Electrical stimulation driving functional improvements and cortical changes in subjects with stroke EMG feedback treatment of upper limb in hemiplegic stroke patients: a pilot study. Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use Assessing Wolf Motor Function Test as Outcome Measure for Research in Patients After Stroke Training of Reaching in Stroke Survivors With Severe and Chronic Upper Limb Paresis Using a Novel Nonrobotic Device: A Randomized Clinical Trial Satisfaction with care in post-stroke patients undergoing a telerehabilitation programme at home Repetitive Bilateral Arm Training With Rhythmic Auditory Cueing Improves Motor Function in Chronic Hemiparetic Stroke Randomized clinical trial of therapeutic exercise in subacute stroke. Robot-assisted therapy for long-term upper-limb impairment after stroke. Daily Functioning and Quality of Life in a Randomized Controlled Trial of Therapeutic Exercise for Subacute Stroke Survivors Effects of Conventional Physical Therapy and Functional Strength Training on Upper Limb Motor Recovery After Stroke: A Randomized Phase II Study Rehabilitation of Reaching and Grasping Function in Severe Hemiplegic Patients Using Functional Electrical Stimulation Therapy Stroke motor recovery: active neuromuscular stimulation and repetitive practice schedules Controlled study of neuroprosthetic functional electrical stimulation in sub-acute post-stroke rehabilitation. A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Effectiveness of home rehabilitation for ischemic stroke Comparing unilateral and bilateral upper limb training: The ULTRA-stroke program design A randomized controlled trial to evaluate intensity of community-based rehabilitation provision following stroke or hip fracture in old age The effectiveness of community-based rehabilitation for stroke patients who remain at home: a pilot randomized trial Cluster Randomized Pilot Controlled Trial of an Occupational Therapy Intervention for Residents With Stroke in UK Care Homes Modified Constraint-Induced Therapy Combined With Mental Practice: Thinking Through Better Motor Outcomes Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care. Can readmission after stroke be prevented? Results of a randomized clinical study: a postdischarge follow-up service for stroke survivors. Best Conventional Therapy Versus Modular Impairment-Oriented Training for Arm Paresis After Stroke: A Single-Blind, Multicenter Randomized Controlled Trial Correlates of subjective well-being in stroke patients. A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital. Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach. Does a short period of rehabilitation in the home setting facilitate functioning after stroke? A randomized controlled trial A home-based rehabilitation program for the hemiplegic upper extremity by power-assisted functional electrical stimulation Intensive Sensorimotor Arm Training Mediated by Therapist or Robot Improves Hemiparesis in Patients With Chronic Stroke A multicentre randomized controlled trial of leisure therapy and conventional occupational therapy after stroke Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial Follow-up services for stroke survivors after hospital discharge-a randomized control study Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke Randomised controlled trial to evaluate early discharge scheme for patients with stroke Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. Multicenter Randomized Trial of Robot-Assisted Rehabilitation for Chronic Stroke: Methods and Entry Characteristics for VA ROBOTICS Preliminary study of the effect of low-intensity home-based physical therapy in chronic stroke patients. Home-based electromyography-triggered stimulation in chronic stroke Follow-up of a controlled trial of domiciliary stroke rehabilitation (DOMINO Study). Effectiveness of Sensory and Motor Rehabilitation of the Upper Limb Following the Principles of Neuroplasticity: Patients Stable Poststroke The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial Effects of a range-of-motion exercise programme. Comparing stroke rehabilitation outcomes between acute inpatient and nonintense home settings. Mechanical Arm Trainer for the Treatment of the Severely Affected Arm After a Stroke: A Single-Blinded Randomized Trial in Two Centers The effects of community-based rehabilitation on stroke patients in China: a single-blind, randomized controlled multicentre trial Combined Botulinum Toxin Type A With Modified Constraint-Induced Movement Therapy for Chronic Stroke Patients With Upper Extremity Spasticity: A Randomized Controlled Study 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. A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. Does treadmill exercise improve performance of cognitive or upper-extremity tasks in people with chronic stroke? A randomized cross-over trial.
It has been proposed that somatosensory stimulation in the form of electromyographically triggered neuromuscular electrical stimulation ( NMES ) to the peripheral nerve can influence functional measures of motor performance in subjects with stroke and can additionally produce changes in cortical excitability . Using a controlled , double-blind design , we studied the effects of intensive ( 60 h/3 weeks ) treatment at home with NMES compared with a sham treatment , applied to the extensor muscles of the hemiplegic forearm to facilitate h and opening in 16 chronic stroke subjects . We investigated improvement in functional use of the h and and change in cortical activation as measured by functional magnetic resonance imaging ( fMRI ) . Following treatment , subjects improved on measures of grasp and release of objects ( Box and Block Test and Jebsen Taylor H and Function Test [ JTHFT ] : small objects , stacking , heavy cans ) , isometric finger extension strength , and self-rated Motor Activity Log ( MAL ) : Amount of Use and How Well score . The sham subjects did not improve on any grasp and release measure or self-rated scale , but did improve on isometric finger extension strength . Importantly , however , following crossover , these subjects improved further in the measure of strength , grasp and release ( Box and Block [ JTHFT ] : page turning ) , and self-rated MAL : Amount of Use score and How Well score . Using fMRI and a finger-tracking task , an index of cortical intensity in the ipsilateral somatosensory cortex increased significantly from pre-test to post-test following treatment . Cortical activation , as measured by voxel count , did not change . These findings suggest that NMES may have an important role in stimulating cortical sensory areas allowing for improved motor function Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients Objective : ( 1 ) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the dem and on therapist re sources . ( 2 ) To explore whether extended mitt use alone may enhance outcome . Design : A combined case-control and r and omized controlled study with pre- and post-treatment measures by blinded observers . Setting : A university hospital rehabilitation department . Participants : Sixteen stroke patients ( nine men and seven women ; mean age 56.7 years ; on average 28.9 months post stroke , five of whom were 6 - 9 months post stroke ) with moderate motor impairments in the contralateral upper limb . Intervention : Constraint-induced therapy ( mitt on the less affected h and 90 % of waking hours for 12 days ) with 2 - 3 patients per therapist and 6 h of group training per day . After the training period , the patients were r and omized either to using the mitt at home every other day for two-week periods for another three months ( in total 21 days ) or to no further treatment . Outcome measures : Modified Motor Assessment Scale , Sollerman H and Function Test , Two-Point Discrimination test and Motor Activity Log . Results : The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale ( 1.44 ( 95 % confidence interval ( 95 % CI ) 0.59 - 2.28 ) points ; P = 0.003 ) and on Sollerman H and Function Test ( 3.81 ( 95 % CI 0.26 - 7.36 ) points ; P = 0.037 ) but showed no sensory change in the Two-Point Discrimination Test ( P = 0.283 ) . The median difference in self-reported motor ability ( Motor Activity Log ) also improved ( P B=0.001 ) . However , no additional effect was seen from wearing a mitt for another three months . Conclusion : Constraint-induced group therapy , allowing several patients per therapist , seems to be a feasible alternative to improve upper limb motor function . The restraint alone , extended in time , did not enhance the treatment effect 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 Background and Purpose — Severe upper limb paresis is a major contributor to disability after stroke . This study investigated the efficacy of a new nonrobotic training device , the Sensorimotor Active Rehabilitation Training ( SMART ) Arm , that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension , permitting stroke survivors with severe paresis to practice a constrained reaching task . Methods — A single-blind , r and omized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis . Thirty-three participants completed the study , of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation , 13 received training using the SMART Arm alone , and 10 received no intervention ( control ) . Training consisted of 12 1-hour sessions over 4 weeks . The primary outcome measure was “ upper arm function , ” item 6 of the Motor Assessment Scale . Secondary outcome measures included impairment measures ; triceps muscle strength , reaching force , modified Ashworth scale ; and activity measures : reaching distance and Motor Assessment Scale . Assessment s were administered before ( 0 weeks ) and after training ( 4 weeks ) and at 2 months follow-up ( 12 weeks ) . Results — Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up . There was no significant difference between these 2 groups . There was no change in the control group . Conclusions — Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis , highlighting the benefits of intensive task-oriented practice , even in the context of severe paresis We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment . We compared the degree of satisfaction of patients undergoing a virtual reality ( VR ) therapy programme at home ( Tele-VR group ) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting ( VR-group ) . The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient 's movement was represented . In tele-therapy , the patient equipment was installed in their homes , connected to the hospital by four ISDN lines at a total b and width of 512 kbit/s . Rehabilitation data were transmitted via one line and videoconferencing via the other three . Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke , were r and omized into VR or Tele-VR groups . A question naire was used at the end of treatment to measure each patient 's degree of satisfaction . Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated , except one . In motor performance , the Tele-VR group improved significantly ( P ≤ 0.05 ) , while the VR group showed no significant change . Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required Background and Purpose Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke . We investigated the hypothesis that bilateral arm training with rhythmic auditory cueing ( BATRAC ) will improve motor function in the hemiparetic arm of stroke patients . Methods In this single group pilot study we determined the effects of 6 weeks of BATRAC on 14 patients with chronic hemiparetic stroke ( median time after stroke , 30 months ) immediately after training and at 2 months after training . Four 5-minute periods per session ( 3 times per week ) of BATRAC were performed with the use of a custom- design ed arm training machine . Results The patients showed significant and potentially durable increases in the following : Fugl-Meyer Upper Extremity Motor Performance Test of impairment ( P < 0.0004 ) , Wolf Motor Function Test ( performance time measure , P < 0.02 ) , and University of Maryl and Arm Question naire for Stroke measuring daily use of the hemiparetic arm ( P < 0.002 ) . Isometric strength improved in elbow flexion ( P < 0.05 ) and wrist flexion ( P < 0.02 ) for the paretic arm and in elbow flexion ( P < 0.02 ) and wrist extension ( P < 0.02 ) for the nonparetic arm . Active range of motion improved for paretic-side shoulder extension ( P < 0.01 ) , wrist flexion ( P < 0.004 ) , and thumb opposition ( P < 0.002 ) , and passive range of motion improved for paretic wrist flexion ( P < 0.03 ) . Conclusions Six weeks of BATRAC improves functional motor performance of the paretic upper extremity as well as a few changes in isometric strength and range of motion . These benefits are largely sustained at 8 weeks after training cessation BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care BACKGROUND Effective rehabilitative therapies are needed for patients with long-term deficits after stroke . METHODS In this multicenter , r and omized , controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke , we r and omly assigned 49 patients to receive intensive robot-assisted therapy  , 50 to receive intensive comparison therapy , and 28 to receive usual care . Therapy consisted of 36 1-hour sessions over a period of 12 weeks . The primary outcome was a change in motor function , as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke , at 12 weeks . Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale . Secondary analyses assessed the treatment effect at 36 weeks . RESULTS At 12 weeks , the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care ( difference , 2.17 points ; 95 % confidence interval [ CI ] , -0.23 to 4.58 ) and worse than that for patients receiving intensive comparison therapy ( difference , -0.14 points ; 95 % CI , -2.94 to 2.65 ) , but the differences were not significant . The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care ( difference , 7.64 points ; 95 % CI , 2.03 to 13.24 ) . No other treatment comparisons were significant at 12 weeks . Secondary analyses showed that at 36 weeks , robot-assisted therapy significantly improved the Fugl-Meyer score ( difference , 2.88 points ; 95 % CI , 0.57 to 5.18 ) and the time on the Wolf Motor Function Test ( difference , -8.10 seconds ; 95 % CI , -13.61 to -2.60 ) as compared with usual care but not with intensive therapy . No serious adverse events were reported . CONCLUSIONS In patients with long-term upper-limb deficits after stroke , robot-assisted therapy did not significantly improve motor function at 12 weeks , as compared with usual care or intensive therapy . In secondary analyses , robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy . ( Clinical Trials.gov number , NCT00372411 . Background and Purpose — The ability of therapeutic exercise after stroke to improve daily functioning and quality of life ( QOL ) remains controversial . We examined treatment effects on these outcomes in a r and omized controlled trial ( RCT ) of  exercise  in subacute stroke survivors . Methods — This is a secondary analysis of a single-blind RCT of a 12-week program versus usual care . Baseline , post-treatment and 6-month post-treatment daily functioning and QOL were assessed by Barthel index , Functional Independence Measure , instrumental activities of daily living , Medical Outcomes Study short-form 36-item question naire ( SF-36 ) , and Stroke Impact Scale ( SIS ) . Results — Of 100 r and omized subjects , 93 completed the postintervention assessment , ( mean age 70 ; 54 % male ; 81 % white ; mean Orpington Prognostic Score 3.4 ) , and 80 had 6-month post-treatment assessment . Immediately after intervention , the intervention group improved more than usual care in SF-36 social function ( 14.0 points ; P=0.0051 ) and in SIS ( strength [ 9.2 points ; P=0.0003 ] , emotion [ 5.6 points ; P=0.0240 ] , social participation [ 6.6 points ; P=0.0488 ] , and physical function [ 5.0 points ; P=0.0145 ] ) . Treatment was marginally more effective on Barthel score ( 3.3 points ; P=0.0510 ) , SF-36 ( physical function [ 6.8 points ; P=0.0586 ] , physical role function [ 14.4 points ; P=0.0708 ] ) , and SIS upper extremity function ( 7.2 points ; P=0.0790 ) . Effects were diluted 6 months after treatment ended . Conclusion — This rehabilitation exercise program led to more rapid improvement in aspects of physical , social , and role function than usual care in persons with subacute stroke . Adherence interventions to promote continued exercise after treatment might be needed to continue benefit Background . Functional training and muscle strength training may improve upper limb motor recovery after stroke . Combining these as functional strength training ( FST ) might enhance the benefit , but it is unclear whether this is better than conventional physical therapy ( CPT ) . Comparing FST with CPT is not straightforward . Objective . This study aim ed at assessing the feasibility of conducting a phase III trial comparing CPT with FST for upper limb recovery . Methods . R and omized , observer-blind , phase II trial . Subjects had upper limb weakness within 3 months of anterior circulation infa rct ion . Subjects were r and omized to CPT ( no extra therapy ) , CPT + CPT , and CPT + FST . Intervention lasted 6 weeks . Primary outcome measure was the Action Research Arm Test ( ARAT ) . Measurements were taken before treatment began , after 6 weeks of intervention , and 12 weeks thereafter . Attrition rate was calculated and differences between groups were interpreted using descriptive statistics . ARAT data were used to inform a power calculation . Results . Thirty subjects were recruited ( 8 % of people screened ) .  Attrition rate was 6.7 % at outcome and 40 % at follow-up . At outcome the CPT + FST group showed the largest increase in ARAT score and this was above the clinical ly important level of 5.7 points . Median ( interquartile range ) increases were 11.5 ( 21.0 ) for CPT ; 8.0 ( 13.3 ) for CPT + CPT ; and 19.5 ( 22.0 ) for CPT + FST . The estimated sample size for an adequately powered subsequent phase III trial was 279 subjects at outcome . Conclusion . Further work toward a phase III clinical trial appears justifiable Objective . The aim of this study was to establish the efficacy of a therapeutic intervention based on functional electrical stimulation ( FES ) therapy to improve reaching and grasping function after severe hemiplegia due to stroke . Methods . A total of 21 subjects with acute stroke were r and omized into 2 groups , FES plus conventional occupational and physiotherapy ( FES group ) or only conventional therapy ( control group ) 5 days a week for 12 to 16 weeks . A third group of 7 subjects with chronic hemiplegia ( at least 5 months poststroke ) received only FES therapy ( chronic group ) and pre — post training changes were compared . FES was applied to proximal and then distal muscle groups during specific motor tasks . At baseline and at the end of treatment , grasping function was assessed using the Rehabilitation Engineering Laboratory H and Function Test , along with more st and ard measures of rehabilitation outcome . Results . The FES group improved significantly more than the control group in terms of object manipulation , palmar grip torque , pinch grip pulling force , Barthel Index , Upper Extremity Fugl — Meyer scores , and Upper Extremity Chedoke — McMaster Stages of Motor Recovery . The chronic stroke subjects demonstrated improvements in most categories , but the changes were not statistically significant . Conclusions . FES therapy with upper extremity training may be an efficacious intervention in the rehabilitation of reaching and grasping function during acute stroke rehabilitation Objective : To investigate progress toward motor recovery in patients with chronic hemiparesis ( mean time since stroke 3.2 years ) , comparing different types of practice schedules . Design : To increase voluntary control of the upper extremity , active neuromuscular stimulation was administered during blocked and r and om practice schedules as patients performed three specific movements : wrist/finger extension , elbow joint extension , and shoulder joint abduction . Methods : 34 stroke subjects volunteered to participate and were r and omly assigned to one of three treatment groups : blocked practice ( the same movement was repetitively performed on successive trials ) combined with active neuromuscular stimulation ; r and om practice ( different movements on successive trials ) along with active stimulation ; or no active stimulation assistance control group . Subjects completed two days of 90 minute training for each of two weeks with at least 24 hours of rest between sessions . A session was three sets of 30 successful active neuromuscular stimulation trials with the three movements executed 10 times/set . Results : Mixed design analyses on three categories of behavioural measures indicated motor improvements for the blocked and r and om practice /stimulation groups in comparison with the control group during the post-test period , with a larger number of blocks moved , faster premotor and motor reaction times , and less variability in the sustained muscular contraction task . Conclusions : Upper extremity rehabilitation intervention of active stimulation and blocked practice performed as well as stimulation/r and om practice . Moreover , these purpose ful voluntary movement findings support and extend sensorimotor integration theory to both practice schedules OBJECTIVE Assess the effects of daily neuroprosthetic ( NESS H and master ) functional electrical stimulation in sub-acute stroke . DESIGN Controlled study , patients clinical ly stratified to 2 groups ; no active finger movement , and partial active finger movements , and then r and omized to control and neuroprosthesis groups . Observer blinded evaluations at baseline and completion of the 6-week study . SUBJECTS 22 patients with moderate to severe upper limb paresis 3 - 6 months post-onset . METHODS Patients in day hospital rehabilitation , receiving physical and occupational therapy 3 times weekly . The neuroprosthesis group used the device at home . RESULTS The neuroprosthesis group had significantly greater improvements in spasticity , active range of motion and scores on the functional h and tests ( those with partial active motion ) . Of the few patients with pain and oedema , there was improvement only among those in the neuroprosthesis group . There were no adverse reactions . CONCLUSION Supplementing st and ard outpatient rehabilitation with daily home neuroprosthetic activation improves upper limb outcomes BACKGROUND AND PURPOSE Many stroke survivors have minimal to moderate neurological deficits but are physically deconditioned and have a high prevalence of cardiovascular problems ; all of these are potentially modifiable with exercise . The purpose s of this r and omized , controlled pilot study were ( 1 ) to develop a home-based balance , strength , and endurance program ; ( 2 ) to evaluate the ability to recruit and retain stroke subjects ; and ( 3 ) to assess the effects of the interventions used . METHODS Twenty minimally and moderately impaired stroke patients who had completed inpatient rehabilitation and who were 30 to 90 days after stroke onset were r and omized to a  control group or to an experimental group that received a therapist-supervised , 8-week , 3-times-per-week , home-based exercise program . The control group received usual care as prescribed by the patients ' physicians . Baseline and postintervention assessment s included the Fugl-Meyer Motor Assessment , the Barthel Index of Activities of Daily Living ( ADL ) , the Lawton Scale of Instrumental ADL , and the Medical Outcomes Study -36 Health Status Measurement . Functional assessment s of balance and gait included a 10-m walk , 6-Minute Walk , and the Berg Balance Scale . Upper extremity function was evaluated by the Jebsen Test of H and Function . RESULTS Of 22 patients who met study criteria , 20 completed the study and 2 refused to participate . The experimental group tended to improve more than the control group in motor function ( Fugl-Meyer Upper Extremity : mean change in score , 8 . 4 versus 2.2 ; Fugl-Meyer Lower Extremity : 4.7 versus -0.9 ; gait velocity : median change , 0.25 versus .09 m/s ; 6-Minute Walk : 195 versus 114 ft ; Berg Balance Score : 7.8 versus 5 ; and Medical Outcomes Study -36 Health Status Measurement of Physical Function : 15 . 5 versus 9 ) . There were no trends in differences in change scores by the Jebsen Test of H and Function , Barthel Index , and Lawton Instrumental ADL Scale . CONCLUSIONS This study demonstrated that a r and omized , controlled clinical trial of a poststroke exercise program is feasible . Measures of neurological impairments and lower extremity function showed the most benefit . Effects of the intervention on upper extremity dexterity and functional health status were equivocal . The lasting effects of the intervention were not assessed The objective of this study was to develop and examine the effectiveness of an individual home rehabilitation program for patients with ischemic stroke . This was a r and omized controlled trial in 60 patients with recent middle cerebral artery infa rct ion . After hospital discharge for acute stroke care , they were r and omly assigned to receive either a home rehabilitation program for three months ( intervention group ) or usual care ( control group ) . We collected outcome data over three months after their discharge from the hospital .  The Barthel Index ( BI ) , the Modified Rankin Scale ( MRS ) , the health-related quality -of-life index ( EQ-5D ) , the Hospital Anxiety and Depression score ( HADs ) , and the Thai Mental State Examination ( TMSE ) were used to analyze the outcomes . In the intervention group , all outcomes were significantly better ( p<0.05 ) than in the control group , except in the case of TMSE . A favorable outcome , which was defined as minimal or no disability as measured by BI ( score 95–100 ) , was achieved by 93.33 % of patients in the intervention group , and 90 % had favorable scores ( 0 or 1 ) on the MRS . This showed a benefit in reducing disability , with two being the number of patients considered as needed-to-treat ( NNT ) ( 95 % CI , 1.0–1.2 ) . All dimensions of EQ-5D in the intervention group were significantly better for quality of life and generic health status than in the control group ( p=0.001 ) . Depression was found in one patient ( 3.33 % ) in the intervention group and in two patients ( 6.67 % ) in the control group . Dementia was found in three patients ( 10 % ) in the intervention group and in four patients ( 13.33 % ) in the control group . We concluded that an early home rehabilitation program for patients with ischemic stroke in the first three-month period provides significantly better outcomes in improving function , reducing disability , increasing quality of life , and reducing depression than a program of usual care does Background About 80 % of all stroke survivors have an upper limb paresis immediately after stroke , only about a third of whom ( 30 to 40 % ) regain some dexterity within six months following conventional treatment programs . Of late , however , two recently developed interventions - constraint-induced movement therapy ( CIMT ) and bilateral arm training with rhythmic auditory cueing ( BATRAC ) - have shown promising results in the treatment of upper limb paresis in chronic stroke patients . The ULTRA-stroke ( acronym for Upper Limb TRaining After stroke ) program was conceived to assess the effectiveness of these interventions in subacute stroke patients and to examine how the observed changes in sensori-motor functioning relate to changes in stroke recovery mechanisms associated with peripheral stiffness , interlimb interactions , and cortical inter- and intrahemispheric networks . The present paper describes the design of this single-blinded r and omized clinical trial ( RCT ) , which has recently started and will take several years to complete . Methods / Design Sixty patients with a first ever stroke will be recruited . Patients will be stratified in terms of their remaining motor ability at the distal part of the arm ( i.e. , wrist and finger movements ) and r and omized over three intervention groups  receiving modified CIMT , modified BATRAC , or an equally intensive ( i.e. , dose-matched ) conventional treatment program for 6 weeks . Primary outcome variable is the score on the Action Research Arm test ( ARAT ) , which will be assessed before , directly after , and 6 weeks after the intervention . During those test sessions all patients will also undergo measurements aim ed at investigating the associated recovery mechanisms using haptic robots and magneto-encephalography ( MEG ) . Discussion ULTRA-stroke is a 3-year translational research program which aims ( 1 ) to assess the relative effectiveness of the three interventions , on a group level but also as a function of patient characteristics , and ( 2 ) to delineate the functional and neurophysiological changes that are induced by those interventions .The outcome on the ARAT together with information about changes in the associated mechanisms will provide a better underst and ing of how specific therapies influence neurobiological changes , and which post-stroke conditions lend themselves to specific treatments . Trial Registration The ULTRA-stroke program is registered at the Netherl and s Trial Register ( NTR , http://www.trialregister.nl , number NTR1665 ) Objective : To compare intensive with non-intensive home-based rehabilitation provision following stroke or hip fracture in old age ( 65 years ) . Design : Parallel single-blind r and omized control trial . Setting : Domiciliary provided multidisciplinary rehabilitation . Subjects : One hundred and sixty patients aged 65 or over recently discharged from hospital after suffering a stroke or hip fracture . Intervention : Patients assigned to receive six or more face-to-face contacts or three or less face-to-face contacts from members of a multidisciplinary rehabilitation team . Main measures : Patients assessed using the Barthel Index , Therapy Outcome Measure , Euroqol 5D ( EQ-5D ) , Hospital Anxiety and Depression Scale ( HADS ) and Frenchay Activities Index ( FAI ) at three months . All follow-up assessment s were conducted blind to allocation . Results : Subgroup analysis was conducted on the basis of incident condition ( stroke or hip fracture ) . Significant differences were detected for the stroke subgroup at three months [ Therapy Outcome Measure H and icap ( median difference 0.5 ( P < 0.05 ) ) and EQ-5D ( median difference 0.17 ( P < 0.05 ) ) ] and in change at three months [ Therapy Outcome Measure ( mean difference 0.52 ( SD 0.85 ) 95 % CI ( 0.16 , 0.88 ) ) and EQ-5D ( mean difference 0.15 ( SD 0.25 ) 95 % CI ( 0.05 , 0.26 ) ) ] . No significant differences were detected between the two arms of the study for the hip fracture subgroup . Conclusion : Following stroke older people who receive a more intensive communitybased multidisciplinary rehabilitation service may experience short-term benefit in relation to social participation and some aspects of health-related quality of life . A more intensive service after discharge from hospital following a hip fracture is unlikely to result in similar patient benefit Objective : To assess the effectiveness of community-based rehabilitation for stroke patients who were not admitted to hospital in South London . Design : R and omized controlled trial . Setting : Patients ' homes in South London . Subjects : Stroke patients not admitted to hospital after a stroke . Intervention : Rehabilitation at home by rehabilitation team for up to three months or usual care . Main outcome measures : The primary outcome measure was the Barthel score . Secondary measures included the Motricity Index , Rivermead ADL , Hospital Anxiety and Depression score and Nottingham Health Profile . Results : Forty-three patients who remained at home were r and omized to rehabilitation team ( 23 ) or ‘ usual ’ care ( 20 ) . The mean number of physiotherapy sessions was three ( range 1–14 ) for the rehabilitation team group and two for the usual care group . Patients ( with a deficit ) in the rehabilitation arm of the trial were more likely to receive  occupational , physical and speech therapy  than those in the control arm ( p = 0.03 , 0.01 and 0.008 , respectively ) . For those patients actually receiving therapy , there was no evidence that the amount received differed between the groups . However , the number of patients in each of these comparisons was very small . The outcome for patients in the  rehabilitation team arm of the trial was nonsignificantly higher ( 0.05 < p < 0.2 ) than for those in the control arm for the areas of Nottingham Health Profile , anxiety , depression , caregiver strain and the proportion of patients living at home . Based on the data observed here , a trial with approximately 150 patients in each arm would be needed to have adequate power to detect a 33 % difference between intervention and control groups in these outcomes . Conclusion : Community therapy support for patients not admitted to hospital is feasible but to determine whether it is cost- or clinical ly effective would require trials of adequate size Background and Purpose — A pilot evaluation of an occupational therapy intervention to improve self-care independence for residents with stroke-related disability living in care homes was the basis of this study . Methods — A cluster r and omized controlled trial with care home as the unit of r and omization was undertaken in Oxfordshire , UK . Twelve homes ( 118 residents ) were r and omly allocated to either intervention ( 6 homes , 63 residents )  or control ( 6 homes , 55 residents ) . Occupational therapy was provided to individuals but included carer education . The control group received usual care . Assessment s were made at baseline , postintervention ( 3 months ) and at 6-months to estimate change using the Barthel Activity of Daily Living Index ( BI ) scores , “ poor global outcome ” , ( defined as deterioration in BI score , or death ) and the Rivermead Mobility Index . Results — At 3 months BI score in survivors had increased by 0.6 ( SD 3.9 ) in the intervention group and decreased by 0.9 ( 2.2 ) in the control group ; a difference of 1.5 ( 95 % CI allowing for cluster design , −0.5 to 3.5 ) . At 6 months the difference was 1.9 ( −0.7 to 4.4 ) . Global poor outcome was less common in the intervention group . At 3 months , 20/63 ( 32 % ) were worse/dead in the intervention group compared with 31/55 ( 56 % ) in the control group , difference −25 % ( −51 % to 1 % ) . At 6 months the difference was similar , −26 % ( −48 % to −3 % ) . Between-group changes in Rivermead Mobility Index scores were not significantly different . Conclusion — Residents who received an occupational therapy intervention  were less likely to deteriorate in their ability to perform activities of daily living Background and Purpose — Modified constraint-induced therapy ( mCIT ) is an outpatient therapy encouraging repetitive , task-specific practice with the affected arm . mCIT has shown efficacy in all stages poststroke . Given its efficacy when combined with other therapy regimens , the current study examined the efficacy of mental practice when combined with mCIT versus mCIT only using r and omized , controlled methods . Method — Ten patients with chronic stroke ( 7 males ; mean age , 61.4±3.02 years ; age range , 48 to 79 years ; mean time since stroke , 28.5 months ; range , 13 to 42 months ) exhibiting stable , affected arm motor deficits were administered mCIT , consisting of : ( 1 ) structured therapy emphasizing affected arm use in functional activities 3 days/week for 10 weeks ; and ( 2 ) less affected arm restraint 5 days/week for 5 hours . Both of these components were administered during a 10-week period . Subjects r and omly assigned to the mCIT+mental practice experimental condition also received 30-minute mental practice sessions provided directly after therapy sessions . These mental practice sessions required daily cognitive rehearsal of the activities of daily living practice d during mCIT clinical sessions . Results — No pre-existing differences were found between groups on any demographic variable or movement scale . All subjects exhibited marked reductions in affected arm impairment and functional limitation . However , subjects in the mCIT+mental practice group exhibited significantly larger changes on both movement measures after intervention : Action Research Arm Test , + 15.4-point change versus + 8.4-point change for mCIT only subjects ( P<0.001 ) ; Fugl-Meyer , + 7.8-point change versus + 4.1-point change for the mCIT only subjects ( P=0.01 ) . These changes were sustained 3 months after intervention . Conclusions — mCIT remains a promising motor intervention . However , its efficacy appears to be enhanced by use of mental practice provided directly after mCIT clinical sessions Abstract Objective : To establish if a brief programme of domiciliary occupational therapy could improve the recovery of  patients with stroke discharged from hospital . Design : Single blind r and omised controlled trial . Setting : Two hospital sites within a UK teaching hospital . Subjects : 138 patients with stroke with a definite plan for discharge home from hospital . Intervention : Six week domiciliary occupational therapy or routine follow up . Main outcome measures : Nottingham extended activities of daily living score and “ global outcome ” ( deterioration according to the Barthel activities of daily living index , or death ) . Results : By eight weeks the mean Nottingham extended activities of daily living score in the intervention group was 4.8 points ( 95 % confidence interval −0.5 to 10.0 , P=0.08 ) greater than that of the control group . Overall , 16 ( 24 % ) intervention patients had a poor global outcome compared with 30 ( 42 % ) control patients ( odds ratio 0.43 , 0.21 to 0.89 , P=0.02 ) . These patterns persisted at six months but were not statistically significant . Patients in the intervention group were more likely to report satisfaction with a range of aspects of services . Conclusion : The functional outcome and satisfaction of patients with stroke can be improved by a brief occupational therapy programme carried out in the patient 's home immediately after discharge . Major benefits may not , however , be sustained OBJECTIVES To compare the effectiveness and costs of a new domiciliary rehabilitation service for elderly stroke patients with geriatric day-hospital care . DESIGN R and omized controlled trial . PARTICIPANTS Stroke patients aged 55 + who required further rehabilitation after hospital discharge or after referral to geriatricians from the community .  SETTING Poole area , East Dorset , a mixed urban/rural area on the south coast of Engl and . MAIN OUTCOMES Primary -changes between hospital discharge and 6-month follow-up in physical function as measured by Barthel index . Secondary -changes over this period in Rivermead Mobility Index and mental state ( Philadelphia Geriatric Centre Morale Scale ) and differences in social activity ( Frenchay Activities Index ) and generic health status ( SF-36 ) . Health service and social service cost per patient were compared for the two groups . RESULTS 180 patients were eligible and 140 ( 78 % ) were r and omized . The groups were well balanced for age , sex , social class and initial Barthel index . We achieved follow-up in 88 % of subjects who were alive at 6 months . We detected no significant differences in patient outcomes , although there was a non-significant improvement in measures of physical function and social activity in the domiciliary group . Domiciliary patients had more physiotherapy time per session and more district nurse time , and made greater use of social service day centres and home helps . Total cost per patient did not differ significantly between the two groups , with reduced health service costs in the domiciliary arm offset by higher social service costs . CONCLUSION No significant differences were detected in the effectiveness of the two services . Neither service influenced patients ' mental state , and their social activity remained low . Total costs were similar . A mixed model of day-hospital and domiciliary care may be most cost-effective for community stroke rehabilitation , but this requires further evaluation BACKGROUND AND PURPOSE About 50 % of stroke survivors are discharged to their homes with lasting disability . Knowledge , however , of the importance of follow-up services that targets these patients is sparse . The purpose of the present study was to evaluate 2 models of follow-up intervention after discharge . The study hypothesis was that intervention could reduce readmission rates and institutionalization and prevent functional decline . We report the results regarding readmission . METHODS This r and omized study included 155 stroke patients with persistent impairment and disability who , after the completion of inpatient rehabilitation , were discharged to their homes . The patients were r and omized to 1 of 2 follow-up interventions provided in addition to st and ard care or to st and ard aftercare . Fifty-four received follow-up home visits by a physician ( INT1-HVP ) , 53 were provided instructions by a physiotherapist in their home ( INT2-PI ) , and 48 received st and ard aftercare only ( controls ) . Baseline characteristics for the 3 groups were comparable . Six months after discharge , data were obtained on readmission and institutionalization . RESULTS The readmission rates within 6 months after discharge were significantly lower in the intervention groups than in the control group ( INT1-HVP 26 % , INT2-PI 34 % , controls 44 % ; P=0.028 ) . Multivariate analysis of readmission risk showed a significant favorable effect of intervention ( INT1-HVP or INT2-PI ) in interaction with length of hospital stay ( P=0.0332 ) , indicating that the effect of intervention was strongest for patients with a prolonged inpatient rehabilitation . CONCLUSIONS Readmission is common among disabled stroke survivors .  Follow-up intervention after discharge seems to be a way of preventing readmission , especially for patients with long inpatient rehabilitation Background . The study investigated whether passive splinting or active motor training as either individualized best conventional therapy or as st and ardized impairment-oriented training ( IOT ) would be superior in promoting motor recovery in subacute stroke patients with mildly or severely paretic arms . Methods . A total of 148 anterior circulation ischemic stroke patients were r and omly assigned to 45 minutes of additional daily arm therapy over 3 to 4 weeks as either ( a ) passive therapy with inflatable splints or active arm motor therapy as either ( b ) individualized best conventional therapy ( CONV ) or ( c ) st and ardized IOT , that is Arm BASIS training for severe paresis or Arm Ability training for mild paresis . Main outcome measures included the following : Fugl-Meyer arm motor score ( severely paretic arms ) and the TEMPA time scores ( mildly affected arms ) . Pre — post ( immediate effects ) and pre—4 weeks follow-up analyses ( long-term effects ) were performed . Results . Overall improvements were documented ( mean baseline and change scores efficacy : Fugl-Meyer , arm motor scores , 24.4 , + 9.1 points ; TEMPA , 119 , −26.6 seconds ; P < .0001 ) , but with no differential effects between splint therapy and the combined active motor rehabilitation groups . Both efficacy and effectiveness analyses indicated , however , bigger immediate motor improvements after IOT as compared with best conventional therapy ( Fugl-Meyer , arm motor scores : IOT + 12.3 , CONV + 9.2 points ; TEMPA : IOT −31.1 seconds , CONV −20.5 seconds ; P = .0363 ) ; for mildly affected patients long-term effects could also be substantiated . Conclusions . Specificity of active training seemed more important for motor recovery than intensity ( therapy time ) . The comprehensive modular IOT approach promoted motor recovery in patients with either severe or mild arm paresis BACKGROUND AND PURPOSE Data on survival and functioning after stroke needs to be supplemented by measures emphasizing the patients ' subjective perception . We studied ( 1 ) subjective well-being ( SWB ) as a latent variable in a common-factor model with four items , ( 2 ) the reliability of these four items , and ( 3 ) variables related to SWB in stroke patients . METHODS Data on all stroke patients ( n=1417 ) and a r and om sub sample of stroke-free individuals of similar age ( n=1439 ) were collected from the Nord-Trøndelag Health Survey , a cross-sectional study of 74977 persons . Based on a two- sample factor analysis model , scores of SWB were calculated , and variables explaining SWB were studied in a regression model . RESULTS Four items were a priori believed to measure SWB as a latent variable ( " satisfaction , " " strength , " " calmness , " and " cheerfulness " ) . This was confirmed by factor analysis . The reliability of these items ( the proportion of the variance of the items that can be explained by the common factor ) was between .42 and .53 . Regression analyses showed a significant effect of having had a stroke , gender ( lower SWB in men ) , age ( increasing SWB with increasing age ) , perceived general health , nervousness , loneliness , sleep problems , social support , and use of analgesics . There was no statistical interaction between these variables and having had a stroke . CONCLUSIONS Higher SWB after stroke relates to female gender , older age , good general and mental health , and a firm social network This study compared the functional ability and perceived health status of stroke patients treated by a domiciliary rehabilitation team or by routine hospital-based services after discharge from hospital . Patients discharged from two acute and three rehabilitation hospitals in Nottingham were r and omly allocated in three strata ( Health Care of the Elderly , General Medical and Stroke Unit ) to receive domiciliary or hospital-based care after discharge . Functional recovery was assessed by the Extended Activities of Daily Living ( ADL ) scale three and six months after discharge and perceived health at six months was measured by the Nottingham Health Profile .  A total of 327 eligible patients of 1119 on a register of acute stroke admissions were recruited over 16 months . Overall there were no differences between the groups in their Extended ADL scores at three or six months , or their Nottingham Health Profile scores at six months . In the Stroke Unit stratum , patients treated by the domiciliary team had higher household ( p = 0.02 ) and leisure activity ( p = 0.04 ) scores at six months than those receiving routine care . In the Health Care of the Elderly stratum , death or a move into long-term institutional care at six months occurred less frequently in patients allocated to the routine service , about half of whom attended a geriatric day hospital . Overall there was no difference in the effectiveness of the domiciliary and hospital-based services , although younger stroke unit patients appeared to do better with home therapy while some frail elderly patients might have benefited from day hospital attendance OBJECTIVE Telerehabilitation enables a remotely controlled programme to be used to treat motor deficits in post-stroke patients . The effects of this telerehabilitation approach were compared with traditional motor rehabilitation methods . DESIGN R and omized single-blind controlled trial . PATIENTS A total of 36 patients with mild arm motor impairments due to ischaemic stroke in the region of the middle cerebral artery . METHODS The experimental treatment was a virtual reality-based system delivered via the Internet , which provided motor tasks to the patients from a remote rehabilitation facility . The control group underwent traditional physical therapy for the upper limb . Both treatments were of 4 weeks duration . All patients were assessed one month prior to therapy , at the commencement and termination of therapies and one month post-therapy , with the Fugl-Meyer Upper Extremity , the ABILH AND and the Ashworth scales . RESULTS Both rehabilitative therapies significantly improved all outcome scores after treatment , but only the Fugl-Meyer Upper Extremity scale showed differences in the comparison between groups . CONCLUSION Both strategies were effective , but the experimental approach induced better outcomes in motor performance . These results may favour early discharge from hospital sustained by a telerehabilitation programme , with potential beneficial effects on the use of available re sources Objective : To assess the effect of three weeks of rehabilitation in the home setting for younger patients with stroke with the aim of improving activity level . Design : A r and omized controlled study with blinded evaluations at discharge , three weeks , three months and one year after discharge . Setting : Home of the patient or the ordinary day rehabilitation clinic at the university hospital . Subjects : Fifty-eight patients ( median age 53 years ) consecutively discharged from inpatient rehabilitation with a first occurrence of stroke participated in training directly after discharge . Intervention : Rehabilitation was given for 9 hours/week over three weeks . The home group received individually tailored training , based on the patient 's needs and desires , with a focus on activities in their natural context . Support and information were also given . The intervention in the day clinic group was aim ed mainly at improved functions . Main measures : The main outcome was activity , assessed with the Assessment of Motor and Process Skill ( AMPS ) . The impairment level was also evaluated . Costs were estimated . Result : There were no significant differences between the groups on any of the four assessment s. However , there seemed to be an earlier improvement on some measures ( including AMPS ) for the home group . For both groups there was a greater improvement on the activity level than on the impairment level . The costs of the home group were less than half of the costs of the day clinic group . Conclusion : With the present results , both rehabilitation programmes could be recommended , however , further studies are needed to define patients who may specifically benefit from the home rehabilitation programme . Costs should be taken into consideration Purpose . To assess the effects of daily power-assisted functional electrical stimulation ( FES ) home program therapy in chronic stroke . Methods . A total of 20 consecutively enrolled stroke patients with spastic upper-extremity impairments > 1 year after stroke were recruited for this non-blinded r and omized controlled trial . Subjects were assigned to control and FES groups and followed for 5 months . The FES group used a power-assisted FES device to induce greater muscle contraction by electrical stimulation in proportion to the integrated electromyography ( EMG ) signal picked up on surface electrodes . Target muscles were the extensor carpi radialis longus ( ECRL ) and extensor carpi radialis brevis ( ECRB ) , extensor digitorum communis ( EDC ) , extensor indicis proprius ( EIP ) , and deltoid ( Del ) . Patients underwent 30 ∼ 60 min FES sessions at home about 6 days/week . Root mean square ( RMS ) of ECRL , EDC and Del maximum voluntary EMGs , active range of motion ( ROM ) of wrist and finger extension and shoulder flexion , modified Ashworth scale ( MAS ) , and clinical tests were investigated before and after FES training . Results . The FES group displayed significantly greater improvements in RMS , active ROM , MAS and functional h and tests , and was able to smoothly perform activities of daily life using the hemiplegic upper extremities . Conclusions . Daily power-assisted FES home program therapy can effectively improve wrist and finger extension and shoulder flexion . Proprioceptional sensory feedback might play an important role in power-assisted FES therapy Investigators have demonstrated that a variety of intensive movement training protocol s for persistent upper limb paralysis in patients with chronic stroke ( 6 months or more after stroke ) improve motor outcome . This r and omized controlled study determined in patients with upper limb motor impairment after chronic stroke whether movement therapy delivered by a robot or by a therapist using an intensive training protocol was superior . Robotic training ( n = 11 ) and an intensive movement protocol ( n = 10 ) improved the impairment measures of motor outcome significantly and comparably ; there were no significant changes in disability measures . Motor gains were maintained at the 3-month evaluation after training . These data contribute to the growing awareness that persistent impairments in those with chronic stroke may not reflect exhausted capacity for improvement . These new protocol s , rendered by either therapist or robot , can be st and ardized , tested , and replicated , and potentially will contribute to rational activity-based programs Objective : To evaluate the effects of leisure therapy and conventional occupational therapy ( OT ) on the mood , leisure participation and independence in activities of daily living ( ADL ) of stroke patients 6 and 12 months after hospital discharge . Design : Multicentre r and omized controlled trial . Setting and participants : Four hundred and sixty-six stroke patients from five UK centres . Main outcome measures : The General Health Question naire ( 12 item ) , the Nottingham Extended ADL Scale and the Nottingham Leisure Question naire , assessed by post  , with  telephone clarification . Results : Four hundred and forty ( 94 % ) and 426 ( 91 % ) subjects were alive at 6 and 12 months , respectively . Three hundred and seventy-four ( 85 % of survivors ) and 311 ( 78 % of survivors ) responded at 6 and 12 month follow-up respectively . At six months and compared to the control group , those allocated to leisure therapy had nonsignificantly better GHQ scores ( –1.2 : 95 % CI –2.9 , + 0.5 ) , leisure scores ( + 0.7 , 95 % CI –1.1 , + 2.5 ) and Extended ADL scores ( + 0.4 : 95 % CI –3.8 , + 4.5 ) : the ADL group had nonsignificantly better GHQ scores ( –0.1 : 95 % CI –1.8 , + 1.7 ) and Extended ADL scores ( + 1.4 : 95 % CI –2.9 , + 5.6 ) and nonsignificantly worse leisure scores ( –0.3 : 95 % CI –2.1 , + 1.6 ) . The results at 12 months were similar . Conclusion : In contrast to the findings of previous smaller trials , neither of the additional OT treatments showed a clear beneficial effect on mood , leisure activity or independence in ADL measured at 6 or 12 months BACKGROUND Patients who have a stroke are not always admitted to hospital , and 22 - 60 % remain in the community , frequently without coordinated rehabilitation . We aim ed to assess the efficacy of an occupational therapy intervention for patients with stroke who were not admitted to hospital . METHODS In this single-blind r and omised controlled trial , consecutive stroke patients on a UK community register in Nottingham and Derbyshire were allocated r and omly to up to 5 months of occupational therapy at home or to no intervention ( control group ) 1 month after their stroke . The aim of the occupational therapy was to encourage independence in personal and instrumental activities of daily living . Patients were assessed on outcome measures at baseline ( before r and omisation ) and at 6 months . The primary outcome measure was the score on the extended activities of daily living ( EADL ) scale at 6 months . Other outcome measures included the Barthel index , the general health question naire 28 , the carer strain index , and the London h and icap scale . All assessment s were done by an independent assessor who was unaware of treatment allocation . The analysis included only data from completed question naires . FINDINGS 185 patients were included : 94 in the occupational therapy group and 91 in the control group . 22 patients were not assessed at 6 months . At follow-up , patients who had occupational therapy had significantly higher median scores than the controls on : the EADL scale ( 16 vs 12 , p<0.01 , estimated difference 3 [ 95 % CI 1 to 4 ] ) ; the Barthel index ( 20 vs 18 , p<0.01 , difference 1 , [ 0 - 1 ] ) ; the carer strain index ( 1 vs 3 , p<0.05 , difference 1 [ 0 to 2 ] ) ; and the London h and icap scale ( 76 vs 65 , p<0.05 , difference 7 , [ 0.3 to 13.5 ] ) . There were no significant differences on the general health question naire between the patient or carer . INTERPRETATION Occupational therapy significantly reduced disability and h and icap in patients with stroke who were not admitted to hospital Objective : To evaluate whether follow-up services for stroke survivors could improve functional outcome and reduce readmission rate . In this paper results of functional outcome are reported . Design : R and omized controlled trial allocating patients to one of three different types of aftercare : ( 1 ) follow-up home visits by a physician , ( 2 ) physiotherapist instruction in the patient 's home , or ( 3 ) st and ard aftercare . Subjects : Stroke patients with persisting impairment and disability who , after completing inpatient rehabilitation , were discharged to their homes . Outcome measures : Six months after discharge , functional outcome was assessed with Functional Quality of Movement , Barthel Index , Frenchay Activity Index and Index of Extended Activites of Daily Living . Results : One-hundred and fifty-five stroke patients were included in the study . Fifty-four received follow-up home visits by a physician , 53 were given instructions by a physiotherapist in their home and 48 received st and ard aftercare only . No statistically signi ca nt differences in functional outcome six months after discharge were demonstrated between the three groups . However , all measurements showed a tendency towards higher scores indicating better function in both interventions groups compared with the control group . Conclusion : Follow-up services after stroke may be a way of improving functional outcome . The results of the present study should be evaluated in future trials . More research in this eld is needed , especially studies of how to support stroke survivors to resume social and leisure activities Objective : To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke , supervised once a week by therapists . Design : A r and omized controlled trial of 100 patients discharged from hospital after a stroke , requiring ongoing therapy . The control group received outpatient or day hospital therapy ; the experimental group were visited once a week by an occupational and /or physiotherapist who prescribed a programme of exercises and activities for the following week . Subjects were studied for the first three months after discharge from hospital . Setting : A district general hospital , or the homes of subjects r and omized to the experimental group , in New Zeal and . Main outcome measures : ( 1 ) Characteristics of the groups , ( 2 ) gait speed , limb function , activities of daily living , ( 3 ) time with therapists , ( 4 ) mood of both subjects and caregivers , ( 5 ) anticipation of outcome at entry , compared with perceived outcome at exit . Results : No statistical differences between the control and experimental groups in characteristics , or in any outcomes measured , except that the contact time period , but not the number of visits , was longer in the experimental group ( p = 0.003 ) . Conclusions : A supervised home-based programme is as effective as outpatient or day hospital therapy Abstract Objective : To assess the clinical effectiveness of an early discharge policy for patients with stroke by using a community based rehabilitation team . Design : R and omised controlled trial to compare conventional care with an early discharge policy . Setting : Two teaching hospitals in inner London . Subjects : 331 medically stable patients with stroke ( mean age 71 ) who lived alone and were able to transfer independently or who lived with a resident carer and were able to transfer with help . Interventions : 167 patients received specialist community rehabilitation for up to 3 months after r and omisation . 164 patients continued with conventional hospital and community care . Main outcome measures : Barthel score at 12 months . Secondary outcomes measured impairment with motoricity index , minimental state examination , and Frenchay aphasia screening test ; disability with the Rivermead activity of daily living scales , hospital anxiety and depression scale , and 5 m walk ; h and icap with the Nottingham health profile ; carer stress with caregiver strain index and patient and carer satisfaction . The main process measure was length of stay after r and omisation . Results : One year after r and omisation no significant differences in clinical outcomes were found apart from increased satisfaction with hospital care in the community therapy group . Length of stay after r and omisation in the community therapy group was significantly reduced ( 12 v 18 days ; P<0.0001 ) . Patients with impairments were more likely to receive treatment in the community therapy group . Conclusions : Early discharge with specialist community rehabilitation after stroke is feasible , as clinical ly effective as conventional care , and acceptable to patients . Considerable reductions in use of hospital beds are achievable . Key messages Early discharge from hospital after stroke with specialist rehabilitation at home is feasible without an increase in readmission rates or stress to carers This r and omised controlled trial shows this method to be as effective as conventional care when assessed with a range of measures of impairment , disability , h and icap , carer stress , and patient and carer satisfaction at 1 year Significant reductions in bed usage can be achieved by the provision of a community rehabilitation team with no significant increase in rehabilitation OBJECTIVE To evaluate the effectiveness of 2 rehabilitative approaches for improving paretic limb reaching by chronic stroke subjects . DESIGN Pre- and posttest reaching to targets ipsilateral , midline , and contralateral to the impaired side . SETTING Training in subjects ' homes ; testing in a laboratory setting . PARTICIPANTS Twelve poststroke volunteers were matched using the Motor Assessment Scale ( MAS ) and then were r and omly assigned to 1 of 2 training conditions . Subjects were subsequently categorized as at a high or low functional level , using the reaching pretest movement time scores . INTERVENTIONS Training ( trunk unrestrained ) using the paretic limb was 4 weeks ( 12 sessions ) . Task-related training ( TRT ) involved reaching to objects placed across the workspace . Progressive resistive exercise ( PRE ) involved whole-arm pulling against resistive therapeutic tubing in planes and distances similar to that in TRT . Main outcome measures Kinematic analysis of arm trajectory and trunk motion using the Peak Performance System , as well as scores on the MAS and the Rivermead Motor Assessment ( RMA ) . RESULTS For low-level groups , TRT result ed in increased substitutive trunk use at the target ipsilateral to the moving arm , and for midline and contralateral targets after PRE . Only low-level , TRT subjects straightened h and paths , which suggested better coordination of elbow-shoulder motion , and improved on the RMA . High-level subjects decreased trunk use at ipsilateral target after PRE , which was not observed after TRT . No significant differences between training conditions were found for other kinematic variables . CONCLUSIONS Training benefits appear to depend on initial level of functioning . Although compensatory trunk use was evident , low-level subjects seemed to benefit most from TRT . High-level subjects , whose kinematics showed fairly normal movement organization , demonstrated less compensatory movement after PRE Background . Chronic upper extremity impairment due to stroke has significant medical , psychosocial , and financial consequences , but few studies have examined the effectiveness of rehabilitation therapy during the chronic stroke period . Objective . To test the safety and efficacy of the MIT-Manus robotic device for chronic upper extremity impairment following stroke . Methods . The VA Cooperative Studies Program initiated a multicenter , r and omized , controlled trial in November 2006 ( VA ROBOTICS ) . Participants with upper extremity impairment ≥6 months poststroke were r and omized to robot-assisted therapy ( RT ) , intensive comparison therapy ( ICT ) , or usual care ( UC ) . RT and ICT consisted of three 1-hour treatment sessions per week for 12 weeks . The primary outcome was change in the Fugl-Meyer Assessment upper extremity motor function score at 12 weeks relative to baseline . Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale . Results . A total of 127 participants were r and omized : 49 to RT , 50 to ICT , and 28 to UC . The majority of participants were male ( 96 % ) , with a mean age of 65 years . The primary stroke type was ischemic ( 85 % ) , and 58 % of strokes occurred in the anterior circulation . Twenty percent of the participants reported a stroke in addition to their index stroke . The average time from the index stroke to enrollment was 56 months ( range , 6 months to 24 years ) . The mean Fugl-Meyer score at entry was 18.9 . Conclusions . VA ROBOTICS demonstrates the feasibility of conducting multicenter clinical trials to rigorously test new rehabilitative devices before their introduction to clinical practice . The results are expected in early 2010 This study was a preliminary examination of the effect of low-intensity home-based physical therapy on the performance of activities of daily living ( ADL ) and motor function in patients more than 1 year after stroke . Twenty patients were recruited from a community stroke register in Nan-Tou County , Taiwan , to a r and omized , crossover trial comparing intervention by a physical therapist immediately after entry into the trial ( Group I ) or after a delay of 10 weeks ( Group II ) . The intervention consisted of home-based physical therapy once a week for 10 weeks . The Barthel Index ( BI ) and Stroke Rehabilitation Assessment of Movement ( STREAM ) were used as st and ard measures for ADL and motor function . At the first follow-up assessment at 11 weeks , Group I showed greater improvement in lower limb motor function than Group II . At the second follow-up assessment at 22 weeks , Group II showed improvement while Group I had declined . At 22 weeks , the motor function of upper limbs , mobility , and ADL performance in Group II had improved slightly more than in Group I , but the between-group differences were not significant . It appears that low-intensity home-based physical therapy can improve lower limb motor function in chronic stroke survivors . Further studies will be needed to confirm these findings Objectives : ( 1 ) To determine the feasibility of a home-based electromyography triggered neuromuscular stimulation ( ETMS ) programme ; and ( 2 ) to determine ETMS efficacy in increasing affected wrist extension and reducing affected arm impairment . Design : R and omized , controlled , pre-lpost , cross-over design . Setting : Outpatient rehabilitation hospital . Patients : Twelve chronic stroke patients with palpable muscle contraction in their affected wrist extensors but no movement ( 7 males ; mean age=59.75 years , age range 44 - 75 years ; mean time since stroke=52.75 months , range 13 - 131 months ) . Intervention : Subjects were r and omly assigned to receive either : ( a ) ETMS use twice every weekday in 35-min increments during an eight-week period followed by an eight-week home exercise programme ( ETMS/home exercise programme ) ( n=8 ) ; or ( b ) an eight-week home exercise programme followed by use of ETMS twice every weekday in 35-min increments during an eight-week period ( home exercise programme ) ( n=4 ) . Main outcome measures : The Fugl-Meyer , Action Research Arm Test and goniometry . Results : After home exercise programme participation , subjects showed nominal or no changes on any of the outcome measures . After ETMS , patients showed modest impairment reductions , as shown by the Fugl-Meyer , and no Action Research Arm Test changes . However , both groups showed a 218 increase in active affected wrist extension after ETMS use . Conclusion : ETMS use is feasible in the home environment . Neither participation in a traditional home exercise programme nor ETMS use conveyed changes on the Fugl-Meyer or Action Research Arm Test . However , ETMS use increased active affected limb extension . This new movement may provide a potential pathway for subjects to participate in other interventions , such as modified constraint induced therapy The DOMINO study compared domiciliary and hospital-based rehabilitation services for stroke patients after discharge from hospital , stratified by the hospital ward at discharge . No difference between the services had been found at 6 months , but home therapy was better than outpatient department therapy at improving household ability and leisure activity in the patients discharged from the Stroke Unit ( SU ) , and attendance at a day hospital may have been better than a domiciliary service at preventing death or institutionalization for patients discharged from Health Care of the Elderly ( HCE ) wards . We report the follow-up of the patients between 6 months and 1 year after discharge , during which time few patients received further treatment and little change in health or function occurred . Over this period the benefits of domiciliary rehabilitation in the SU group were lost , largely because the patients who had been treated in outpatient departments continued to improve . Between 6 months and 1 year the numbers of HCE patients in the two treatment groups who died or were institutionalized were similar , but the advantage of day hospital attendance was still evident at 1 year Based on the principles of neuroplasticity , the purpose of this crossover study was to determine if improvement in upper extremity ( UE ) function and independence could be achieved in patients 6 months to 7 years poststroke following an outpatient rehabilitation program ( supervised 1.5 hours per week for 8 weeks reinforced with home gloving unaffected side and attended , grade d , repetitive sensory and motor training activities ) . Twenty-one subjects ( right or left hemiparesis ; able to walk 100 feet with or without a cane ; partially opened and closed the h and ; partially elevated the shoulder and elbow against gravity ) were r and omly assigned to Group A ( sensory training 4 weeks , motor training 4 weeks ) or Group B ( motor training 4 weeks , sensory training 4 weeks ) . Greater than 20 % ( P < 0.01 ) improvement was measured in functional independence and UE function ( fine motor , sensory discrimination , and musculoskeletal performance ) . Gains were hemispheric and training specific and maintained over 3 months . This study provides evidence documenting significant improvement in function in the late poststroke recovery period following 12 hours of supervised learning based sensory motor training Objective : To evaluate the efficacy of a task-oriented intervention in enhancing arm function in people with stroke . Design : Two-centre , observer-blinded , stratified , block-r and omized controlled trial . Setting : General community . Patients : Ninety-one individuals within one year of a first or recurrent stroke consented to participate between May 2000 and February 2003 . Interventions : The experimental intervention involved practice of functional , unilateral and bilateral tasks that were design ed to improve gross and fine manual dexterity whereas the control intervention was composed of walking tasks . Members in both groups participated in three sessions a week for six weeks . Main outcome measure(s ) : The primary test of arm function was the Box and Block Test . Secondary tests included the Nine-Hole Peg Test , maximal grip strength , the Test d'Evaluation des Membres supé rieurs des Personnes Agées ( TEMPA ) and the Stroke Rehabilitation Assessment of Movement . Results : Results are for the more affected arm . Baseline performance on the Box and Block Test was an average of 26 blocks ( st and ard deviation ( SD=16 ) in the experimental group ( n=47 ) and 26 blocks ( Sd=18 ) in the control group ( n=44 ) . These values represent approximately 40 % of age-predicted values . Values for the postintervention evaluation were an average of 28 ( SD=17 ) and 28 ( SD=19 ) blocks for the experimental and control group respectively . No meaningful change on other measures of arm function was observed . Conclusions : A task-oriented intervention did not improve voluntary movement or manual dexterity of the affected arm in people with chronic stroke AIM This paper reports an evaluation of a range-of-motion exercise programme aim ed at improving joint flexibility , activity function , perception of pain , and depressive symptoms in a sample of stroke survivors in long-term care facilities . BACKGROUND The benefits of physical rehabilitation for stroke survivors have been well established . There is , however , little empirical data on the effects of a simple nurse-led range-of-motion exercise programme in improving function for these people . METHOD A r and omized controlled trial was conducted in 1999 with 59 bedridden older stroke survivors in residential care . Participants were r and omly assigned to usual care or one of two intervention groups . The 4-week , twice-per-day , 6 days-per-week range-of-motion exercise protocol s were similar in both intervention groups , and consisted of full range-of-motion exercises of the upper and lower extremities . To test the effect of different degrees of staff involvement , in intervention group I , a Registered Nurse was present to supervise participants performing the exercises , while intervention group II involved a Registered Nurse physically assisting participants to achieve maximum range-of-motion within or beyond their present abilities . RESULTS Both intervention groups had statistically significant improvement in joint angles , activity function , perception of pain and depressive symptoms compared with the usual care group ( P < 0.05 ) . Post hoc comparison revealed that the joint angles in intervention group II were statistically significantly wider than in both the other groups ( P < 0.01 ) . CONCLUSIONS A simple nurse-led range-of-motion exercise programme can generate positive effects in enhancing physical and psychological function of bedridden older people with stroke . Further studies are needed to investigate the long-term effects of the programme in maximizing function , reducing care utilization and enhancing quality of life for this population OBJECTIVE To compare outcomes in stroke survivors who received rehabilitation services in an acute inpatient rehabilitation setting ( multidisciplinary rehabilitation team ) with outcomes in survivors in a home-based setting ( family caregivers , limited team supervision ) . DESIGN R and omized clinical trial , with mean follow-up after 60 days . SETTING Inpatient rehabilitation setting and home-based setting s. PATIENTS Sixty patients ( age range , 43 - 80yr ) who had a stroke between 1996 and 1999 and had been referred after medical stabilization , r and omly divided into 2 groups : group 1 , inpatient rehabilitation ; group 2 , home-based rehabilitation . INTERVENTIONS Group 1 : therapeutical and neuromuscular exercises with occupational therapy with professional supervision ; group 2 : conventional exercises with family caregiver and limited professional supervision . MAIN OUTCOME MEASURES Spasticity was evaluated with the Ashworth Scale , motor status with Brunnstrom 's stages , functional status with the FIM instrument , and cognitive status with the Mini-Mental State Examination before and after rehabilitation . RESULTS Patients rehabilitated in acute inpatient setting s had better motor , functional , and cognitive outcomes ( p < .05 ) . Spasticity changes did not differ between the groups . CONCLUSION Intense inpatient rehabilitation services for stroke survivors provide significantly more favorable functional and cognitive outcomes with relatively low complications than did nonintense rehabilitation efforts in home setting Hesse S , Werner C , Pohl M , Mehrholz J , Puzich U , Krebs HI : Mechanical arm trainer for the treatment of the severely affected arm after a stroke : a single-blinded r and omized trial in two centers . Am J Phys Med Rehabil 2008;87:779–788 . Objective : To test whether training with a new mechanical arm trainer leads to better outcomes than electrical stimulation of the paretic wrist extensors in subacute stroke patients with severe upper limb paresis . Electrical stimulation is a st and ard and reimbursable form of therapy in Germany . Design : R and omized controlled trial of 54 in patients enrolled 4–8 wks from stroke onset , mean upper-extremity subsection of Fugl-Meyer assessment ( 0–66 ) at admission less than 18 . In addition to st and ard care , all patients practice d 20–30 mins arm trainer or electrical stimulation every workday for 6 wks , totaling 30 sessions . Primary outcome was the Fugl-Meyer assessment , secondary outcomes were the Box and Block test , the Medical Research Council and the modified Ashworth scale , blindly assessed at enrollment , after 6 wks , and at 3-mo follow-up . Results : Both groups were homogeneous at study onset . Shoulder pain occurred in two arm trainer patients . The primary Fugl-Meyer assessment outcome improved for both groups over time ( P < 0.001 ) , but this improvement did not differ between groups . The initial ( terminal ) mean Fugl-Meyer assessment scores were 8.8 ± 4.8 ( 19.2 ± 14.5 ) for the arm trainer and 8.6 ± 3.5 ( 13.6 ± 7.9 ) for the electrical stimulation group . No patient could transport a block initially , but at completion significantly more arm trainer patients were able to transport at least three blocks ( five vs. zero , P = 0.023 ) . No significant differences were observed between the groups on the secondary Box and Block outcome at follow-up ( eight vs. four patients ) . All Box and Block responders had an initial Fugl-Meyer assessment ≥10 . Conclusions : Arm trainer training did not lead to a superior primary outcome  over electrical stimulation training . However , “ good performers ” on the secondary outcome seemed to benefit more from the arm trainer training Objective : To evaluate the effects of community-based rehabilitation therapy on  neurological function deficit in stroke patients . Design : Prospect i ve , single-blind , r and omized controlled multicentre trial . Setting : At home , in Shanghai , China . Subjects : A total of 737 stroke patients in the community . Intervention : The rehabilitation group received additional st and ardized community-based rehabilitation therapy at home for five months . Main outcome measures : Patients were evaluated using the Clinical Neurological Function Deficit Scale before intervention and at the end of two and five months . Results : Although both the rehabilitation group and the control group improved over time , the rehabilitation group showed a greater improvement in Clinical Neurological Function Deficit Scale scores . The differences between the groups were significant . After five months , the Clinical Neurological Function Deficit Scale scores of the cerebral infa rct ion rehabilitation group improved by 6.77 ; the haemorrhage rehabilitation group by 7.99 ; the total rehabilitation group by 7.03 . In comparison , the Clinical Neurological Function Deficit Scale scores of the cerebral infa rct ion control group improved by 1.57 ; the haemorrhage control group by 5.34 ; the total control group by 2.43 . This implies a difference in improvement of 5.2 in the cerebral infa rct ion group , 2.65 in the haemorrhage group , and 4.6 in the total group in favour of the rehabilitation group between groups . Conclusion : St and ardized community-based rehabilitation therapy may help stroke patients to improve their neurological function Background and objective . Botulinum toxin type A ( BtxA ) injection and modified constraint-induced movement therapy ( mCIMT ) are both promising approaches to enhance recovery after stroke . The combined application of these 2 promising modalities has rarely been studied . The aim was to investigate whether combined BtxA and mCIMT would improve spasticity and upper extremity motor function more than BtxA plus conventional rehabilitation in chronic stroke patients with upper extremity spasticity . Methods . In a prospect i ve , r and omized controlled , observer-blinded trial with 6-month follow-up , 32 patients ( ≥1 year after stroke ) with ability to actively extend > 10 ° at metacarpophalangeal and interphalangeal joints and 20 ° at wrist of the affected upper limb were r and omized to receive BtxA + mCIMT ( combination group ) or BtxA + conventional rehabilitation ( control group ) for 2 hours/day , 3 days/week for 3 months . The primary outcome assessed spasticity on the Modified Ashworth Scale . Secondary outcomes assessed real-world arm function ( Motor Activity Log ) , laboratory motor activity ( Action Research Arm Test ) , and patients ’ global satisfaction . Results . A total of 32 stroke patients were recruited , and 29 completed the study . Spasticity significantly improved in all subjects at 4 weeks and 3 months postinjection without between-group differences . The combination group showed significantly greater improvements in elbow , wrist , and finger spasticity ( P = .019 , P = .019 , and P < .001 , respectively ) , affected upper extremity real-world arm function ( P < .001 ) and laboratory motor activity ( P < .001 ) than the control group at 6-month postinjection . Patients reported considerable satisfaction and no serious adverse events occurred . Conclusions . Combining BtxA and mCIMT is an effective and safe intervention for improving spasticity and motor function in chronic stroke patients . The results are promising enough to justify further studies . We recommend future research to address the likely need for including rehabilitation with BtxA to improve function in patients with poststroke spasticity 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 assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke . DESIGN R and omized controlled trial . SETTING Rehabilitation research laboratory and a community hall . PARTICIPANTS A sample of 63 people ( > or = 50y ) with chronic deficits result ing from stroke ( onset > or = 1y ) . INTERVENTIONS The arm group underwent an exercise program design ed to improve upper-extremity function ( 1h/session , 3 sessions/wk for 19wk ) . The leg group underwent a lower-extremity exercise program . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , Fugl-Meyer Assessment ( FMA ) , h and -held dynamometry ( grip strength ) , and the Motor Activity Log . RESULTS Multivariate analysis showed a significant group by time interaction ( Wilks lambda=.726 , P=.017 ) , indicating that overall , the arm group had significantly more improvement than the leg group . Post hoc analysis demonstrated that gains in WMFT ( functional ability ) ( P=.001 ) and FMA ( P=.001 ) scores were significantly higher in the arm group . The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke . Participants with moderate arm impairment benefited more from the program . CONCLUSIONS The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke . This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness OBJECTIVE To determine whether acute exercise , using a body-weight-supported treadmill , improves performance on subsequent cognitive tests or an upper-extremity task in people with stroke . DESIGN The study was a within-subject , cross-over design in which 21 subjects received , r and omly , 2 different testing sequences separated by an interval of 7 to 10 days . SETTING Outpatient department of a rehabilitation hospital . PARTICIPANTS Of 72 potential participants in the convenience sample , 21 people with chronic stroke completed the study . They were 0.5 to 5 years after only 1 documented stroke , were able to walk with or without a cane , were able to grasp with the affected h and , and scored more than 24 on the Mini-Mental State Examination . INTERVENTIONS One session of body-weight-supported treadmill walking for 20 minutes at 70 % of estimated heart rate reserve or level 13 on the Borg rating of perceived exertion scale . The control condition consisted of a 20-minute review of a home exercise program with a physiotherapist . MAIN OUTCOME MEASURES Cognitive tests included Trail Making Tests Parts A and B , Symbol Digit Substitution Test , and Paced Auditory Serial Addition Test . The Action Research Arm Test ( ARAT ) measured hemiplegic upper-extremity motor skill . RESULTS Treadmill exercise  improved movement of the hemiplegic upper extremity ( P=.04 ) but not cognitive performance . The improvement in the ARAT occurred without a change in strength ( measured by grip strength ) and was negatively correlated with maximum treadmill speed ( R(2)=.20 ; P=.04 ) . CONCLUSIONS These findings suggest that acute treadmill exercise improves subsequent skilled movement of the hemiplegic upper extremity that seems unrelated to attention , visuomotor processing , or strength . The etiology and duration of this enhancing effect are worth further study . The existence of an exercise-cognition relationship in people with stroke is an intriguing area of future research
BACKGROUND With an increased focus on home-based stroke services and the undertaking of programmes , targeted at upper limb recovery within clinical practice , a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required .
OBJECTIVES To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke .