A multi-centre randomised controlled study of early intensive task-related training of the upper limb following stroke

Investigators : Ms Kimberly Miller, Prof Mary Galea, Dr Bev Phillips

The objective of this study was to evaluate the efficacy of an early, intensive task-related training program designed to improve motor and sensory function of the hemiplegic upper limb following stroke.

Subjects were recruited within six weeks of their first cortical stroke and randomly allocated to treatment (T) or control (C) interventions.   All subjects received three weeks of daily intervention including assigned independent practice activities additional to their standard therapy program.   The T group received task-related training of their upper limb emphasising uni-manual and bimanual functional activities.   The C group received exercises to improve postural control and concentration. Assessments were conducted pre- and post-intervention, and three months post-intervention.   Motor recovery of the affected upper limb was assessed using the Chedoke-McMaster Stroke Assessment (CMSA).   Manual dexterity, grip and pinch forces, and hand sensation were also assessed. Perceived quality of life was recorded using the Stroke-Adapted 30-Item Sickness Impact Profile at three months post-intervention.

The Figures illustrate examples of tasks practiced by stroke subjects during the training period.

Thirty subjects (16 T and 14 C) completed the study. While there were no statistically significant differences between the two groups initially, the T group had significantly greater gains in motor recovery of the arm on the CMSA ( p < 0.001), in pinch forces between the affected thumb and index finger ( p = 0.04), and in hand sensation ( p = 0.01) at three months post-intervention.   The T group also reported significantly greater quality of life ( p < 0.001).

The results of this study support implementation of early intensive task-related training to improve motor and sensory function of the upper limb following stroke.

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