title: Unilateral versus bilateral upper limb training after stroke: the Upper Limb Training After Stroke clinical trial.
abstract: OBJECTIVE
  Unilateral and bilateral training protocols for upper limb rehabilitation after stroke represent conceptually contrasting approaches with the same ultimate goal. In a randomized controlled trial, we compared the merits of modified constraint-induced movement therapy, modified bilateral arm training with rhythmic auditory cueing, and a dose-matched conventional treatment. Modified constraint-induced movement therapy and modified bilateral arm training with rhythmic auditory cueing targeted wrist and finger extensors, given their importance for functional recovery. We hypothesized that modified constraint-induced movement therapy and modified bilateral arm training with rhythmic auditory cueing are superior to dose-matched conventional treatment.
  
  
  METHODS
  Sixty patients, between 1 to 6 months after stroke, were randomized over 3 intervention groups. The primary outcome measure was the Action Research Arm test, which was conducted before, directly after, and 6 weeks after intervention.
  
  
  RESULTS
  Although all groups demonstrated significant improvement on the Action Research Arm test after intervention, which persisted at 6 weeks follow-up, no significant differences in change scores on the Action Research Arm test were found between groups postintervention and at follow-up.
  
  
  CONCLUSIONS
  Modified constraint-induced movement therapy and modified bilateral arm training with rhythmic auditory cueing are not superior to dose-matched conventional treatment or each other in improving upper limb motor function 1 to 6 months after stroke.
  
  
  BACKGROUND
  http://www.trialregister.nl. Unique identifier: NTR1665.
authors.affiliation: Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands. l.van.delden@vu.nl
authors.forename: A Lex E Q
authors.initials: AL
authors.lastname: van Delden
authors.forename: C Lieke E
authors.initials: CL
authors.lastname: Peper
authors.forename: Kirsten N
authors.initials: KN
authors.lastname: Nienhuys
authors.forename: Nienke I
authors.initials: NI
authors.lastname: Zijp
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Beek
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D000161:Acoustic Stimulation / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D002985:Clinical Protocols / Q000592:standards; D003463:Cues; D005080:Exercise Test / Q000379:methods; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005385:Fingers / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*; D014953:Wrist / Q000503:physiopathology
keywords: rehabilitation; stroke; upper extremity