title: Efficacy and task structure of bimanual training post stroke: a systematic review.
abstract: BACKGROUND
  Bimanual training has been shown to be as effective as, but not superior to, unimanual paretic upper extremity (UE) training interventions in improving paretic UE function and use post stroke. However, it is still unclear whether different training interventions or task structures within bimanual interventions may differentially affect the outcomes.
  
  
  OBJECTIVE
  The objectives of this review were to (1) systematically determine the efficacy of bimanual training in relation to the International Classification of Functioning, Disability and Health model components and (2) explore the structure of current bimanual training interventions.
  
  
  METHODS
  A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eleven studies were accepted for review.
  
  
  RESULTS
  Three main types of bimanual training emerged: functional task training (FTT), bilateral training with rhythmic auditory cues (BATRAC), and robot-assisted training (RAT). Bimanual training is generally efficacious overall in improving paretic UE movement in individuals with subacute and/or chronic stroke as compared with other interventions. FTT, BATRAC, and RAT showed no significant differences compared with conventional therapy. Bimanual training may have greater proximal control benefits but fewer benefits in terms of subjects' perceived amount and quality of use as compared with constraint-induced movement therapy.
  
  
  CONCLUSIONS
  There were not enough data to draw any conclusions about the effects of bimanual task symmetry or commonality of goal.
authors.affiliation: Department of Physical Therapy, Walsh University, North Canton, Ohio.
authors.forename: Angela
authors.initials: A
authors.lastname: Wolf
authors.affiliation: Department of Physical Therapy, Walsh University, North Canton, Ohio.
authors.forename: Rachel
authors.initials: R
authors.lastname: Scheiderer
authors.affiliation: Department of Physical Therapy, Walsh University, North Canton, Ohio.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Napolitan
authors.affiliation: Department of Physical Therapy, Walsh University, North Canton, Ohio.
authors.forename: Courtney
authors.initials: C
authors.lastname: Belden
authors.affiliation: Department of Physical Therapy, Walsh University, North Canton, Ohio.
authors.forename: Lauren
authors.initials: L
authors.lastname: Shaub
authors.affiliation: Department of Physical Therapy, Walsh University, North Canton, Ohio.
authors.forename: Maureen
authors.initials: M
authors.lastname: Whitford
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
keywords: bimanual; interlimb; rehabilitation; stroke; upper extremity