Effects Of Bilateral Arm Training Research Articles

The Effect of Bilateral Arm Training on Daily Activity in Stroke Patients

Stroke patients frequently experience weakness and even paralysis in certain body parts, which can make daily chores more challenging. Therefore, we need interventions that can increase the daily activity of stroke patients so that they can carry out their daily activities successfully. This study aimed to determine the effect of bilateral arm training on daily activity in stroke patients. This study used a quasi-experimental approach with a two-group pretest-posttest design. There were 38 respondents, with 19 in each group. After conducting the pretest, respondents in the intervention group were given bilateral arm training for two weeks, and after the posttest, the control group was given this training as well. The Barthel Index questionnaire was used to assess the activity level of stroke patients in this study. The paired t-test and independent t-test were utilized for statistical analysis. The intervention group’s daily activity levels increased, as measured by the mean score, which increased from 62.89 to 68.16 (p = 0.009). The scores in the control group remained constant from before to after the intervention periods, ranging between 40 and 80 with a mean of 60.00. The independent t-test showed a significant difference in the post-test scores between the two groups (p = 0.040). It can be concluded that bilateral arm training can improve daily activity in stroke patients. Additionally, this intervention can be performed in a hospital setting and nurses can teach the patient, family, and caregiver as part of discharge planning.
 Keywords: activity daily living, bilateral arm training, stroke

EFFICACY OF BILATERAL ARM TRAINING ON UPPER LIMB MOTOR FUNCTION IN STROKE PATIENTS

Background of the study: Stroke is the leading cause of adult disability. Stroke patients experience a significant change in motor function. Perceived loss of hand function has been reported as a major problem in approximately 65% of patients with stroke. Motor dysfunction of upper extremity which indeed affects functional performance of daily life is an outcome of stroke. So restriction of motor function is highly relevant for stroke patients to make them functionally independent. Stroke rehabilitation needs to concentrate on retraining techniques which are simple, affordable and effective. Objectives of the study: The objective of the study is to find the effects of bilateral arm training in the management of upper limb motor function in stroke patients.

The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review.

To systematically review the modulatory effects of bilateral arm training (BAT) on the brain of stroke patients in contrast to unilateral arm training (UAT) or regular motor training. We conducted a literature search using PubMed, EMBASE, MEDLINE, and Science Citation Index Expanded databases from the inception to March 2019 for identifying any relevant studies. Two authors independently screened the literature, extracted data, and qualitatively described the included studies. Eleven studies with a total of 225 stroke patients were included in this review. 156 out of those participants received neuroimaging or neurophysiological examinations. Six studies reported enhanced activation of the ipsilesional primary motor area (M1) induced by BAT, as measured by MEP and fMRI. Beyond the M1, three studies showed that supplementary motor area (SMA) was activated, and three studies found the primary sensory cortex area (S1) was activated by BAT in stroke patients, as measured by fMRI. One article showed that the inter-/intra-hemispheric functional connections of the sensorimotor network were more highly strengthened after BAT than regular motor training, in particular the functional connectivity between the SMA and the M1 in the bi-hemispheres. Three studies reported that BAT increased the inhibitory flow from the ipsilesional hemisphere to the contralesional hemisphere, as measured by interhemispheric transcallosal inhibition (IHI). However, the superiority of BAT in inducing a symmetric IHI than UAT was controversial. BAT is potentially more effective than UAT in improving upper limb recovery after stroke by activating the ipsilesional primary motor area (M1), supplementary motor area (SMA), and primary sensory cortex (S1) and enhancing the intra-hemispheric and interhemispheric connectivity within the sensorimotor network and the cortical motor system.

Effects of bilateral arm training on upper extremity function in right and left hemispheric stroke.

This experimental study on 24 stroke patients aimed at evaluating and comparing the effects of bilateral arm training on upper extremity (UE) motor function between right and left hemispheric chronic stroke patients. Both groups received the same intervention involving 5 functional tasks for 1 hour, 3 days per week, for a total of 6 weeks. Fugl-Meyer Assessment-Upper Extremity and Wolf-Motor Function Test were applied as outcome measures at baseline and after 6 weeks of training to assess the recovery of function in the affected area. Intra-group analysis showed no significant improvement in the wrist and hand function in the left hemispheric stroke (LHS) (p>0.05), while right hemispheric stroke (RHS) patients did not improve significantly in the coordination/speed domain (p>0.05). Inter-group analysis showed no significant difference between right and left hemispheric stroke patients (p>0.05). Bilateral arm training showed beneficial effects in improving UE function in both RHS and LHS patients. Distal UE function in LHS and coordination and speed of movement in RHS patients did not show any significant improvement.

Kronik İnmeli Hastalarda Ritmik İşitsel Uyarı İle Bilateral Kol Eğitim Tedavisinin Üst Ekstremite Fonksiyonlarına ve Günlük Yaşam Aktivitelerine Etkisinin Araştırılması

Amaç: Bu çalışma ile kronik inmeli hastalarda uygulanan ritmik işitsel uyarı ile bilateral kol eğitiminin (RİUBKE) üst ekstremite fonksiyonları, günlük yaşam aktivitelerine katılım ve ağrı üzerine etkilerinin incelenmesi amaçlanmıştır. Yöntem: Randomize kontrollü bu çalışmaya 28 hasta dahil edildi. Hastalar RİUBKE (n=15) ve kontrol (n=13) olarak iki gruba ayrıldı. Tüm hastaların demografik verileri, Brunnstrom evreleri, Modifiye Ashworth Skalası (MAS) ve ağrı düzeyleri kaydedildi. Hastaların tümü 3 hafta süreyle konvansiyonel terapi programına alındı. Ek olarak RİUBKE grubundaki hastalara, RİUBKE cihazı ile haftanın 5 günü 3 hafta süreyle bilateral üst ekstremite eğitimi uygulandı. Plejik üst ekstremite motor fonksiyonları Jebsen Taylor El Fonksiyon Testi (JTEFT) ve Box and Block Test (BBT) ile, günlük yaşam aktiviteleri Modifiye Barthel İndeks (MBİ) ile, ağrı düzeyleri Görsel Analog Skala (GAS) ile Tüm değerlendirmeler tedavi öncesi ve tedaviden 3 hafta sonra değerlendirildi. Tüm veriler Mann Whitney U testi ve Wilcoxon testi kullanılarak analiz edildi. Bulgular: BBT ve JTEFT’in bazı parametrelerinde (sayfa çevirme, büyük ağır obje kaldırma ve tavla pulu dizme) (p<0,05, tüm parametreler) gelişme kaydedildi. MBİ ve GAS parametrelerinde istatiksel olarak anlamlı fark saptanmadı (p>0,05). Sonuç: RİUBKE ile üst ekstremite bilateral eğitiminin kronik inmeli hastalarda üst ekstremite fonksiyonları üzerine etkili olduğu kanaatine varıldı. Alınan bu sonuçlar inme rehabilitasyonunda RİUBKE ile bilateral eğitimin konvansiyonel tedavilerle birlikte kullanılabileceğini düşündürmektedir.

A Study to Compare The Effects of Unilateral Arm Training Versus Bilateral Arm Training in Post-Stroke Patients with Motor Impairment of Hand

Background of The Study: Motor function deficits are life changing and devastating consequences ofstroke9. It affects the patient’s mobility, daily life activities, participation in society. The most commonmanifestation of upper extremity motor impairment includes muscle weakness, changes in the tone andimpaired motor control. Both unilateral and bilateral arm training found to be an effective strategy for therecovery of upper limb motor function after stroke.Aim of The Study: The aim of the study is to compare the effects of unilateral arm training versus bilateralarm training in post-stroke patients with motor impairment of hand.Objective Of The Study:Ø To assess the effects of unilateral arm training in post-stroke patients with motor impairment of hand.Ø To assess the effects of bilateral arm training in post-stroke patients with motor impairment of hand.Ø To compare the effects of unilateral arm training versus bilateral arm training in poststroke patients withmotor impairment of hand.Method: 30 post stroke patients were recruited for the study based on the inclusion criteria and were dividedinto group A and group B consisting of 15 subjects each. Group A were treated with unilateral arm trainingand Group-B were treated with bilateral arm training. Pretest and posttest scores assessment was done.Result: It showed significant improvement in functional ability of the upper limb as measured by ARATand CAHAI-13. The p value of both the group is <0.05. This study showed that Group-B subjects whowere treated with Bilateral arm training proved to be more effective than Group-A who were treated withunilateral arm training in post stroke patients with motor impairment of hand.Conclusion: This study showed that bilateral arm training is more effective than unilateral arm training inimproving the overall motor function of hand in post stroke individuals.

Stroke upper extremity rehabilitation: Effect of bilateral arm training

OBJECTIVES: The main objective of this study is to investigate the effect of bilateral arm training on upper extremity motor and functional recovery in stroke hemiparesis. METHODOLOGY: Twenty-eight patients with chronic stroke, attending the Department of Occupational Therapy, National Institute for the locomotor disabilities, Kolkata, West Bengal, India, participated in a single-blinded randomized pretest and posttest control group experimental study. Patients were randomized over two intervention groups; experimental group received bilateral arm training (n = 14) and the control group received an equally intensive conventional treatment program (n = 14). Each group received intensive training for 1 h/day, 5 days/week, and for 6 weeks. Pretreatment and posttreatment measurements were taken for upper extremity motor ability, functional ability, and functional use of the upper extremity using Fugl-Meyer Assessment of Physical performance (FMA-upper extremity section), Action Research Arm Test, and Motor Activity Log, respectively. RESULTS: Bilateral arm training (P = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (P = 0.33). The bilateral arm training group also had greater improvements in FMA and Motor Activity Log score compared to conventional therapy group. CONCLUSION: Bilateral arm training can be used as a better treatment choice for improving upper extremity function in comparison to conventional therapy.

Error-augmented bimanual therapy for stroke survivors.

Stroke recovery studies have shown the efficacy of bimanual training on upper limb functional recovery and others have shown the efficacy of feedback technology that augments error. In a double-blinded randomized controlled study (N = 26), we evaluated the short-term effects of bilateral arm training to foster functional recovery of a hemiparetic arm, with half of our subjects unknowingly also receiving error augmentation (where errors were visually and haptically enhanced by a robot). Twenty-six individuals with chronic stroke were randomly assigned to practice an equivalent amount of bimanual reaching either with or without error augmentation. Participants were instructed to coordinate both arms while reaching to two targets (one for each arm) in three 45-minute treatments per week for two weeks, with a follow-up visit after one week without treatment. Subjects' 2-week gains in Fugl-Meyer score averaged 2.92, and we also observed improvements Wolf Motor Functional Ability Scale average 0.21, and Motor Activity Log of 0.58 for quantity and 0.63 for quality of life scores. The extra benefit of error augmentation over the three weeks became apparent in Fugl-Meyer score only after removing an outlier from consideration. This modest advantage of error augmentation was detectable over a short interval encouraging further research in interactive self-rehabilitation systems that can enhance error motor recovery.

S185 The effect of bilateral arm training on motor areas excitability in chronic stroke patients

Objectives Physical therapy exercises that do not enhance motor areas neuroplasticity lead to motor impairment especially at the upper extremity (UE) in the chronic stroke patients. The aim of this study was to assess the effect of using bilateral arm training on motor areas excitability (neuroplasticity) in the chronic stroke patients. Methods Thirty male chronic stroke patients with moderate impairment of UE were assigned into two equal groups. The changes of motor areas excitability (neuroplasticity) were assessed before and after arm training by spectral analysis of mapping electroencephalogram (EEG). Delta, theta, alpha, beta 1 and beta 2 waves were recorded. The equation which was used to detect the neural plasticity and the changing at motor areas excitability was dividing the fast wave/slow waves or detecting the ratio of mean frequency of (beta 2 + beta 1 + alpha/theta + delta). Results Patients in group 1 (G1) received unilateral arm training and patients in group 2 (G2) received bilateral arm training. The Results: Showed significant increase in the excitability (neuroplasticity) at (F4 + F8) and (C4) motor areas in G2 comparing to G1 (p!9 .006) and (p!9 .036 ) respectively. Discussion Bimanual training leads to activation of extensive networks in both hemispheres. Conclusions It was concluded that bilateral arm training is a recommended method to enhance the motor areas excitability (neuroplasticity) in the chronic stroke patients. Significance Post stroke physical therapy can make use of bimanual training for better rehabilitation.

Bilateral arm training and cortical reorganization in cerebral infarction: A functional MRI study

Objective To study the effect of bilateral arm training on cortical reorganization in cerebral infarction patients using blood oxygen level-dependent functional MRI (BOLD-fMRI). Methods Fourteen cerebral infarction subjects with moderate to severe upper limb impairment participated in this randomized and single-blinded training study. Subjects in the bilateral arm training group (n=7) practiced bilateral symmetrical or opposite activities, while the control group (n=7) performed conventional, mainly unilateral, arm training. Those in both groups received fMRI scans before and after the training with passive elbow movement as the task in the imaging. Results Both groups had significant improvements in their average scores on the Fugl-Meyer upper extremity assessment and in their modified Barthel index scores after the treatment, and there were no significant differences between the two groups. Brain activation had increased in both groups after the treatment, especially in the bilateral training group. After the treatment, the first motor area (M1), the first somatosensory area and the supplementary motor area on both sides were activated in the bilateral training group. Moreover, for patients in the bilateral training group with injuries of moderate severity, the M1 of the opposite side tended to be activated, while for those more severely injured the same side had a tendency to be activated. Conclusion Convalescing subcortical infarction patients with moderate to severe upper limb impairment benefit from bilateral arm training in terms of motor activity and performing activities in daily life. It may be related to the normalization of inhibition between the hemispheres of the bilateral cerebral cortex and the reconnection of ipsilateral corticospinal pathways. Key words: Cerebral infarction; Bilateral arm training; Neural plasticity; Magnetic resonance imaging

The effect of repetitive bilateral arm training with rhythmic auditory cueing on motor performance and central motor changes in patients with chronic stroke

The aim of this study was to compare the effects of bilateral arm training with auditory cueing (BATRAC) versus control intervention on motor performance of the upper extremity (UE) and to explore the central neurophysiological mechanism underlying this effect in moderately impaired chronic stroke patients. This was a randomized-controlled clinical trial. Overall, 76 chronic stroke patients (mean age = 50.2 ± 6.2 years), 6–67 months after the onset of the first stroke were enrolled. They received either BATRAC (with both UE trained simultaneously in symmetric and asymmetric patterns) or control intervention (unilateral therapeutic exercises for the paretic UE). Each session lasted for 1 h, scheduled as three sessions/week (on an alternate day) for 8 successive weeks. Outcome measures included the Fugl-Meyer motor performance test for the UE (FMUE) and percutaneous transcranial magnetic stimulation to elicit motor-evoked potential (MEP) in paretic abductor pollicis brevis muscle. Group comparisons indicated a significantly better improvement in the MEP parameters (transcranial magnetic stimulation threshold, central motor conduction time, and MEP amplitude) in the BATRAC group. The FMUE scores increased in both groups, but there was no significant difference between groups in the FMUE scores. These findings recommend the use of BATRAC in chronic stroke patients not only to improve motor performance but also to induce central neurophysiological effects.

The Effects of Bilateral Arm Training on Reaching Performance and Activities of Daily Living of Stroke Patients

The Effects of Bilateral Arm Training on Reaching Performance and Activities of Daily Living of Stroke Patients

Combined Transcranial Direct Current Stimulation and Robot-Assisted Arm Training in Subacute Stroke Patients

Background. No rehabilitation intervention has effectively improved functional use of the arm and hand in patients with severe upper limb paresis after stroke. Pilot studies suggest the potential for transcranial direct current stimulation and bilateral robotic training to enhance gains. Objective. In a double-blind, randomized trial the combination of these interventions was tested. Methods. This study randomized 96 patients with an ischemic supratentorial lesion of 3 to 8 weeks’ duration with severe impairment of motor control with a Fugl-Meyer score (FMS) for the upper limb <18 into 3 groups. For 6 weeks, group A received anodal stimulation of the lesioned hemisphere, group B received cathodal stimulation of the nonlesioned side for 20 minutes at 2.0 mA, and group C received sham stimulation. The electrodes were placed over the hand area and above the contralateral orbit. Contemporaneously, the subjects practiced 400 repetitions each of 2 different bilateral movements on a robotic assistive device. Results. The groups were matched at onset. The FMS improved in all patients at 6 weeks (P < .001). No between-group differences were found; initial versus finish FMS scores were 7.8 ± 3.8 versus 19.1 ± 14.4 in group A, 7.9 ± 3.4 versus 18.8 ± 10.5 in group B, and 8.2 ± 4.4 versus 19.2 ± 15.0 in group C. No significant changes between groups were present at 3 months. Conclusions. Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness. Unilateral hand training and upregulation of the nonlesioned hemisphere might also be tried in this population.

Bilateral movement training and stroke motor recovery progress: A structured review and meta-analysis

The purpose was to conduct a structured review and meta-analysis to determine the cumulative effect of bilateral arm training on motor capabilities post stroke. Forty-eight stroke studies were selected from three databases with 25 comparisons qualifying for inclusion in our meta-analysis. We identified and coded four types of bilateral arm interventions with 366 stroke patients. A random effects model using the standardized mean difference technique determined a large and significant effect size (0.734; SE = 0.125), high fail-safe N (532), and medium variability in the studies ( I 2 = 63%). Moderator variable analysis on the type of bilateral training revealed two large and significant effects: (a) BATRAC (0.842; SE = 0.155) and (b) coupled bilateral and EMG-triggered neuromuscular stimulation (1.142; SE = 0.176). These novel findings provide strong evidence supporting bilateral arm training with the caveat that two coupled protocols, rhythmic alternating movements and active stimulation, are most effective.

The Effects of Bilateral Arm Training on Motor Control and Functional Performance in Chronic Stroke: A Randomized Controlled Study

Background. Most studies of bilateral arm training (BAT) did not employ a randomized controlled trial design and involved very limited functional training tasks. Objective . Compare the effects of BAT with control intervention (CI) on motor control and motor performance of the upper extremity and also functional gains in patients with chronic stroke. Methods. This 2-group randomized controlled trial with pretreatment and posttreatment measures enrolled 33 stroke patients (mean age = 53.85 years) 6 to 67 months after onset of a first stroke. They received either a BAT program concentrating on both upper extremities moving simultaneously in functional tasks by symmetric patterns or CI (control treatment) for 2 hours on weekdays for 3 weeks. Outcome measures included kinematic analyses assessing motor control strategies for unilateral and bimanual reaching and clinical measures involving the Fugl-Meyer Assessment (FMA) of motor-impairment severity and the Functional Independence Measure (FIM) and the Motor Activity Log (MAL) evaluating functional ability. Results. After treatment, the BAT group showed better temporal and spatial efficiency during unilateral and bilateral tasks and less online error correction only during the bilateral task than the control group. The BAT group showed a significantly greater improvement in the FMA than the control group but not in the FIM and MAL. Conclusions. Relative to CI, BAT improved the spatiotemporal control of the affected arm in both bilateral and unilateral tasks, decreased online corrections to perform bilateral tasks, and reduced motor impairment. These findings support the use of BAT to improve motor control and motor function of the affected upper limb in stroke patients.

Fine motor control in adults with and without chronic hemiparesis: baseline comparison to nondisabled adults and effects of bilateral arm training

McCombe Waller S, Whitall J. Fine motor control in adults with and without chronic hemiparesis: baseline comparison to nondisabled adults and effects of bilateral arm training. Arch Phys Med Rehabil 2004;85:1076–83. Objectives To characterize fine motor control through finger tapping in both arms of 10 patients with chronic stroke, to make baseline comparisons with matched controls, and to examine the responsiveness of deficits seen in stroke patients after 6 weeks of bilateral arm-based training. Design Nonrandomized controlled, cohort before-after trial. Setting Research institution. Participants Ten people from the community with chronic unilateral ischemic stroke and 10 age- and sex-matched healthy controls. Participants with hemiparesis had completed all conventional care and were more than 6 month poststroke. Inclusion criteria were at least 6 months since a unilateral stroke, ability to follow simple instructions and 2-step commands, volitional control of the nonparetic arm, and at least minimal antigravity movement in the shoulder of the paretic arm. Interventions Not applicable. Main outcome measures Measurements included rate and timing consistency of unilateral tapping at a preferred and a maximal rate and the accuracy and stability of interlimb coordination in bilateral simultaneous (inphase) and alternating (antiphase) tapping at a preferred rate. Results Nonparetic finger control was similar to that of the nondisabled participants except under bilateral conditions, where it was less consistent. A subgroup with residual paretic finger function, had slower and less consistent paretic finger tapping, as well as less accurate and more variable interlimb coordination; however, basic bilateral coupling relationships were preserved. Bilateral arm-based training improved bilateral nonparetic consistency but slowed unilateral preferred tapping. Training also improved paretic fine motor control in 2 of 4 participants with mild stroke severity. The 2 responders, with dominant hemisphere lesions, indicated a possible recovery advantage with bilateral training for such lesions. Conclusions In general, nonparetic finger control for tapping was preserved but paretic finger control was compromised. Disruption of nonparetic control of tapping, particularly consistency of tapping, occurred during bilateral tapping tasks but was responsive to 6 weeks of bilateral arm-based training. Despite the apparent lack of training specificity, the generalizable effects of bilateral arm training to fine motor interlimb coordination may reflect central motor control mechanisms for upper-extremity coordination, which may be accessed and may influence the recovery of arm function after stroke.