Upper-limb Activity Research Articles

Upper Limb Robotic Rehabilitation After Stroke: A Multicenter, Randomized Clinical Trial.

After stroke, only 12% of survivors obtain complete upper limb (UL) functional recovery, while in 30% to 60% UL deficits persist. Despite the complexity of the UL, prior robot-mediated therapy research has used only one robot in comparisons to conventional therapy. We evaluated the efficacy of robotic UL treatment using a set of 4 devices, compared with conventional therapy. In a multicenter, randomized controlled trial, 247 subjects with subacute stroke were assigned either to robotic (using a set of 4 devices) or to conventional treatment, each consisting of 30 sessions. Subjects were evaluated before and after treatment, with follow-up assessment after 3 months. The primary outcome measure was change from baseline in the Fugl-Meyer Assessment (FMA) score. Secondary outcome measures were selected to assess motor function, activities, and participation. One hundred ninety subjects completed the posttreatment assessment, with a subset (n = 122) returning for follow-up evaluation. Mean FMA score improvement in the robotic group was 8.50 (confidence interval: 6.82 to 10.17), versus 8.57 (confidence interval: 6.97 to 10.18) in the conventional group, with no significant between-groups difference (adjusted mean difference -0.08, P = 0.948). Both groups also had similar change in secondary measures, except for the Motricity Index, with better results for the robotic group (adjusted mean difference 4.42, P = 0.037). At follow-up, subjects continued to improve with no between-groups differences. Robotic treatment using a set of 4 devices significantly improved UL motor function, activities, and participation in subjects with subacute stroke to the same extent as a similar amount of conventional therapy. Video Abstract is available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A291).

Prompting affected arm use in the real-world by measuring upper limb activity with 3-axis accelerometry:

Prompting affected arm use in the real-world by measuring upper limb activity with 3-axis accelerometry:

Facilitating Upper Limb Function using Assistive Technology in a Neurological Patient with Bilateral Upper Limb Impairment: A Case Report

Purpose: A combination of a stroke and spinal cord injury adversely affecting both upper limbs is an unusual combination for a patient presenting for outpatient rehabilitation services. Although the management of these conditions in isolation is well documented, there is limited literature regarding rehabilitation for these conditions in combination, particularly the use of assistive technology in this setting. Methods: A case report is presented of a 53-year-old male referred for outpatient rehabilitation following a left-sided stroke, with resultant dense right sided hemiplegia. A pre-existing spinal cord injury had affected his left upper limb such that he had marked proximal weakness. This combination of impairments meant he was unable to perform even basic activities of daily living involving the upper limbs. A therapy program, led by an occupational therapist with support and input from the multi-disciplinary team, included the use of an assistive device (a mobile arm support) to facilitate functional upper limb activities. This greatly improved his ability to do upper limb functional activities. Conclusion: The use of an assistive device enabled the patient to engage in meaningful activities of daily living involving the upper limbs.

Effects of virtual reality combined with balance training on upper limb function, balance, and activities of daily living in persons with acute stroke: a preliminary study

Effects of virtual reality combined with balance training on upper limb function, balance, and activities of daily living in persons with acute stroke: a preliminary study

Effects of Virtual Rehabilitation and Constraint Induced Movement Therapy on Brain Derived Neurotrophic Factor Mediated Motor Improvement in Stroke Patients

Objectives: To carry out a comparison between serum BDNF levels as well as enhancement in upper limb motor function in terms of gross movement, pinch, grip, primary grasp, pre and post intervention in the study and control groups. Study design And Setting: It was a Randomized Control Study conducted from March 2015 to March 2016 at Holy Family Hospital Rawalpindi in collaboration with the Multidisciplinary research laboratory at Islamic International Medical College, Rawalpindi. Methodology: In this study; forty stroke patients were randomly designated to either the study group or the control group. Upper limb activity capability which was quantified by Action Research Arm Test (ARAT) and serum Brain Derived Neurotrophic Factor (BDNF) was measured in both control and study group. The control group underwent traditional upper limb physiotherapy for 16 sessions. The study group underwent Constraint Induced Movement Therapy for the upper limb in combination with the use of motion capture video gaming technology for 16 sessions each of twenty minutes duration. Before and after completion of intervention sessions; ARAT and serum BDNF were measured and compared in both control and study groups. Results: Serum BDNF levels was significantly improved in study group as compare to control group (p<0.001). ARAT showed significant improvement in study group participants as compare to control groups (p<0.001). Conclusion: Virtual rehabilitation was an efficacious method for Neuroplastic enhancement in stroke patients

Extra upper limb practice after stroke: a feasibility study

BackgroundThere is a need to provide a large amount of extra practice on top of usual rehabilitation to adults after stroke. The purpose of this study was to determine if it is feasible to add extra upper limb practice to usual inpatient rehabilitation and whether it is likely to improve upper limb activity and grip strength.MethodA prospective, single-group, pre- and post-test study was carried out. Twenty adults with upper limb activity limitations who had some movement in the upper limb completed an extra hour of upper limb practice, 6 days per week for 4 weeks. Feasibility was measured by examining recruitment, intervention (adherence, efficiency, acceptability, safety) and measurement. Clinical outcomes were upper limb activity (Box and Block Test, Nine-Hole Peg Test) and grip strength (dynamometry) measured at baseline (week 0) and end of intervention (week 4).ResultsOf the 212 people who were screened, 42 (20%) were eligible and 20 (9%) were enrolled. Of the 20 participants, 12 (60%) completed the 4-week program; 7 (35%) were discharged early, and 1 (5%) withdrew. Participants attended 342 (85%) of the possible 403 sessions and practiced for 324 (95%) of the total 342 h. In terms of safety, there were no study-related adverse events. Participants increased 0.29 blocks/s (95% CI 0.19 to 0.39) on the Box and Block Test, 0.20 pegs/s (95% CI 0.10 to 0.30) on the Nine-Hole Peg Test, and 4.4 kg (95% CI 2.9 to 5.9) in grip strength, from baseline to end of intervention.ConclusionsIt appears feasible for adults who are undergoing inpatient rehabilitation and have some upper limb movement after stroke to undertake an hour of extra upper limb practice. The magnitude of the clinical outcomes suggests that further investigation is warranted and this study provides useful information for the design of a phase II randomized trial.Trial registrationAustralian and New Zealand Clinical Trial Registry (ACTRN12615000665538).

Action observation training for rehabilitation in brain injuries: a systematic review and meta-analysis

BackgroundTo systematically review and analyse the effects of Action Observation Training on adults and children with brain damage.MethodsSeven electronic databases (Cochrane, EBSCO, Embase, Eric, PubMed, Scopus and Web of Science) were searched up to 16 September 2018 to select Randomized Controlled Trials focused on adults and children with brain damage that included AOT training on upper and/or lower limb carried out for at least 1 week. Identification of studies and data extraction was conducted with two reviewers working independently. Oxford Centre for Evidence-based Medicine (March2009) – Levels of Evidence and Physiotherapy Evidence Database scale were used to grade studies. The data collected from the articles were analysed using software R, version 3.4.3. Hedge’s g values were calculated and effect size estimates were pooled across studies. Separate meta-analyses were carried out for each ICF domain (i.e. body function and activity) for upper and lower limb.ResultsOut of the 210 records identified after removing duplicates, 22 were selected for systematic review and 19 were included in the meta-analysis. Thirteen studies included in the meta-analysis focused on upper limb rehabilitation (4 in children and 9 in adults) and 6 on lower limb rehabilitation (only studies in adults). A total of 626 patients were included in the meta-analysis. An overall statistically significant effect size was found for upper limb body function (0.44, 95% CI: [0.24, 0.64], p < 0.001) and upper limb activity domain (0.47, 95% CI: [0.30, 0.64], p < 0.001). For lower limb, only the activity domain was analysed, revealing a statistically significant overall effect size (0.56, 95% CI: [0.28, 0.84], p < 0.001).ConclusionsAction Observation Training (AOT) is an innovative rehabilitation tool for individuals with brain damage, which shows promising results in improving the activity domain for upper and lower limbs, and also the body function domain for the upper limb. However, the examined studies lack uniformity and further well-designed, larger controlled trials are necessary to determine the most suitable type of AOT particularly in children.Systematic review registrationCRD42019119600.

The Impact of Tennis and Golfer's Elbow on Shoulder External Rotators and Abductors' Peak Torque.

Upper limb activities require a repetitive movement of the shoulder external rotator and abductor muscles. The malfunction of the proximal part of the upper limb kinetic chain tends to change the mechanics of the distal part and increase the risk of injuries. To compare the normalized eccentric peak torque (NEPT) of the shoulder external rotator and abductor muscles among healthy athletes and those with tennis elbow and golfer's elbow. An experimental cross-sectional study. Isokinetic laboratory, Faculty of Physical Therapy, Cairo University. A total of 30 male athletes participated voluntarily in this study. Participants were distributed into 3 groups: healthy group, tennis elbow group, and golfer's elbow group. NEPT of shoulder abductors and external rotators. The Biodex Isokinetic Dynamometer was used to measure the variables of interest. There was a significant increase in the NEPT of shoulder abductors and external rotators in healthy control group compared with both tennis elbow and golfer's elbow groups at an angular velocity of 60°/s (P < .05). Moreover, there was a significant increase in the NEPT of shoulder external rotators and abductors at an angular velocity of 120°/s in healthy control group compared with tennis elbow group and in golfer's elbow group compared with tennis elbow group (P < .05). Tennis elbow and golfer's elbow are associated with decreased NEPT of shoulder external rotators and abductors compared with those of healthy athletes. This tends to decrease the external stability of the shoulder joint and put high stress on the distal joints of the upper kinetic chain.

Constraint-Induced Movement Therapy in multiple sclerosis: Safety and three-dimensional kinematic analysis of upper limb activity. A randomized single-blind pilot study.

There are few evidences on safety of Constraint-Induced Movement Therapy (CIMT), as well as its effects in neurological conditions, including multiple sclerosis (MS). To evaluate safety and effectiveness of a 2-week CIMT protocol on upper limb activity of progressive MS patients through a three-dimensional (3D) kinematic analysis. In this randomized single-blind pilot study, we randomly allocated patients affected by progressive MS reporting a reduced use of one upper limb into two different groups: CIMT group (less affected limb blocked by a splint) and control group (undergoing bi-manual treatment). Primary outcome was CIMT safety. Furthermore, we assessed CIMT effects through clinical outcomes (hand grip strength, HGS, and 9 Hole Peg Test, 9HPT) and 3D kinematic analysis (normalized jerk, number of movement units, going phase duration, mean velocity, endpoint error). All evaluations were performed at baseline (T0) and after 2 weeks of treatment (T1) for both arms in both groups. Ten MS patients, mean aged 51.0±7.7 years, were randomly allocated in the 2 groups. After treatment, no differences were found in the blocked arm. Furthermore, CIMT group showed significant improvements in clinical and kinematic parameters. CIMT might be considered a safe and effective technique in MS patients.

Acute Effects of the 6-Minute Pegboard and Ring Test in COPD.

There are few reports in the literature supporting the understanding of the physiological mechanisms of intolerance in patients with COPD to perform unsupported upper limb activities. The aims of this study were to quantify the electrical activity and oxygenation of inspiratory and upper limb muscles, and to investigate whether electromyographic manifestations of muscle fatigue are related to upper limb function as assessed by the 6-min pegboard and ring test (6PBRT) in subjects with COPD and in healthy subjects. Thirty subjects with COPD (FEV1 42.1 ± 16.4% predicted; 68.0 ± 7.6 y old) comprised the COPD group, and 34 healthy subjects (66.8 ± 8.0 y old) comprised the control group. Both groups were assessed for body composition with dual-energy radiograph absorptiometry and spirometry. The 6PBRT was performed with simultaneous assessment of electromyography, near-infrared spectroscopy, and gas analyses (expiratory minute volume). Differences were observed between groups for performance (number of rings) in the 6PBRT, with the COPD group achieving lower values than the control group (P < .001). The ventilatory demand (expiratory minute volume/maximum voluntary ventilation) and root mean square amplitude of the sternocleidomastoid muscle were higher in the COPD group than in the control group (P < .04). Lower values for oxyhemoglobin and total hemoglobin were found in intercostal muscles of the COPD group compared to the control group. The root mean square amplitude of the intercostal muscles was lower in the COPD group, while it was similar between groups for anterior deltoid and trapezius muscles. Median frequency of anterior deltoid muscles presented a decreased in both groups. Our results indicate that the 6PBRT was performed at a higher electrical activity in the accessory inspiratory muscles, such as the sternocleidomastoid muscle, and a lower oxygenation profile in the intercostal muscles in subjects with COPD compared with healthy controls, but without muscle fatigue signs. These findings suggest that the higher ventilatory demand presented in subjects with COPD could have contributed to the worse performance in this group without signals of peripheral muscle limitation.

Preliminary Examination of the Ability of a New Wearable Device to Capture Functional Hand Activity After Stroke.

Background and Purpose- A reliable measure of movement repetitions is required to assist in determining the optimal dose for maximizing upper limb recovery after stroke. This study investigated the ability of a new wearable device to capture reach-to-grasp repetitions in individuals with stroke. Methods- Eight individuals with stroke wore an instrumented wrist bracelet while completing 12 upper limb activities. Participants completed 5 and 10 repetitions of each activity on 2 separate sessions (time 1 and time 2) and completed clinical assessments (Fugl-Meyer Upper Extremity Assessment and Action Research Arm Test). Mean reach-to-grasp counts (ie, hand counts) were compared across activities. Scaling properties were assessed by the ratio of 10 repetitions to 5 repetitions for the activities (ie, expected value of 2). Bland-Altman diagrams were used to examine agreement between time 1 and time 2 counts. Results- The wrist bracelet averaged 0 to 0.6 hand counts per repetition for the arm-only and hand-only activities and averaged 1 to 2 counts per repetition of the reach-to-grasp activities. The mean ratio of 10 repetition to 5 repetition counts was ≈2 for all of the reach-to-grasp activities. Mean differences from time 1 to time 2 were <0.3 counts/repetition for all activities except one. Conclusions- These preliminary results provide evidence that the wrist bracelet is able to capture hand counts over a variety of tasks in a consistent manner. This wrist bracelet could be further developed as a tool to record dose of upper limb practice for research or clinical practice, as well as providing motivation and accountability to patients participating in treatments requiring upper limb movement repetitions. Currently, there are limitations in interpreting the impact of impairment and common compensatory movements on hand counts, and it would be valuable for future studies to explore these effects.

Upper limb activity of twenty myoelectric prosthesis users and twenty healthy anatomically intact adults

The upper limb activity of twenty unilateral upper limb myoelectric prosthesis users and twenty anatomically intact adults were recorded over a 7-day period using two wrist worn accelerometers (Actigraph, LLC). This dataset reflects the real-world activities of the participants during their normal day-to-day routines. Participants included students, working adults, and retirees recruited from across the United Kingdom. This dataset offers a potential wealth of knowledge into a poorly understood cohort. The raw unprocessed data files and the activity count data exported from the Actilife software are provided. We also provide a non-wear algorithm developed for the removal of prosthesis non-wear periods and resulting activity count data corresponding to prothesis wear periods. Finally, we have included the transposed activity diaries provided by the participants. Analysis to date has primarily involved assessment of the symmetry of upper limb activity, however, there is potential to undertake additional analysis such as understanding the differences in the way a prosthesis is used compared to an anatomical arm.

A systematic review of the application and psychometric properties of the graded Wolf Motor Function Test

Introduction Adapted from the Wolf Motor Function Test, the graded Wolf Motor Function Test is an upper limb activity assessment for use following stroke and brain injury. The aim of this systematic review was to identify and appraise evidence where the test has been used or has undergone psychometric evaluation. Method A systematic review of five databases was conducted to identify studies reporting the graded Wolf Motor Function Test using a keyword search. Intervention and clinical measurement studies were eligible for inclusion. Data quality was assessed using the adapted Critical Appraisal Skills Programme questions and the Consensus-based Standards for the Selection of Health Measurement Instruments Risk of Bias checklist. Results Twelve studies, of mostly low quality, were included. Studies included one randomised controlled trial, 10 pre- and post-studies and one clinical measurement study. All studies involved participants following stroke. Reliability was the only measurement property assessed in two studies, which were of a ‘doubtful’ and ‘poor’ quality. Conclusion Low quality studies impede the ability of clinicians and researchers to best determine the applicability of the graded Wolf Motor Function Test to patient groups and research contexts. Further exploration of the psychometric properties of the graded Wolf Motor Function Test is recommended across stroke populations using rigorous design methods.

Reference Values for Glittre Activities of the Daily Living Test in Healthy Subjects Among Indian Population- A Cross-Sectional Study

Background: The Glittre ADL test was done to assess the functional capacity of patients with COPD. 6 MWT was used to check for functional capacity, but there was a limitation of upper limb work or activities other than walking. Objective: To develop reference equations for Glittre ADL test on the basis of anthropometric and demographic variables in healthy individual among Indian population. Methods: This cross-sectional study was conducted with 423 healthy participants of either gender between 20-70 years. Participants were divided into 5 groups based on age. Each participant underwent anthropometric assessment &amp; two glitter ADL tests. Two out of the best performance out of two was considered and the minimum time spend was taken. Results: The mean time spent by males in different age groups was 20-30 years 3.18±0.56, 30-40 years 3.36±0.17, 40-50 years 3.46±0.18, 50-60 years 3.53±0.15, 60-70 years 4.02±0.27.For females in different age groups the mean time was 20-30 years 3.31±0.14, 30-40 years 3.41±0.13, 40-50 years 3.48±0.13, 50-60 years 3.75±0.28, 60-70 years 4.30±0.19. Equation 1 : Glittre ADL-test predicted =3.399+(0.018×age years)+(-0.004×height cm), Equation 2 : Glittre ADL-test predicted =2.805+(-0.002× BMI)+(0.018×age year). Conclusion: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, height as independent variables and can be useful for predicting the performance of adult individuals.

Quantifying Real-World Upper-Limb Activity Via Patient-Initiated Movement After Nerve Reconstruction for Upper Brachial Plexus Injury

A critical concept in brachial plexus reconstruction is the accurate assessment of functional outcomes. The current standard for motor outcome assessment is clinician-elicited, outpatient clinic-based, serial evaluation of range of motion and muscle power. However, discrepancies exist between such clinical measurements and actual patient-initiated use. We employed emerging technology in the form of accelerometry-based motion detectors to quantify real-world arm use after brachial plexus surgery. To evaluate (1) the ability of accelerometry-based motion detectors to assess functional outcome and (2) the real-world arm use of patients after nerve transfer for brachial plexus injury, through a pilot study. Five male patients who underwent nerve transfer after brachial plexus injury wore bilateral motion detectors for 7 d. The patients also underwent range-of-motion evaluation and completed multiple patient-reported outcome surveys. The average age of the recruits was 41 yr (±17 yr), and the average time from operation was 2 yr (±1 yr). The VT (time of use ratio) for the affected side compared to the unaffected side was 0.73 (±0.27), and the VM (magnitude ratio) was 0.63 (±0.59). VT strongly and positively correlated with shoulder flexion and shoulder abduction: 0.97 (P=.008) and 0.99 (P=.002), respectively. Accelerometry-based activity monitors can successfully assess real-world functional outcomes after brachial plexus reconstruction. This pilot study demonstrates that patients after nerve transfer are utilizing their affected limbs significantly in daily activities and that recovery of shoulder function is critical.

Análise qualitativa do efeito da terapia por contensão induzida em crianças com paralisia cerebral

This study describes the results of four children with hemiparetic cerebral palsy, age between four and eleven years (6.50± 3.32) who had performed a Constraint-induced Movement Therapy (CIMT) protocol. The purpose was to analyze qualitatively the effects of the CIMT protocol on the use of the affected upper limb. The protocol was performed for three weeks, with restriction of the nonaffected upper limb and functional activities were performed with the transfer of gains during treatment to the real environment. A qualitativeanalysis of the upper limb movement was performed through the Quality of Upper Skills Test (QUEST) scale and the assessment of distal adjustments. Improvements on the QUEST scale score and on the distal adjustments were observed in all four participants after the training protocol. The constraint-induced movement therapy may be an effective intervention aiming to improve the quality of the upper limb movement in children with hemiparetic cerebral palsy.

A systematic review of upper limb activity measures for 5- to 18-year-old children with bilateral cerebral palsy.

To investigate measurement properties and feasibility of upper limb activity measures in children aged 5-18years with bilateral cerebral palsy (CP). Five electronic databases were searched to identify measures of upper limb activity with published psychometric data for children with bilateral CP aged 5-18years. Measures included both Patient-Reported Outcome Measures (PROMs) and observational measures. The COnsensus-based Standards for selection of health Measurement Instruments checklist was used to evaluate methodological quality of studies for each measure. Forty-eight measures were identified, eight of which met inclusion criteria for reliability and validity. Four PROMs were included: the ABILHAND-Kids and Children's Arm Rehabilitation Measure are parent questionnaires measuring overall manual ability; the ACTIVLIM-CP is a parent questionnaire measuring global activity (upper and lower extremity) performance, and, the Pediatric Upper Limb Measure, Short Form is a child self-report questionnaire. Four observational measures were included: the Both Hands Assessment (BoHA) is an observational measure of bimanual activity performance; the Melbourne Assessment of Unilateral Upper Limb Function and the Melbourne Assessment 2 measure quality of movement of each upper limb separately, and the Peabody Developmental Motor Scales-Second Edition assesses fine motor skill capacity in young children. Based upon available evidence, the most suitable PROM for evaluation of upper limb activity in children with bilateral CP is the ACTIVLIM-CP, and the most suitable observational measure is the BoHA. Selection of upper limb measures depend on clinical information required and available resources. The BoHA is the only observational-based assessment which measures bimanual upper limb activity performance in children with bilateral CP. Recommendation for future measurement studies include familiarisation with the standards required for excellence, which include adequate sample size and content validity studies for PROMs.

Effects of Mental Imagery Training Combined With Electromyogram-Triggered Neuromuscular Electrical Stimulation on Patients With Chronic Stroke

Abstract Date Presented 04/05/19 Mental imagery training combined with EMG-NMES (MIT EMG-NMES) and EMG-NMES are beneficial to improving upper-limb motor function and activities of daily living in patients with chronic stroke. These findings indicate that the choice of the intervention depends on the patient’s condition. In case of MIT EMG-NMES, patients should be able to imagine the movement of the affected body, especially through performance memory, and have a certain level of cognitive function. Primary Author and Speaker: Jin-Hyuck Park

End-point kinematics using virtual reality explaining upper limb impairment and activity capacity in stroke

BackgroundFor evaluation of upper limb impairment and activity capacity, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) are recommended to be included in stroke trials. To improve the understanding of mechanisms of motor recovery, and differentiate between restitution and compensation, kinematic analysis is also recommended for assessment of upper limb function after stroke.AimTo determine the extent to which end-point kinematic variables obtained from the target-to-target pointing task were associated with upper limb impairment or activity limitation as assessed by traditional clinical scales in individuals with stroke.MethodsSixty-four individuals, from acute stage up to one year after stroke, were included from the Stroke Arm Longitudinal study at the University of Gothenburg (SALGOT) cohort. They performed a target-to-target pointing task in a virtual environment using a haptic stylus which also captured the kinematic parameters. Multiple linear regression was done to determine the amount of variance explained by kinematic variables on FMA-UE and ARAT scores after controlling for confounding variables.ResultsMean velocity and number of velocity peaks explained 11 and 9% of the FMA-UE score uniquely and 16% when taken together. Movement time and number of velocity peaks explained 13 and 10% of the ARAT score respectively.ConclusionThe kinematic variables of movement time, velocity and smoothness explain only a part of the variance captured by using clinical observational scales, reinforcing the importance of multi-level assessment using both kinematic analysis and clinical scales in upper limb evaluation after stroke.Trial registrationThe trial was registered with register number NCT01115348 at clinicaltrials.gov, on May 4, 2010. URL: https://clinicaltrials.gov/ct2/show/NCT01115348.

A physical activity program is no more effective than standard care at maintaining upper limb activity in community-dwelling people with stroke: secondary outcomes from a randomized trial

Objective: To evaluate whether an 18-month, physical activity coaching program is more effective than standard care in terms of upper-limb activity. Design: A prospective, randomized controlled trial. Setting: Three municipalities in Norway. Population: A total of 380 persons with stroke. Intervention: The intervention group received follow-up visits and coaching on physical activity and exercise each month for 18 months after inclusion, by a physiotherapist. The control group received standard care. Main measures: The primary outcome, in this secondary analysis, was Motor Assessment Scale items 6, 7, and 8. Secondary outcomes were National Institute of Health Stroke Scale item 5, the Stroke Impact Scale domain 7, and the Modified Ashworth Scale in flexion/extension of the elbow. Results: In total, 380 persons with stroke were recruited, with mean (SD) age 72 (11) years, and baseline scores total National Institute of Health Stroke Scale was 1.4 (2.2)/1.6 (2.4) and Motor Assessment Scale items 6, 7 and 8 in the intervention/control group was 5.5 (1.2)/5.5 (1.2), 5.4 (1.4)/5.4 (1.3), and 3.6 (2)/3.5 (2), respectively. There was no significant difference between groups in terms of upper limb function in any of the Motor Assessment Scale items. In this population with minor stroke, upper-limb activity was good at three months post-stroke (74% of the maximum) and remained good 18 months later (77% of maximum). Conclusion: After intervention, there was no difference between the groups in terms of upper-limb activity.