Effect Of Conventional Physical Therapy Research Articles

Enhanced Muscle Activation Using Robotic Assistance Within the Electromechanical Delay: Implications for Rehabilitation?

Robotic rehabilitation has been shown to match the effects of conventional physical therapy on motor function for patients with neurological diseases. Rehabilitation robots have the potential to reduce therapists' workload in time-intensive training programs as well as perform actions that are not replicable by human therapists. We investigated the effects of one such modality that cannot be achieved by a human therapist: assistance and resistance within the electromechanical delay between muscle activation and muscle contraction during arm extension. We found increased muscle activation when providing robotic assistance within this electromechanical delay. Assistance provided within this delay moves the participant's arm quicker than their own muscle and increases the subsequent peak voluntary muscle activation compared to normal arm extension by 68.97 ± 80.05 % (SE = 0.021; p = 0.007 ). This is surprising since all previous literature shows that muscle activation either decreases or does not change when participants receive robotic assistance. As a consequence, traditional robotic rehabilitation incrementally reduces assistance as the patient improves to maintain levels of muscle activation which is suggested to be important for neuronal repair. The present result may enable therapists to no longer have to choose between providing assistance or increasing muscle activation. Instead, therapists may be able to provide assistance while also increasing muscle activation.

Comparison of the Effects of Conventional Physical Therapy Versus Progressive Overload Training in Patients with Shoulder Impingement Syndrome; A Randomised Clinical Trial

Abstract
 Background: Rotator cuff tendinitis and shoulder impingement are regarded as the frequent intrinsic reasons for shoulder discomfort and disability. 
 Objective: A study was conducted to compare the effects of conventional physical therapy and progressive overload training in patients with shoulder impingement syndrome.
 Methods: Thirty patients with shoulder impingement syndrome were included. These patients were randomised into two groups. One group received structured, progressive resistance training, and the other received conventional therapy. The intervention group participants participated in progressive resistance training three days per week for six weeks. The numeric pain rating scale was used to assess pain intensity and the range of motion measured by the goniometer. The statistical package for social sciences (SPSS), version 21 for Windows, was used for data analysis. An independent t-test was used to compare the effects between the two
 groups. 
 Result: Out of 30 participants, there were twenty-four females and six males. The mean age of the participants was 44±5.1 years. Participants from the intervention group had better pain control (P < 0.05) and improved range of motion (P < 0.05) compared to the control group. 
 Conclusion: We conclude in this group of patients, progressive overload training was more effective in alleviating pain and improving the range of motion in patients with shoulder impingement syndrome.

Effects of conventional physical therapy with and without proprioceptive neuromuscular facilitation on balance, gait, and function in patients with Parkinson's disease.

The study was conducted at University of Lahore Teaching Hospital and Sir Ganga Ram Hospital, Lahore, using non-probability convenience sampling. Thirty-eight patients of Parkinson's disease were allocated by randomisation into two groups. PNF Group (group A) performed proprioceptive neuromuscular facilitation incorporated with conservative treatment, while for the conventional therapy group (group B) only conservative treatment was followed. Berg Balance Scale, Freezing of Gait questionnaire, and Functional Independence measure were used as outcome measuring tool. Berg balance scale values were significantly improved in group A at 12th week as compared to group B. Freezing of gait and functional independence was more significantly reduced in group A at sixth and 12th week as compared to group B. Hence, it is concluded that Proprioceptive neuromuscular facilitation combined with routine treatment regime improves balance, gait, and function of Parkinson's patients more effectively as compared with routine treatment protocol only.

Comparison of the effectiveness of conventional physical therapy and extracorporeal shock wave therapy on pain, disability, functional status, and depression in patients with chronic low back pain.

The aim of this study was to compare the effectiveness of conventional physical therapy (transcutaneous electrical nerve stimulation, hot pack, and therapeutic ultrasound) and extracorporeal shock wave therapy (ESWT) on pain, disability, functional status, and depression in patients with chronic low back pain (LBP). Ninety-one patients with chronic LBP were included in the study and randomized to groups that received ESWT or conventional physiotherapy; of these, 70 completed the study (37 males, 33 females; mean age: 46.4±13.3 years; range, 18 to 65 years). Outcome measures included the Visual Analog Scale, the pressure pain algometer, Oswestry Disability Index (ODI), Health Assessment Questionnaire (HAQ), fingertip-to-floor distance, and the Beck Depression Inventory. The assessments were made before treatment and at the first and 12th weeks after treatment. Extracorporeal shock wave therapy was more effective than conventional physical therapy in terms of Visual Analog Scale scores, the pressure algometer, ODI, HAQ, and fingertip-to-floor distance at the first and 12th week. Extracorporeal shock wave therapy is superior to conventional physical therapy in terms of improving pain, spinal mobility, and functional status in patients with chronic LBP.

The Effects of Conventional Physical Therapy with and Without Dry Needling on Pain, Range of Motions and Functional Disability in Patients with Shoulder Impingement Syndrome

Dry needling is a technique in which thin monofilament-based needles are inserted into soft tissues, especially trigger points in muscles. It is being used in a range of neuromuscular pain syndromes such as shoulder impingement syndrome in current study. In physical therapy, it is narrowly referred to as an intramuscular procedure for the treatment of myofascial trigger points (MTrPs). Objective: To compare the conventional physical therapy with and without dry needling on pain, range of motion, and functional disability in patients with shoulder impingement syndrome. Methods: It was randomized controlled trial conducted on 66 patients of shoulder impingement syndrome based on inclusion criteria and divided randomly allocated equally in two groups of 33 in each of conventional therapy and dry needling group. The outcome measures used were numeric pain rating scale for pain, DASH for hand arm function and shoulder ranges of motion. The SPSS 25.0 was used to analyse data. The descriptive statistics was applied, and inferential statistics was applied based on findings of tests of normality. Results: The results showed that the post interventional pain score was 1.43±1.37, 32.11 for conventional group and for experimental group that of 1.60±1.02, 34.89 with non-significant difference 0.544, while DASH score was 27.02±13.22, 38.85 for conventional group and for experimental group that of 19.92±11.20, 28.15 with significant difference 0.024. The results for flexion, abduction, internal and external rotation were non-significant with p value >0.05. Conclusions: It was concluded that although there was significant improvement in pain, range of motion and function in both of dry needling and conventional groups, however, pain and shoulder ranges improved equally in both groups without a statistically significant difference while that of disability improved significantly in dry needling group

Effects of Kinesiology Taping on Sleep Quality in Participants with Cronical Low Back Pain

Our main aim in this study is to compare the effectiveness of conventional physical therapy in the context of sleep quality of participants with chronic low back pain and the effectiveness of kinesiology taping applied to the waist area in a very short time. 40 participants (30 females, 10 males) whose age ranges ranged from 25 to 50 years were randomly divided into two groups (banding group and control group). In both groups, a home exercise program was given by applying therapeutic ultrasound for 5 minutes, TENS (Transcutaneous Electrical Nerve Stimulation) for 30 minutes and infrared for 30 minutes. In kinesiology taping groups, taping was applied to the waist region with the star technique, once for 48 hours. VAS (Visual Analog Scale) for pain, hip flexor flexibility test and hand-finger floor distance test for flexibility, Berg balance scale for balance, Beck anxiety scale for anxiety, Oswestry disability index for disability level, Tampa kinesiophobia scale for kinesiophobia, sleep quality Pittsburg sleep quality index and Nottingham life profiles were used for quality of life. Evaluations were made twice, before and after the treatment. The significance level was accepted as p <0.05

Cerebellar Intermittent Theta-Burst Stimulation Reduces Upper Limb Spasticity After Subacute Stroke: A Randomized Controlled Trial.

Objective: This study aims to explore the efficacy of cerebellar intermittent theta-burst stimulation (iTBS) on upper limb spasticity in subacute stroke patients.Methods: A total of 32 patients with upper limb spasticity were enrolled and randomly assigned to treatment with cerebellar iTBS or sham stimulation before conventional physical therapy daily for 2 weeks. The primary outcomes included the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the shear wave velocity (SWV). The secondary outcomes were the H-maximum wave/M-maximum wave amplitude ratio (Hmax/Mmax ratio), motor-evoked potential (MEP) latency and amplitude, central motor conduction time (CMCT), and the Barthel Index (BI). All outcomes were evaluated at baseline and after 10 sessions of intervention.Results: After the intervention, both groups showed significant improvements in the MAS, MTS, SWV, and BI. In addition, patients treated with cerebellar iTBS had a significant increase in MEP amplitude, and patients treated with sham stimulation had a significant decrease in Hmax/Mmax ratio. Compared with the sham stimulation group, the MAS, MTS, and SWV decreased more in the cerebellar iTBS group.Conclusion: Cerebellar iTBS is a promising adjuvant tool to reinforce the therapeutic effect of conventional physical therapy in upper limb spasticity management after subacute stroke (Chinese Clinical Trial Registry: ChiCTR1900026516).

Impact of core stability exercises on bone mineralization and functional capacity in children with polyarticular juvenile idiopathic arthritis: a randomized clinical trial

Juvenile idiopathic arthritis (JIA) is the most prevalent rheumatic disease in children. The core stability exercises ensure proper muscular strength and balance around the lumbo-pelvic-hip complex. This study evaluated whether the use of core stability exercises would increase the effectiveness of conventional physical therapy (PT) in enhancing bone mineralization and improving functional capacity in children with polyarticular JIA. Thirty-three children with polyarticular JIA (age; 10-14years) assigned randomly into two groups: the control group (n = 16) received the conventional PT, and the study group (n = 17) received the core stability exercises in addition to the same conventional PT program. Both core stability and conventional PT exercises continued for 3months. The measures of bone mineralization and functional ability were investigated by dual-energy X-ray absorptiometry (DXA) device and 6-min walk test (6MWT), respectively, at baseline and immediately post-treatment. Analysis of covariance (ANCOVA) revealed significant differences between groups in favor of the study group regarding measures of bone mineralization of lumbar spine and femoral neck regions as P < 0.05, except for volumetric bone mineral density of lumbar spine the P > 0.05. There was a significant difference between the two groups concerning functional capacity measured in 6MWT (P < 0.05), where children in the study group walked 531.71 ± 90.59m compared with the control group 509.31 ± 73.10m. Core stability exercises are an effective adjunctive therapy to enhance bone health status and improve functional capacity in children with polyarticular JIA. Key Points • In addition to conventional physical therapy, core stability exercises had a definite effect on improving bone health status and quality of life in children with polyarticular juvenile idiopathic arthritis. • Improved bone mineralization and functional capacity due to core stability exercises contain two parts: strengthening training and controlling equilibrium.

Can addition of low level laser therapy to conventional physical therapy be beneficial for management of pain and cervical range of motion in patients with trigger point of upper trapezius?

Objective: Trigger points commonly develop in upper trapezius muscle. These might be associated with neck pain arising from trigger points of trapezius. This study was conducted to compare the effectiveness of conventional physical therapy (CPT) with and without low level laser therapy (LLLT) on pain and cervical range of motion (ROM) in patients with trigger point of upper trapezius muscle.&#x0D; Methodology: An RCT was conducted with a sample size of 62 patients. The study was completed within 9 months after approval of synopsis. Data were collected from Health Care Physiotherapy, Sports, Spine &amp; Rehabilitation Center, Faisalabad (Pakistan). Patients were randomly allocated into two equal groups; 31 patients of Group-1 received low-level laser therapy with CPT, while Group-2 (n=31) patients received CPT as the only treatment protocol. Patients pain level was assessed using Numeric Pain Rating Scale (NPRS) and cervical ROM was measured by goniometry at baseline and subsequently at 2nd and 4th week follow-ups.&#x0D; Results: Results of the study obtained by applying repeated measures ANOVA showed that there was mean reduction in pain scores from day 1 to week 4 in within group analysis of LLLT + CPT Group (Group=1) and within group analysis of CPT Group (Group=2) (p &lt; 0.05). Statistically significant improvement was observed in all mean cervical ROMs especially for lateral flexion ROM for both groups in within group analysis (p &lt; 0.05). Statistically significant improvement was seen in NPRS score at week four between Group-1 and 2, measured by independent sample t-test with p &lt; 0.05. Whereas, independent sample t-test results showed no significant improvement in cervical ROMs at week four between Group-1 and 2 (p ˃ 0.05).&#x0D; Conclusion: Conventional physical therapy and low level laser therapy used in combination are more effective than conventional physical therapy alone in patients of trigger points of upper trapezius.&#x0D; Citation: Waseem I, Tanveer F, Fatima A. Can addition of low level laser therapy to conventional physical therapy be beneficial for management of pain and cervical range of motion in patients with trigger point of upper trapezius? Anaesth pain &amp; intensiv care 2019;23(2):__&#x0D; DOI: https://doi.org/10.35975/apic.v24i1.&#x0D; Received – 4 September 2019,&#x0D; Reviewed – 31 December 2019, 26 January 2020,&#x0D; Revised – 18 March 2020,&#x0D; Accepted – 9 May 2019

Effect of Core Stability Exercise in Patients with Neckpain

Background: Pain is the most common symptom of which the human kind complaints. Neck pain is thesecond common condition cause of time off work after low back pain. According to 18% of the responders,the cause of their symptoms was unknown. The most frequently reported causes were ascribed to workingconditions (29%), tension: stress (29%) and a poor posture (21%). Sitting at work for more than 95% of theworking time seems to be a risk factor for neck pain.Aims and Objectives: To study the effectiveness of conventional physical therapy in patients with neckpain and to study the additive effect of core stability exercises on conventional physical therapy in patientswith neck pain.Materials and Methods: Study included 30 (Thirty) patients with chronic case of non-specific neck painbetween age group of 18-40 years. They were divided into 2 groups: Group A (Conventional therapy +Core stability exercises group) included 15 patients and Group B (Conventional therapy group) included 15patients by random sampling. The patients were treated for a period of 1 month. Pain was assessed by VisualAnalogue Scale, neck function was measured by Neck Disability Index and deep neck flexor strength wasmeasured by craniocervical flexion test.Results: Results showed that there was significant difference in VAS (P< 0.0001), NDI (P=0.002) and deepneck flexor strength (p< 0.0001) between Group A and B.Conclusion: Core stability exercise along with conventional physiotherapy was found to be more effectivein patients with chronic non-specific neck pain. So, these interventions can be applied in clinical setup incombination with conventional treatment for the better and long term improvements.

Effects of Conventional Physical Therapy with or without Strain Counterstrain in Patients with Trigger Points of Upper Trapezius; a Randomized Controlled Clinical Trial

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt;&lt;strong&gt;Â Â &lt;/strong&gt;Non-specific neck pain has potential contributing factors. One of the factors being emphasized in the modern era is the Myofascial trigger points in the upper trapezius muscle. These could be treated by strain counterstrain method whose effectiveness needs to be evaluated. Hence, the objective of the study was to compare the effects of conventional Physical therapy with or without strain counterstrain in patients with trigger points of upper trapezius muscle.&lt;/p&gt;&lt;p&gt;Â &lt;strong&gt;Patients and Methods&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;It is randomized controlled clinical trial.&lt;/p&gt;&lt;p&gt;48 patients with treatment group A (24 patients) and control group B (24 patients).&lt;/p&gt;&lt;p class="Default"&gt;48 patients with treatment group A (24 patients) and control group B (24 patients).&lt;/p&gt;&lt;p&gt;Patients with non-specific neck pain, having active myofascial trigger points in upper trapezius muscle presented to physical therapy department. Effects of interventions were recorded on neck disability index, visual analogue scale and cervical range of motion goniometer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt; of this study using repeated measure ANOVA demonstrated that within group from day 1 to 7, there was mean reduction of pain by 32.13 (26.99, 37.27) in conventional physical therapy group with Strain counterstrain group (group A) and conventional physical therapy only group (group B) by 12.62 (8.28, 16.96). Less significant improvement was seen within groups for day 1, 4 and 7 in cervical range of motion. There was significant improvement seen in pain, neck disability index and neck range of motions on day 7 between group A and B measured by independent sample t test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;strong&gt;Â Â &lt;/strong&gt;Conventional physical therapy with strain counterstrain was found effective in reducing pain, functional disability and improving range of motion at cervical region.&lt;/p&gt;

Effect of conventional physical therapy and Pilates in functionality, respiratory muscle strength and ability to exercise in hospitalized chronic renal patients: a randomized controlled trial

Objective: To compare the effect of conventional physical therapy and Pilates on function, restoration, and exercise ability in hospitalized chronic renal patients. Methods: A total of 56 inpatients were randomized into two groups: Conventional physical therapy and Pilates. The primary outcomes were functionality (Barthel Index), respiratory muscle strength (manovacuometry), and ability to exercise (step test) evaluated in the following periods: preintervention, after the 5th session, and after the 10th session or at discharge. Three months after randomization, the Barthel Index was applied over the phone. At the end of the 10 sessions or at discharge, the length of hospital stay was calculated and the level of satisfaction with physical therapy care was assessed (MedRisk). Linear mixed models were used for the primary outcomes and the Student’s t-test was used for length of stay and satisfaction. Results: There was no significant between-group difference in functionality (MD −1.3; 95% CI −2.8 to 5.4), inspiratory and expiratory muscle strength (MD −1.3; 95% CI −7.3 to 4.5/MD −4.5; 95% CI −0.7 to 9.7, respectively), performance in the step test (MD −3.3; 95% CI −6.2 to 12.8), patient satisfaction with physical therapy care (MD −2.0; 95% CI −5.1 to 9.1), and length of stay (MD 4.5; 95% CI −15.9 to 6.8). Conclusion: Both interventions, conventional physical therapy and Pilates, showed improvements and there is no difference between them. Therefore both can be used in chronic renal patients.

Effectiveness of conventional physical therapy and Pilates' method in functionality, respiratory muscle strength and ability to exercise in hospitalized chronic renal patients: A study protocol of a randomized controlled trial

Patients with chronic kidney disease can present compromised functional abilities, and hospitalization may further contribute to their health deterioration and loss of functional independence. To compare the effectiveness between Pilates Method and Conventional Physical Therapy in functionality, exercise capacity and respiratory muscle strength in hospitalized patients with chronic kidney disease. 56 patients will be randomized into Control (usual care) or Pilates groups. Functionality (Barthel Index), exercise capacity (Step Test) and respiratory muscle strength (Manovacuometry) will be evaluated during pre-intervention, after the 5th and 10th sessions or at discharge in both groups. The statistical analysis will be calculated using linear mixed models and based on intention-to-treat. The level of significance will be set at α = 5%. This study is the first to develop a Pilates protocol for hospitalized chronic renal failure patients and the results will provide additional treatment options for these patients and for physiotherapists.

FAST INdiCATE Trial Protocol. Clinical Efficacy of Functional Strength Training for Upper Limb Motor Recovery Early after Stroke: Neural Correlates and Prognostic Indicators

RationaleFunctional strength training in addition to conventional physical therapy could enhance upper limb recovery early after stroke more than movement performance therapy plus conventional physical therapy.AimsTo determine (a) the relative clinical efficacy of conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy for upper limb recovery; (b) the neural correlates of response to conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy; (c) whether any one or combination of baseline measures predict motor improvement in response to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy.DesignRandomized, controlled, observer-blind trial.StudyThe sample will consist of 288 participants with upper limb paresis resulting from a stroke that occurred within the previous 60 days. All will be allocated to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy. Functional strength training and movement performance therapy will be undertaken for up to 1·5 h/day, five-days/week for six-weeks.Outcomes and AnalysisMeasurements will be undertaken before randomization, six-weeks thereafter, and six-months after stroke. Primary efficacy outcome will be the Action Research Arm Test. Explanatory measurements will include voxel-wise estimates of brain activity during hand movement, brain white matter integrity (fractional anisotropy), and brain–muscle connectivity (e.g. latency of motor evoked potentials). The primary clinical efficacy analysis will compare treatment groups using a multilevel normal linear model adjusting for stratification variables and for which therapist administered the treatment. Effect of conventional physical therapy combined with functional strength training versus conventional physical therapy combined with movement performance therapy will be summarized using the adjusted mean difference and 95% confidence interval. To identify the neural correlates of improvement in both groups, we will investigate associations between change from baseline in clinical outcomes and each explanatory measure. To identify baseline measurements that independently predict motor improvement, we will develop a multiple regression model.

Acupuncture in Subacute Stroke: No Benefits Detected

There is debate concerning the effect of acupuncture on rehabilitation following stroke, with key reviews unable to find evidence of benefit. This lack of evidence may be due to poor study design, small sample size, and insufficient theoretical background. The present study was designed to determine whether acupuncture combined with conventional physical therapy improves motor function and activities of daily living in patients with subacute stroke compared with conventional physical therapy alone. A multicenter, single-blinded, randomized study was conducted. Four rehabilitation centers in the Jiangsu province of China participated in this study. One hundred eighty-eight patients with subacute stroke admitted to the hospital were randomized into an acupuncture group and a conventional rehabilitation group. A combination of body and scalp acupuncture was used for 3 months in the acupuncture group. All patients underwent conventional stroke rehabilitation. The Fugl-Meyer Assessment (FMA) and Barthel Index (BI) were performed at baseline and at 1, 3, and 6 months after inclusion in the study. No statistically significant differences were found at baseline between the groups. No statistically significant differences were found between the groups using the FMA motor scores and the BI scores at baseline or at 1, 3, or 6 months. Significant improvements were found in each group following treatment. In patients with subacute stroke, the addition of body and scalp acupuncture to a regimen of conventional physical therapy does not result in further improvement in either motor function or ADL beyond the effect of conventional physical therapy alone.

Physical therapy for airway clearance improves cardiac autonomic modulation in children with acute bronchiolitis

BackgroundThe effects of physical therapy on heart rate variability (HRV), especially in children, are still inconclusive. ObjectiveWe investigated the effects of conventional physical therapy (CPT) for airway clearance and nasotracheal suction on the HRV of pediatric patients with acute bronchiolitis. Method24 children were divided into two groups: control group (CG, n=12) without respiratory diseases and acute bronchiolitis group (BG, n=12). The heart rate was recorded in the BG at four different moments: basal recording (30 minutes), 5 minutes after the CPT (10 minutes), 5 minutes after nasotracheal suction (10 minutes), and 40 minutes after nasotracheal suction (30 minutes). The CG was subjected to the same protocol, except for nasotracheal suction. To assess the HRV, we used spectrum analysis, which decomposes the heart rate oscillations into frequency bands: low frequency (LF=0.04-0.15Hz), which corresponds mainly to sympathetic modulation; and high frequency (HF=0.15-1.2Hz), corresponding to vagal modulation. ResultsUnder baseline conditions, the BG showed higher values in LF oscillations, lower values in HF oscillations, and increased LF/HF ratio when compared to the CG. After CPT, the values for HRV in the BG were similar to those observed in the CG during basal recording. Five minutes after nasotracheal suction, the BG showed a decrease in LF and HF oscillations; however, after 40 minutes, the values were similar to those observed after application of CPT. ConclusionsThe CPT and nasotracheal suction, both used for airway clearance, promote improvement in autonomic modulation of HRV in children with acute bronchiolitis.

Effects of Conventional Physical Therapy and Functional Strength Training on Upper Limb Motor Recovery After Stroke: A Randomized Phase II Study

Background. Functional training and muscle strength training may improve upper limb motor recovery after stroke. Combining these as functional strength training (FST) might enhance the benefit, but it is unclear whether this is better than conventional physical therapy (CPT). Comparing FST with CPT is not straightforward. Objective. This study aimed at assessing the feasibility of conducting a phase III trial comparing CPT with FST for upper limb recovery. Methods. Randomized, observer-blind, phase II trial. Subjects had upper limb weakness within 3 months of anterior circulation infarction. Subjects were randomized to CPT (no extra therapy), CPT + CPT, and CPT + FST. Intervention lasted 6 weeks. Primary outcome measure was the Action Research Arm Test (ARAT). Measurements were taken before treatment began, after 6 weeks of intervention, and 12 weeks thereafter. Attrition rate was calculated and differences between groups were interpreted using descriptive statistics. ARAT data were used to inform a power calculation. Results. Thirty subjects were recruited (8% of people screened). Attrition rate was 6.7% at outcome and 40% at follow-up. At outcome the CPT + FST group showed the largest increase in ARAT score and this was above the clinically important level of 5.7 points. Median (interquartile range) increases were 11.5 (21.0) for CPT; 8.0 (13.3) for CPT + CPT; and 19.5 (22.0) for CPT + FST. The estimated sample size for an adequately powered subsequent phase III trial was 279 subjects at outcome. Conclusion. Further work toward a phase III clinical trial appears justifiable.