Is the repetitive training of complex hand and arm movements benefi cial for motor recovery in stroke patients?

Objective: To determine whether a repetitive training of complex movements of arm and hand contributes to functional recovery in stroke patients. Design: Prospective, longitudinal, multiple baseline design across individuals. Setting: Neurological rehabilitation centre. Subjects: Twenty-one patients with stroke in the middle cerebral artery territory. Interventions: Baseline phase: ‘house-typical’ occupational and physiotherapy; training phase: ‘house-typical’ therapy supplemented by repetitive training of (1) grasping and transport movements and (2) sawing movements of the affected arm over 10 minutes each, twice daily, five days per week. Main outcome measures: Rivermead Motor Assessment (RMA, arm section), grip strength, rapid isotonic hand extension, three-dimensional motion analysis. Results: Patients experienced a continuous functional improvement of the affected arm (RMA score from initial 4.9 ± 2.1 to 8.0 ± 4.6, p < 0.001) and an increase of grip strength during the baseline and the training phase (from initial 102.4 ± 43.3 N to 150.6 ± 118.9 N, p < 0.05). Movement analysis revealed a trend to a more precise movement execution. The repetitive training of complex movements did not result in an additional benefit. Conclusion: The repetitive training of complex movements does not further enhance the functional recovery of the affected arm and hand in stroke patients compared with functionally based occupational and physiotherapy.

[1]  B. Bobath,et al.  Book Review: ‘Proceedings’ Put Emphasis on Treatment of Children: Abnormal Motor Behaviour: Abnormal Postural Reflex Activity Caused by Brain Lesions , 1972 .

[2]  N. Lincoln,et al.  Assessment of motor function in stroke patients. , 1979, Physiotherapy.

[3]  M. Arbib,et al.  Grasping objects: the cortical mechanisms of visuomotor transformation , 1995, Trends in Neurosciences.

[4]  H. Hummelsheim,et al.  Influence of physiotherapeutic techniques on motor evoked potentials in centrally paretic hand extensor muscles , 1995 .

[5]  Voss De,et al.  Proprioceptive neuromuscular facilitation. , 1967 .

[6]  B. Bobath.  Adult hemiplegia: Evaluation and treatment , 1978 .

[7]  K. Mauritz,et al.  The influence of EMG‐initiated electrical muscle stimulation on motor recovery of the centrally paretic hand , 1996, European journal of neurology.

[8]  N B Lincoln,et al.  Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. , 1999, Stroke.

[9]  E. Taub,et al.  Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication. , 1999, Stroke.

[10]  M. Hallett,et al.  Role of the human motor cortex in rapid motor learning , 2001, Experimental Brain Research.

[11]  B. Langhammer,et al.  Bobath or Motor Relearning Programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study , 2000, Clinical rehabilitation.

[12]  H Hummelsheim,et al.  The functional value of electrical muscle stimulation for the rehabilitation of the hand in stroke patients. , 1997, Scandinavian journal of rehabilitation medicine.

[13]  C. Trombly,et al.  The effect of context on skill acquisition and transfer. , 1999, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[14]  D. Wade,et al.  Mobility after stroke: reliability of measures of impairment and disability. , 1990, International disability studies.

[15]  H. Kabat,et al.  Proprioceptive facilitation technics for treatment of paralysis. , 1953, The Physical therapy review.

[16]  K. Mauritz,et al.  Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand , 1995, Journal of the Neurological Sciences.