Upper Extremity Retraining Following Stroke: Effects of Bilateral Practice

Abstract

Clinical observation of bilateral action and the motor control literature suggested a novel method of normalizing patterns of upper extremity movement following stroke, a problem that continues to challenge rehabilitation research. Eight single case, mul tiple baseline experiments on post-acute stroke subjects compared bilateral isokine matic training (BIT) against unilateral practice with the hemiplegic upper extremity (four experiments) or against bilateral practice with hands linked (four experiments). Unilateral performance with the hemiplegic arm of three grasp and reach actions (block placement, simulated drinking, peg to eye level target) was measured by blind, standardized observational kinematic analysis over four phases of ten daily sessions. For all three actions, phase 1 comprised baseline conditions of either unilateral prac tice or bilateral practice with linked hands. Baselines continued until introduction of BIT in staggered order to each of the three actions in phases 2, 3, or 4. Improvements were statistically superior to the generally negligible effects of unilateral or hands linked practice for all three actions in six experiments. One experiment showed significant effects in two of the three actions and the eighth in only one action. Improvements were clinically significant, normal performance ranges being reached for the majority of cases, with good maintenance at six-month follow-up. Key Words: Bilateral prac tice—Brain reorganization—Stroke—Rehabilitation.