A pilot study of activity-based therapy in the arm motor recovery post stroke: a randomized controlled trial Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation Brain-computer interface-based robotic end effector system for wrist and hand rehabilitation: results of a three-armed randomized controlled trial for chronic stroke The PREP algorithm predicts potential for upper limb recovery after stroke. Randomized Trial of a Robotic Assistive Device for the Upper Extremity During Early Inpatient Stroke Rehabilitation Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. A randomized controlled trial of Cognitive Sensory Motor Training Therapy on the recovery of arm function in acute stroke patients Randomized Controlled Trial to Evaluate the Effect of Surface Neuromuscular Electrical Stimulation to the Shoulder After Acute Stroke Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol of a randomized clinical trial Comparing unilateral and bilateral upper limb training: The ULTRA-stroke program design Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors Response to upper-limb robotics and functional neuromuscular stimulation following stroke. Meaningful Task-Specific Training (MTST) for Stroke Rehabilitation: A Randomized Controlled Trial Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study. Clinical Relevance of Action Observation in Upper-Limb Stroke Rehabilitation Comparison of the action research arm test and the Fugl-Meyer assessment as measures of upper-extremity motor weakness after stroke. Repetitive arm functional tasks after stroke (RAFTAS): a pilot randomised controlled trial
Objective : To determine the efficacy of activity-based therapies using arm ergometer or robotic or group occupational therapy for motor recovery of the paretic arm in patients with an acute stroke ( ≤4 weeks ) admitted to an inpatient rehabilitation facility , and to obtain information to plan a large r and omized controlled trial . Design : Prospect i ve , r and omized controlled study . Setting : Stroke unit in a rehabilitation hospital . Subjects : Thirty patients with an acute stroke ( ≤4 weeks ) who had arm weakness ( Medical Research Council grade 2 or less at the shoulder joint ) . Intervention : Occupational therapy ( OT ) group ( control ) ( n = 10 ) , arm ergometer ( n = 10 ) or robotic ( n = 10 ) therapy group . All patients received st and ard , inpatient , post-stroke rehabilitation training for 3 hours a day , plus 12 additional 40-minute sessions of the activity-based therapy . Main measures : The primary outcome measures were discharge scores in the Fugl-Meyer Assessment Scale for upper limb impairment , Motor Status Scale , total Functional Independence Measure ( FIM ) and FIM-motor and FIM-cognition subscores . Results : The three groups ( OT group versus arm ergometer versus robotic ) were comparable on clinical demographic measures except the robotic group was significantly older and there were more  haemorrhagic  stroke patients in the arm ergometer group . After adjusting for age , stroke type and outcome measures at baseline , a similar degree of improvement in the discharge scores was found in all of the primary outcome measures . Conclusion : This study suggests that activity-based therapies using an arm ergometer or robot when used over shortened training periods have the same effect as OT group therapy in decreasing impairment and improving disability in the paretic arm of severely affected stroke patients in the subacute phase Background . Functional electrical stimulation ( FES ) allows active exercises in stroke patients with upper extremity paralysis . Objective . To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and /or h and paralysis . Methods . For this pilot study , 23 acute and subacute stroke patients were r and omly assigned to the intervention ( n = 12 ) and control group ( n = 11 ) . Distributed over 4 weeks , FES training replaced 12 conventional training sessions in the intervention group . An Extended Barthel Index ( EBI ) subscore assessed the performance of activities of daily living ( ADL ) . The Chedoke McMaster Stroke Assessment ( CMSA ) measured h and and arm function and shoulder pain . The Modified Ashworth Scale ( MAS ) assessed resistance to passive movement . Unblinded assessment s were performed prior to and following the end of the training period . Results . The EBI subscore and CMSA arm score improved significantly in both groups . The CMSA h and function improved significantly in the FES group . Resistance to passive movement of finger and wrist flexors increased significantly in the FES group . Shoulder pain did not change significantly . None of the outcome measures , however , demonstrated significant gain differences between the groups . Conclusions . We did not find clear evidence for superiority or inferiority of FES . Our findings , and those of similar trials , suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences The objective of this study was to investigate the efficacy of an Electroencephalography (EEG)-based Motor Imagery ( MI ) Brain-Computer Interface ( BCI ) coupled with a Haptic Knob ( HK ) robot for arm rehabilitation in stroke patients . In this three-arm , single-blind , r and omized controlled trial ; 21 chronic hemiplegic stroke patients ( Fugl-Meyer Motor Assessment ( FMMA ) score 10–50 ) , recruited after pre-screening for MI BCI ability , were r and omly allocated to BCI-HK , HK or St and ard Arm Therapy ( SAT ) groups . All groups received 18 sessions of intervention over 6 weeks , 3 sessions per week , 90 min per session . The BCI-HK group received 1 h of BCI coupled with HK intervention , and the HK group received 1 h of HK intervention per session . Both BCI-HK and HK groups received 120 trials of robot-assisted h and grasping and knob manipulation followed by 30 min of therapist-assisted arm mobilization . The SAT group received 1.5 h of therapist-assisted arm mobilization and forearm pronation-supination movements incorporating wrist control and grasp-release functions . In all , 14 males , 7 females , mean age 54.2 years , mean stroke duration 385.1 days , with baseline FMMA score 27.0 were recruited . The primary outcome measure was upper extremity FMMA scores measured mid-intervention at week 3 , end-intervention at week 6 , and follow-up at weeks 12 and 24 . Seven , 8 and 7 subjects underwent BCI-HK , HK and SAT interventions respectively . FMMA score improved in all groups , but no intergroup differences were found at any time points . Significantly larger motor gains were observed in the BCI-HK group compared to the SAT group at weeks 3 , 12 , and 24 , but motor gains in the HK group did not differ from the SAT group at any time point . In conclusion , BCI-HK is effective , safe , and may have the potential for enhancing motor recovery in chronic stroke when combined with therapist-assisted arm mobilization Stroke is a leading cause of adult disability and the recovery of motor function is important for independence in activities of daily living . Predicting motor recovery after stroke in individual patients is difficult . Accurate prognosis would enable realistic rehabilitation goal - setting and more efficient allocation of re sources . The aim of this study was to test and refine an algorithm for predicting the potential for recovery of upper limb function after stroke . Forty participants were prospect ively enrolled within 3 days of ischaemic stroke . First ,  shoulder abduction and finger extension strength  were grade d 72 h after stroke onset to compute a shoulder abduction and finger extension score . Secondly , transcranial magnetic stimulation was used to assess the functional integrity of descending motor pathways to the affected upper limb . Third , diffusion-weighted magnetic resonance imaging was used to assess the structural integrity of the posterior limbs of the internal capsules . Finally , these measures were combined in the PREP algorithm for predicting an individual 's potential for upper limb recovery at 12 weeks , measured with the Action Research Arm Test . A cluster analysis was used to independently group patients according to Action Research Arm Test score at 12 weeks , for comparison with predictions from the PREP algorithm . There was excellent correspondence between the cluster analysis of Action Research Arm Test score at 12 weeks and predictions made with the PREP algorithm . The algorithm had positive predictive power of 88 % , negative predictive power of 83 % , specificity of 88 % and sensitivity of 73 % . This study provides preliminary data in support of the PREP algorithm for the prognosis of upper limb recovery in individual patients .  PREP may enable tailored planning of rehabilitation and more accurate stratification of patients in clinical trials Background . A recent Cochrane Review showed that early robotic training of the upper limb in stroke survivors can be more effective than other interventions when improving activities of daily living involving the arm function is the aim of therapy . Objective . We tested for efficacy of the study a protocol which involved the use of the NeReBot therapy in partial substitution of st and ard upper limb rehabilitation in post – acute stroke patients . Methods . In this dose-matched , r and omized controlled clinical trial , 34 hemiparetic participants with movement against gravity in shoulder , elbow , and wrist muscle groups were enrolled within 15 days of the onset of stroke . All participants received a total daily rehabilitation treatment for 120 minutes , 5 days per week for 5 weeks . The control group received st and ard therapy for the upper limb . The experimental group received st and ard therapy ( 65 % of exercise time ) associated with robotic training ( 35 % of exercise time ) . Muscle tone ( Modified Ashworth Scale ) , strength ( Medical Research Council ) , and synergism ( Fugl-Meyer motor scores ) were measured at impairment level , whereas dexterity ( Box and Block Test and Frenchay Arm Test ) and activities of daily living ( Functional Independence Measure ) were measured at activity level . All assessment s were performed at baseline , at the end of therapy ( time T1 ) , at 3 months ( time T2 ) , and at 7 months ( time T3 ) after entry . All between-group analyses were tested using nonparametric test with Bonferroni ’s adjustments for multiple testing . Results . No significant between-group differences were found with respect to demographic characteristics , motor , dexterity , and ADLs at baseline , postintervention ( T1 ) and at follow-up ( T2 and T3 ) . Conclusions . The robot therapy by NeReBot did not lead to better outcomes compared with conventional inpatient rehabilitation CONTEXT Reorganization in central motor networks occurs during early recovery from hemiparetic stroke . In chronic stroke survivors , specific rehabilitation therapy can improve upper extremity function . OBJECTIVE To test the hypothesis that in patients who have chronic motor impairment following stroke , specific rehabilitation therapy that improves arm function is associated with reorganization of cortical networks . DESIGN , SETTING , AND PATIENTS A r and omized controlled clinical trial conducted in a US ambulatory rehabilitation program with 21 patients ( median [ IQR ] , 50.3 [ 34.8 - 77.3 ] months after unilateral stroke ) . Data were collected between 2001 and 2004 . INTERVENTIONS Patients were r and omly assigned to bilateral arm training with rhythmic auditory cueing ( BATRAC ) ( n = 9 ) or st and ardized dose-matched therapeutic exercises ( DMTE ) ( n = 12 ) . Both were conducted for 1 hour , 3 times a week , for 6 weeks . MAIN OUTCOME MEASURES Within 2 weeks before and after the intervention , brain activation during elbow movement assessed by functional magnetic resonance imaging ( fMRI ) and functional outcome assessed using arm function scores . RESULTS Patients in the BATRAC group but not in the DMTE group increased hemispheric activation during paretic arm movement ( P = .03 ) . Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum ( P = .009 ) . BATRAC was associated with significant increases in activation in pre central ( P<.001 ) and post central gyri ( P = .03 ) and the cerebellum ( P<.001 ) , although 3 BATRAC patients showed no fMRI changes . Considering all patients , there were no differences in functional outcome between groups . When only BATRAC patients with fMRI response were included ( n = 6 ) , BATRAC improved arm function more than DMTE did ( P = .02 ) . CONCLUSIONS These preliminary findings suggest that BATRAC induces reorganization in contralesional motor networks and provide biological plausibility for repetitive bilateral training as a potential therapy for upper extremity rehabilitation in hemiparetic stroke Objective : The aim of this study was to evaluate the effectiveness of Cognitive Sensory Motor Training Therapy ( Perfetti ’s method ) vis-à-vis conventional occupational therapy in the recovery of arm function after acute stroke . Design : Prospect i ve r and omized controlled trial . Setting : Two rehabilitation centers in Bangkok , Thail and . Subjects : Forty first-time acute stroke patients without severe cognitive or language impairment . Intervention : All subjects were r and omly divided into two groups ; one was treated using Perfetti ’s method and the other using conventional occupational therapy . Each group underwent therapy for 30 minutes , five times a week for four weeks . Main measures : The primary variable was arm function as assessed by the Action Research Arm Test ; secondary variables were the extended Barthel Index and the box and block test score . Results : The intention-to-treat analysis revealed no statistically significant differences between the two groups at the end of treatment for any variable . Conclusions : There was no evidence of a difference between Cognitive Sensory Motor Training Therapy of Perfetti ’s method and conventional occupational therapy with respect to the restoration of h and and arm function after a stroke Background and Purpose — Surface neuromuscular electrical stimulation ( sNMES ) after stroke aims to improve upper limb function and reduce shoulder pain , but current evidence of effectiveness is inconclusive . We have undertaken a r and omized controlled trial to evaluate sNMES to the shoulder after acute stroke . Methods — One hundred seventy-six patients , within 10 days of stroke onset , were r and omized to receive sNMES or placebo  in addition to stroke unit care . The primary outcome measure was upper limb function measured by the Action Research Arm Test ( ARAT ) 3 months after stroke . Secondary outcome measures included other measures of upper limb function , upper limb impairment , pain , disability , and global health status . Outcome assessment s were blinded . Results — There was no difference in arm function between groups in terms of the primary outcome measure . The median ARAT at 3 months was 50 in the intervention group and 55.5 in the control group ( P=0.068 ) . Significant differences were seen at 3 months in favor of the control group for other measures of arm function and impairment : grasp and gross movement subsections of the ARAT , Frenchay Arm Test , and the arm subsection of the Motricity Index . Secondary analysis suggested that these differences were most marked in subjects with severe initial upper limb weakness . Conclusions — A 4-week program of sNMES to the shoulder after acute stroke does not improve functional outcome and may worsen arm function in severely impaired stroke patients . “ Routine ” use of sNMES to the proximal affected upper limb after acute stroke can not be recommended Background Evidence exist that motor observation activates the same cortical motor areas that are involved in the performance of the observed actions . The so called “ mirror neuron system ” has been proposed to be responsible for this phenomenon . We employ this neural system and its capability to re-enact stored motor representations as a tool for rehabilitating motor control . In our new neurorehabilitative schema ( videotherapy ) we combine observation of daily actions with concomitant physical training of the observed actions focusing on the upper limbs . Following a pilot study in chronic patients in an ambulatory setting , we currently design ed a new multicenter clinical study dedicated to patients in the sub-acute state after stroke using a home-based self-induced training .  Within our protocol we assess 1 ) the capability of action observation to elicit rehabilitational effects in the motor system , and 2 ) the capacity of this schema to be performed by patients without assistance from a physiotherapist . The results of this study would be of high health and economical relevance . Methods / design A controlled , r and omized , multicenter , paralleled , 6 month follow-up study will be conducted on three groups of patients : one group will be given the experimental treatment whereas the other two will participate in control treatments .  All patients will undergo their usual rehabilitative treatment beside participation in the study . The experimental condition consists in the observation and immediate imitation of common daily h and and arm actions . The two parallel control groups are a placebo group and a group receiving usual rehabilitation without any trial-related treatment . Trial r and omization is provided via external data management . The primary efficacy endpoint is the improvement of the experimental group in a st and ardized motor function test ( Wolf Motor Function Test ) relative to control groups . Further assessment s refer to subjective and qualitative rehabilitational scores . This study has been review ed and approved by the ethics committee of Aachen University . Discussion This therapy provides an extension of therapeutic procedures for recovery after stroke and emphasizes the importance of action perception in neurorehabilitation The results of the study could become implemented into the wide physiotherapeutic practice , for example as an ad on and individualized therapy 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 ) Background and Objective . This study investigated the relative effects of distributed constraint-induced therapy ( CIT ) and bilateral arm training ( BAT ) on motor performance , daily function , functional use of the affected arm , and quality of life in patients with hemiparetic stroke . Methods . A total of 60 patients were r and omized to  distributed CIT , BAT , or a control intervention of less specific but active therapy . Each group received intensive training for 2 hours/day , 5 days/week , for 3 weeks . Pretreatment and posttreatment measures included the Fugl — Meyer Assessment ( FMA ) , Functional Independence Measure ( FIM ) , Motor Activity Log ( MAL ) , and Stroke Impact Scale ( SIS ) . The proximal and distal scores of FMA were used to examine separate upper limb ( UL ) elements of movement . Results . The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group . The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups . Enhanced performance was found for the distributed CIT group in the MAL , the subtest of locomotion in the FIM , and certain domains of the SIS ( eg , ADL/IADL ) . Conclusion . BAT may uniquely improve proximal UL motor impairment . In contrast , distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis Twelve moderately to severely involved chronic stroke survivors ( > 12 mo ) were r and omized to one of two treatments : robotics and motor learning ( ROB-ML ) or functional neuromuscular stimulation and motor learning ( FNS-ML ) . Treatment was 5 h/d , 5 d/wk for 12 wk . ROB-ML group had 1.5 h per session devoted to robotics shoulder and elbow ( S/E ) training . FNS-ML had 1.5 h per session devoted to functional neuromuscular stimulation ( surface electrodes ) for wrist and h and ( W/H ) flexors/extensors . The primary outcome measure was the functional measure Arm Motor Ability Test ( AMAT ) . Secondary measures were AMAT-S/E and AMAT-W/H , Fugl-Meyer ( FM ) upper-limb coordination , and the motor control measures of target accuracy ( TA ) and smoothness of movement ( SM ) .  ROB-ML produced significant gains in AMAT , AMAT-S/E , FM upper-limb coordination , TA , and SM .  FNS-ML produced significant gains in AMAT-W/H and FM upper-limb coordination Abstract Background / Objective : The upper extremity motor deficit is one of the functional challenges in post stroke patients . The objective of the present study was to evaluate the effectiveness of the meaningful task-specific training ( MTST ) on the upper extremity motor recovery during the subacute phase after a stroke . Method : This was a r and omized , controlled , double-blinded trial in the neurology department of a university hospital and occupational therapy unit of a rehabilitation institute . A convenience sample of 103 people , 4 to 24 weeks ( mean , 12.15 weeks ) after the stroke , was r and omized into 2 groups ( MTST , 51 ; st and ard training group , 52 ) . Subjects in the Brunnstrom stage of arm recovery of 2 to 5 were included in the study . Ninety-five participants completed the 8-week follow-up . Interventions : Participants were assigned to receive either the MTST or dose-matched st and ard training program based on the Brunnstrom stage and Bobath neurodevelopmental technique , 4 to 5 days a week for 4 weeks . Fugl-Meyer assessment ( FMA ) , Action Research Arm Test ( ARAT ) , Grade d Wolf Motor Function Test ( GWMFT ) , and Motor Activity Log ( MAL ) were outcome measures Results : The MTST group showed a positive improvement in the mean scores on the outcome measures at post and follow-up assessment s in comparison to the control group . Further , statistically significant differences were observed in changes between the groups at post and follow-up assessment for FMA , ARAT , GWMFT , and MAL . Conclusion : The MTST produced statistically significant and clinical ly relevant improvements in the upper extremity motor recovery of the patients who had a subacute stroke AIM The aim of this study was to investigate the role of mental practice ( MP ) in functional recovery of upper limbs in stroke patients . METHODS Thirty-six hemiparetic stroke patients ( 15 females and 21 males ) were enrolled in a r and omized single blind cross-over study . Patients were r and omly divided into two groups , ( A and B ) each comprising 18 patients . Patients in group A underwent the conventional neuro-rehabilitation protocol ( therapeutic exercise and occupational therapy ) for three weeks ( 3 hours a day , 5 days a week ) and in the following 3 weeks , they received an additional 60 minutes of MP training . Patients in group B , instead , underwent , in the first 3 weeks , the rehabilitation program plus MP training and in the following 3 weeks , only the conventional neurorehabilitation program . All patients were evaluated at baseline ( T0 ) , at 3 weeks ( T1 ) and at 6 weeks ( T2 ) with the Motricity Index ( MI ) and the Arm Functional Test ( AFT ) . RESULTS At baseline ( T0 ) there were no significant differences at MI and AFT between the two groups . At T1 the differences between the two groups became significant . At T2 the difference was once again minimal . CONCLUSION These results suggest that MP could be used to complement to the conventional neurorehabilitative treatments usually prescribed for post-stroke neuromotor recovery . However , there is still much to be tested and discussed regarding the role that MP might play in the treatment of neurological patients Objective . A r and omized controlled observer-blind trial was design ed to evaluate the effectiveness of action observation as an add-on treatment to the st and ard rehabilitation of upper-limb function , early after stroke . Methods . Stroke survivors ( N = 102 ) were consecutively recruited from 13 centers 30 days ( ±7 ) after a first-ever stroke and r and omly assigned to the  experimental ( EG )  or  control group (  CG ) . EG participants watched video footage of daily routine tasks ( actions ) carried out with the upper limb in order to prepare to imitate the presented action . At the end of each sequence , a therapist prompted the patient to perform the same movement for 2 minutes , providing help when needed . Static images without animals or human beings were shown to the CG . At the end of each sequence , the CG executed movements that simulated the shoulder and elbow joint mobilization activities performed by the EG . Results for the Fugl-Meyer test , Frenchay Arm test , Box and Block test ( BBT ) , Modified Ashworth Scale , and Functional Independence Measure Motor items were recorded before treatment ( T0 ) , after 4 weeks of treatment ( T1 ) , and at the follow-up visit 4 to 5 months after the conclusion of treatment ( T2 ) . Results . An improvement over time was appreciated on all measures of impairment and functional ability with both treatment programs . A Time × Treatment interaction emerged from the generalized estimating equations analysis of BBT , showing significant T0–T1 and T0–T2 differences in favor of EG . Conclusion . This multicenter trial endorses the use of action observation in upper-extremity rehabilitation , along with a role for the mirror neuron system in poststroke recovery OBJECTIVE To assess the relative responsiveness of 2 commonly used upper-extremity motor scales , the Action Research Arm Test ( ARAT ) and the Fugl-Meyer Assessment ( FMA ) , in evaluating recovery of upper-extremity function after an acute stroke in patients undergoing inpatient rehabilitation . DESIGN Prospect i ve . SETTING An acute stroke rehabilitation unit . PARTICIPANTS One hundred four consecutive admissions ( 43 men , 61 women ; mean age + /- st and ard deviation , 72+/-13y ) to a rehabilitation unit 16+/-9 days after acute stroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The following assessment s were completed within 72 hours of admission and 24 hours before discharge :  ARAT , upper-extremity motor domain of the FMA , National Institutes of Health Stroke Scale , FIM instrument total score , and FIM activities of daily living ( FIM-ADL ) subscore .  RESULTS The Spearman rank correlation statistic indicated that the 2 upper-limb motor scales ( ARAT , FMA ) correlated highly with one another , both on admission ( rho = .77 , P < .001 ) and on discharge ( rho = .87 , P < .001 ) . The mean change in score from admission to discharge was 10+/-15 for the ARAT and 10+/-13 for the FMA motor score . The responsiveness to change as measured by the st and ard response mean was .68 for the ARAT and .74 for the FMA motor score . The Spearman rank correlation of each upper-limb motor scale with the FIM-ADL at the time of admission was as follows : ARAT , rho equal to .32 ( P < .001 ) and FMA motor score , rho equal to .54 ( P < .001 ) . CONCLUSIONS Both the FMA motor score and the ARAT were equally sensitive to change during inpatient acute rehabilitation and could be routinely used to measure recovery of upper-extremity motor function Background Repetitive functional task practise ( RFTP ) is a promising treatment to improve upper limb recovery following stroke . We report the findings of a study to determine the feasibility of a multi-centre r and omised controlled trial to evaluate this intervention . Methods A pilot r and omised controlled trial recruited patients with new reduced upper limb function within 14 days of acute stroke from three stroke units . Participants were r and omised to receive a four week upper limb RFTP therapy programme consisting of goal setting , independent activity practise , and twice weekly therapy review s in addition to usual post stroke rehabilitation , or usual post stroke rehabilitation .  The recruitment rate ; adherence to the RFTP therapy programme ; usual post stroke rehabilitation received ; attrition rate ; data quality ; success of outcome assessor blinding ; adverse events ; and the views of study participants and therapists about the intervention were recorded . Results Fifty five eligible patients were identified , 4 - 6 % of patients screened at each site . Twenty four patients participated in the pilot study . Two study sites met the recruitment target of 1–2 participants per month . The median number of face to face therapy sessions received was 6 [ IQR 3–8 ] . The median number of daily repetitions of activities recorded was 80 [ IQR 39–80 ] . Data about usual post stroke rehabilitation were available for 18/24 ( 75 % ) . Outcome data were available for 22/24 ( 92 % ) at one month and 20/24 ( 83 % ) at three months . Outcome assessors were unblinded to participant group allocation for 11/22 ( 50 % ) at one month and 6/20 ( 30 % ) at three months . Four adverse events were considered serious as they result ed in hospitalisation . None were related to study treatment . Feedback from patients and therapists about the RFTP programme was mainly positive . Conclusions A multi-centre r and omised controlled trial to evaluate an upper limb RFTP therapy programme provided early after stroke is feasible and acceptable to patients and therapists , but there are issues which need to be addressed when design ing a Phase III study . A Phase III study will need to monitor and report not only recruitment and attrition but also adherence to the intervention , usual post stroke rehabilitation received , and outcome assessor blinding . Trial registration International St and ard R and omised Controlled Trials Number ( IS RCT N )
Based on the available evidence , motor evoked potentials at rest were the only biomarker that predicted motor outcome in individuals with severe arm impairment following stroke .
To build an underst and ing of the neurobiology underpinning arm recovery in people with severe arm impairment due to stroke , we conducted a pooled individual data systematic review to : 1 ) characterize brain biomarkers ; 2 ) determine relationship(s ) between biomarkers and motor outcome ; and 3 ) establish relationship(s ) between biomarkers and motor recovery .