Effects of unilateral upper limb training in two distinct prognostic groups early after stroke

The EXPLICIT-stroke randomized clinical trial

Journal article (2016)

Authors

Gert Kwakkel Amsterdam Rehabilitation Research Center Reade
Caroline Winters Amsterdam UMC
Carel G M Meskers 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 Center Utrecht
Jurriaan De Groot Leiden University Medical Center
E. de Vlugt Biomechatronics & Human-Machine Control - Mechanical, Maritime and Materials Engineering
J. Hans Arendzen Leiden University Medical Center
Alexander C.H. Geurts Radboud Universiteit Nijmegen
Research Group
Biomechatronics & Human-Machine Control (Mechanical, Maritime and Materials Engineering) (TU Delft)
Upper limb Stroke Constraint-induced movement therapy (CIMT) Electromyography-triggered neuromuscular stimulation (EMG-NMS) Randomized controlled trial (RCT)
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Published Date

2016

Language

English

Reuse Rights

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Faculty

Mechanical, Maritime and Materials Engineering

Department

Biomechanical Engineering

Research Group

Biomechatronics & Human-Machine Control

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