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

• Published in: Clinical rehabilitation 2003-11, Vol.17 (7), p.723-730
• Main Authors: WOLDAG, Hartwig, WALDMANN, Guido, HEUSCHKEL, Gabriele, HUMMELSHEIM, Horst
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arm - physiology; Arm movements; Biological and medical sciences; Diseases of the nervous system; Evaluation; Female; Hand - physiology; Hand movements; Hand Strength - physiology; Humans; Longitudinal Studies; Male; Medical sciences; Middle Aged; Motor performance; Motor Skills - physiology; Occupational therapy; Physical Therapy Modalities - methods; Physiotherapy; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recovery; Recovery of Function - physiology; Rehabilitation; Repetition; Stroke - physiopathology; Stroke Rehabilitation; Strokes; Treatment Outcome
• ISSN: 0269-2155; 1477-0873
• DOI: 10.1191/0269215503cr669oa

To determine whether a repetitive training of complex movements of arm and hand contributes to functional recovery in stroke patients. Prospective, longitudinal, multiple baseline design across individuals. Neurological rehabilitation centre. Twenty-one patients with stroke in the middle cerebral artery territory. 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. Rivermead Motor Assessment (RMA, arm section), grip strength, rapid isotonic hand extension, three-dimensional motion analysis. 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. 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.