title: Responses of the less affected arm to bilateral upper limb task training in early rehabilitation after stroke: a randomized controlled trial.
abstract: OBJECTIVE
  To investigate effects of bilateral training (BT) on ipsilesional arm dexterity and activity limitation; to explore clinical and demographic factors that influence training effects; and to explore relationships between contralesional and ipsilesional recovery.
  
  
  METHODS
  Single-blind randomized controlled trial with outcome assessment at baseline, postintervention (6 wk), and follow-up (18 wk).
  
  
  METHODS
  Inpatient acute and rehabilitation hospitals.
  
  
  METHODS
  Participants were randomized to a BT group in which training involved the ipsilesional and contralesional arms (n=56) or control training involving the contralesional arm only (n=50).
  
  
  METHODS
  Supervised BT or control training for 20 minutes on weekdays over a 6-week period using a standardized program.
  
  
  METHODS
  Upper limb activity limitation: Action Research Arm Test; and dexterity: Nine-Hole Peg Test (9HPT).
  
  
  RESULTS
  Lower baseline scores were found for the ipsilesional arm on both measures compared with published normative values. The BT group demonstrated significantly greater change in dexterity (P=.03) during the intervention phase at 0 to 6 weeks (.06±.07pegs/s) compared with the control group (.02±.02pegs/s). The effect was lost for overall recovery at 0 to 18 weeks (P=.93). Younger participants (age≤68y) performed the 9HPT faster at baseline than older participants (P=.04) and demonstrated greater overall recovery with BT than older participants (P=.04). There was no significant correlation between ipsilesional and contralesional recovery.
  
  
  CONCLUSIONS
  The study suggests that BT may lead to clinically small improvements in ipsilesional performance of fine, rapid dexterity tasks. Younger participants responded better to BT. There was no relationship between contralesional and ipsilesional recovery, suggesting that different causes and recovery mechanisms may exist.
authors.affiliation: School of Nursing and Midwifery, University of Dundee, Dundee, UK. j.y.morris@dundee.ac.uk
authors.forename: Jacqui H
authors.initials: JH
authors.lastname: Morris
authors.forename: Frederike
authors.initials: F
authors.lastname: Van Wijck
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010291:Paresis / Q000175:diagnosis / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012016:Reference Values; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D013647:Task Performance and Analysis; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*