Unilateral versus bilateral upper limb training after stroke: the Upper Limb Training After Stroke clinical trial.

BACKGROUND AND PURPOSE: 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. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl. Unique identifier: NTR1665.

Feasibility and reliability of measuring strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy.

AIM: The aim of this study was to analyse the feasibility and reliability of the tests used to determine muscle strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy (CP). METHODS: Twenty individuals with spastic CP (four females, 16 males; age range 18-49y; Gross Motor Function Classification System level I, n=15; II, n=5; unilateral CP, n=10; bilateral CP, n=10; athletes, n=12; non-athletes, n=8) participated in the study. Isometric and isokinetic knee flexor and extensor strength, sprint power, and aerobic capacity were determined, using, respectively an isokinetic dynamometer, a Wingate cycling test, and a graded maximal bicycle exercise test, on three occasions. Intraclass correlation coefficients (ICC), standard error of measurements, and smallest detectable differences (SDD) were calculated. RESULTS: The feasibility of the isometric strength test, Wingate test, and graded exercise test was good; the isokinetic strength test was difficult to perform for five participants. The strength parameters showed moderate to good ICCs (isometric, 0.74-0.94; isokinetic, 0.88-0.93) but high SDDs (isometric, 25-45%; isokinetic, 30-45%). Sprint power (ICC 0.98; SDD 24%) and aerobic capacity (ICC 0.98-0.99; SDD 16-21%) showed good ICCs and moderate SDDs. INTERPRETATION: All tests, except for the isokinetic strength test, seemed to be feasible for almost all participants. All tests are suitable for evaluating changes in a group; however, only large improvements (16-45%) can be detected when monitoring individual changes.