Effects of unilateral upper limb training in two distinct prognostic groups early after stroke
The EXPLICIT-stroke randomized clinical trial
Gert Kwakkel (Amsterdam Rehabilitation Research Center Reade)
Caroline Winters (Amsterdam UMC)
Erwin E H Van Wegen (Amsterdam UMC)
Rinske H M Nijland (Amsterdam Rehabilitation Research Center Reade)
Annette A A Van Kuijk (Radboud Universiteit Nijmegen)
Anne Visser-Meily ( University Medical Centre Utrecht)
Jurriaan De Groot (Leiden University Medical Center)
Erwin De Vlugt (TU Delft - Mechanical Engineering)
J. Hans Arendzen (Leiden University Medical Center)
Alexander C H Geurts (Radboud Universiteit Nijmegen)
Carel G M Meskers (Amsterdam UMC)
More Info
expand_more
Abstract
Background and Objective. Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered neuromuscular stimulation (EMG-NMS) on upper limb capacity early poststroke. Methods. A total of 159 ischemic stroke patients were included: 58 patients with a favorable prognosis (>10° of FE) were randomly allocated to 3 weeks of mCIMT or usual care only; 101 patients with an unfavorable prognosis were allocated to 3-week EMG-NMS or usual care only. Both interventions started within 14 days poststroke, lasted up until 5 weeks, focused at preservation or return of FE. Results. Upper limb capacity was measured with the Action Research Arm Test (ARAT), assessed weekly within the first 5 weeks poststroke and at postassessments at 8, 12, and 26 weeks. Clinically relevant differences in ARAT in favor of mCIMT were found after 5, 8, and 12 weeks poststroke (respectively, 6, 7, and 7 points; P