA , and MAL scores remained virtually the same for TR and CON groups ; scores improved by 11.4 and 11.5 points , respectively , on the Fugl and ARA for the mCIT group . Amount and quality of arm use , as measured by the MAL , also improved for mCIT patients ( 2.49 and 0.47 , respectively ) . Conclusions : mCIT may be an efficacious method of improving affected arm function and use in stroke patients exhibiting learned nonuse Objective . To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis . Methods . A total of 40 chronic stroke patients ( mean time post .onset , 3.9 years ) were r and omly assigned to the mirror group ( n = 20 ) or the control group ( n = 20 ) and then joined a 6-week training program . Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practice d at home 1 hour daily , 5 times a week . The primary outcome measure was the Fugl-Meyer motor assessment ( FMA ) . The grip force , spasticity , pain , dexterity , h and -use in daily life , and quality of life at baseline — posttreatment and at 6 months — were all measured by a blinded assessor . Changes in neural activation patterns were assessed with functional magnetic resonance imaging ( fMRI ) at baseline and posttreatment in an available subgroup ( mirror , 12 ; control , 9 ) . Results . Posttreatment , the FMA improved more in the mirror than in the control group ( 3.6 ± 1.5 , P < .05 ) , but this improvement did not persist at follow-up . No changes were found on the other outcome measures ( all Ps > .05 ) . fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only ( weighted laterality index difference 0.40 ± 0.39 , P < .05 ) . Conclusion . This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization . Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains
BACKGROUND Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability .
Evidence about effects of individual treatment techniques and modalities is synthesis ed within many review s. For selection of effective rehabilitation treatment , the relative effectiveness of interventions must be known .
However , a comprehensive overview of systematic review s in this area is currently lacking .
OBJECTIVES To carry out a Cochrane overview by synthesis ing systematic review s of interventions provided to improve upper limb function after stroke .