The effect of voluntary trunk rotation and half-field eye-patching for patients with unilateral neglect in stroke: a randomized controlled trial. Single blind randomized controlled trial of visual feedback after stroke: effects on stance symmetry and function. Constraint-induced movement therapy during early stroke rehabilitation. Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial. Recovery from disability after stroke as a target for a behavioural intervention: results of a randomized controlled trial. Randomised trial of a computer-generated tailored written education package for patients following stroke. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial. Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy. Two approaches to treating unilateral neglect after right hemisphere stroke: a preliminary investigation.
To investigate the effectiveness of voluntary trunk rotation and half-field eye-patching to treat patients with unilateral neglect in stroke.
                Pre-post, day 60 follow-up, single-blinded randomized controlled trial.
                Single-centre inpatient rehabilitation hospital.
                Sixty subacute patients with right hemisphere stroke having unilateral neglect within eight weeks post stroke consented to participate between November 2003 and July 2005. They were randomly assigned to three comparison groups.
                Nineteen patients received daily experimental training in voluntary trunk rotation (TR) for 1 hour five times a week for 30 days. Twenty patients received the same kind of treatment together with half-field eye-patching (TR + EP). Fifteen patients in the control group received conventional training with the same contact time.
                Patients were assessed on days 0, 30 and 60 using the Behavioural Inattention Test, the Clock Drawing Test, and the Functional Independence Measure.
                No significant differences between voluntary trunk rotation (TR), voluntary trunk rotation and half-field eye-patching (TR + EP) and controls were found in functional performance and neglect measures at day 30 (P = 0.042-0.994) and follow-up (P = 0.052-0.911) at P = 0.005 using Bonferroni correction.
                The results of this study do not support the use of voluntary trunk rotation alone or with half-field eye-patching to improve functional performance or reduce unilateral neglect in subacute patients with stroke. A number of before and after and single case design studies of visual feedback have shown improvements in stance symmetry after stroke, an associated improvement in function has been demonstrated. This study examines this promising technique further using a single-blind controlled trial. Twenty-six patients were recruited from a register of consecutive admissions and randomized into treatment and control groups. Both groups received additional therapy, only the treatment group received visual feedback. Assessments were carried out independently. Significant improvements were seen in the treatment group in measures of stance symmetry and sway and motor and ADL function. Between group differences had disappeared at three months. The results indicate that feedback training incorporated into functional physiotherapy treatment can improve stance symmetry and sway. Transfer of training was indicated by improvements in ADL and gross motor function. Three months later the improvement was maintained, but did not automatically continue without treatment. Limited data are available about the effectiveness of early rehabilitation after stroke.
                This is the 1st randomized controlled trial of constraint-induced movement therapy (CIMT) in subacute stroke to investigate neurophysiologic mechanisms and long-term outcome.
                Within 2 weeks after stroke, 23 patients with upper extremity (UE) weakness were randomized to 2 weeks of CIMT or traditional therapy at an equal frequency of up to 3 h/day. Motor function of the affected UE was blindly assessed before treatment, after treatment, and 3 months after stroke. Transcranial magnetic stimulation (TMS) measured the cortical area evoking movement of the affected hand.
                Long-term improvement in motor function of the affected UE did not differ significantly between patients who received CIMT versus intensive traditional therapy. All outcome comparisons showed trends favoring CIMT over intensive traditional therapy, but none was statistically significant except for improvements in the Fugl-Meyer (FM) UE motor scale immediately following treatment and in reported quality of hand function at 3 months. Improvement in UE motor function on the FM was associated with a greater number of sites on the affected cerebral hemisphere where responses of the affected hand were evoked by TMS.
                Future trials of CIMT during early stroke rehabilitation need greater statistical power, more inclusive eligibility criteria, and improved experimental control over treatment intensity. The relationship between changes in motor function and in evoked motor responses suggests that motor recovery during the 1st 3 months after stroke is associated with increased motor excitability of the affected cerebral hemisphere. To determine efficacy of a modified constraint-induced movement therapy (mCIMT) protocol for patients with chronic stroke.
                Multiple-baseline, pre-post, single-blinded randomized controlled trial.
                Outpatient clinic.
                Seventeen patients who experienced stroke more than 1 year before study entry and who had upper-limb hemiparesis and learned nonuse.
                Seven patients participated in structured therapy sessions emphasizing more affected arm use in valued activities, 3 times a week for 10 weeks. Their less affected arms were also restrained 5d/wk for 5 hours (mCIMT). Four patients received regular therapy with similar contact time to mCIMT. Six patients received no therapy (control).
                The Fugl-Meyer Assessment of Motor Recovery (FMA), Action Research Arm (ARA) Test, and Motor Activity Log (MAL).
                The mCIMT patients exhibited greater motor changes on the FMA and ARA (18.4, 11.4) than regular therapy (6.0, 7.1) or control (-2.9, -4.5). Statistical analyses showed significant differences in motor improvement on the FMA (F(2,12)=11.2, P=.002) and the ARA (F(2,12)=14.0, P=.001). Post hoc analyses showed that, when pretreatment motor differences are controlled, mCIMT resulted in substantially higher posttreatment FMA and ARA scores. Amount and quality of arm use, measured by the MAL, improved only in mCIMT patients.
                mCIMT may be an efficacious method of improving function and use of the more affected arms of chronic stroke patients. Findings further affirm that repeated, task-specific practice is critical to reacquisition of function, whereas practice schedule intensity is less critical. Disability following stroke is highly prevalent and is predicted by psychological variables such as control cognitions and emotions, in addition to clinical variables. This study evaluated the effectiveness of a workbook-based intervention, designed to change cognitions about control, in improving outcomes for patients and their carers.
                At discharge, stroke patients were randomly allocated (with their carers) to a 5-week intervention (n = 103) or control (normal care: n = 100). The main outcome (at 6 months) was recovery from disability using a performance measure, with distress and satisfaction as additional outcomes.
                The intervention group showed significantly better disability recovery, allowing for initial levels of disability, than those in the control group, F(1,201) = 5.61, p = 0.019. Groups did not differ in distress or satisfaction with care for patients or carers. The only psychological process variable improved by the intervention was Confidence in Recovery but this did not mediate the effects on recovery.
                A large proportion of intervention participants did not complete the workbook tasks. This was perhaps associated with the fairly low level of personal contact with workbook providers. The modest success of this intervention suggests that it may be possible to develop effective behavioural interventions to enhance recovery from disability in stroke patients. The ideal method of providing stroke patients with information has not been established.
                To evaluate the effectiveness of providing stroke patients with computer-generated tailored written information.
                Randomised controlled trial with blinded assessor.
                Acute stroke unit.
                138 stroke patients.
                Patients were randomised to receive either computer-generated tailored written information about stroke or generic written information while in hospital. Three months following discharge, a blinded assessor evaluated the outcomes of knowledge about stroke, self-efficacy (Self-Efficacy to Perform Self-Management Behaviours Scale), anxiety and depression (Hospital Anxiety and Depression (HAD) Scale), perceived health status (COOP charts), satisfaction with content and presentation of the written information received (separate 10-point visual analogue scale for content and presentation), and desire for additional information.
                Complete data were obtained for 133 (96.4%) patients. Patients in the intervention group were significantly more satisfied with the content (difference on a 10-point visual analogue scale was 1, 95% confidence interval 0.4 to 1.7, P = 0.003) and presentation (difference on a 10-point visual analogue scale was 1.2, 95% confidence interval 0.6 to 1.9, P < 0.001). Significantly, fewer patients in the intervention group desired additional information about stroke at follow-up than patients in the control group (4.5% versus 32.8%; P < 0.001). Anxiety change scores improved slightly more in favour of the control group (1.4 difference on the HAD subscale, 95% confidence interval 0.2 to 2.8, P = 0.03). No significant differences between the groups were observed for any of the other outcome measures.
                Providing stroke patients with computer-generated tailored written information improved satisfaction with the information that was received and was more effective in meeting patients' informational needs than non-tailored information, but had no effect on knowledge about stroke, self-efficacy, depression, or perceived health status. Bobath based (BB) and movement science based (MSB) physiotherapy interventions are widely used for patients after stroke. There is little evidence to suggest which is most effective. This single-blind randomised controlled trial evaluated the effect of these treatments on movement abilities and functional independence.
                A total of 120 patients admitted to a stroke rehabilitation ward were randomised into two treatment groups to receive either BB or MSB treatment. Primary outcome measures were the Rivermead Motor Assessment and the Motor Assessment Scale. Secondary measures assessed functional independence, walking speed, arm function, muscle tone, and sensation. Measures were performed by a blinded assessor at baseline, and then at 1, 3, and 6 months after baseline. Analysis of serial measurements was performed to compare outcomes between the groups by calculating the area under the curve (AUC) and inserting AUC values into Mann-Whitney U tests.
                Comparison between groups showed no significant difference for any outcome measures. Significance values for the Rivermead Motor Assessment ranged from p = 0.23 to p = 0.97 and for the Motor Assessment Scale from p = 0.29 to p = 0.87.
                There were no significant differences in movement abilities or functional independence between patients receiving a BB or an MSB intervention. Therefore the study did not show that one approach was more effective than the other in the treatment of stroke patients. This randomized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness. There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements. Imagining hand movements could stimulate restitution and redistribution of brain activity, which accompanies recovery of hand function, thus resulting in a reduced motor deficit. Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to methodological limitations. This randomized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke (on average <3 months post-stroke). Randomization was performed using an automated statistical minimizing procedure. The primary outcome measure was a blinded rating on the Action Research Arm test. The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week, compared to 31 patients who performed equally intensive non-motor mental rehearsal, and 32 patients receiving normal care without additional training. No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test (ANCOVA statistical P=0.77, and effect size partial η2=0.005) or any of the secondary outcome measures. Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke. In light of the evidence, it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right. This preliminary study assessed the efficacy of two treatment methods for persistent unilateral or hemispatial neglect following right hemisphere stroke.
                Two patients received an intervention focusing on the underlying impairment of attention during visual scanning. Two other participants received an intervention that provided repetitive practice during a functional task of oral reading. Standardized tests of attention and neglect were administered before and after treatment. Performance on a functional task assessing generalization of treatment was probed at every session.
                Results indicate no clear conclusions regarding the efficacy of either approach. Factors contributing to these equivocal findings are addressed.
There is insufficient evidence to reach conclusions about the effectiveness of interventions for patients with eye movement disorders after stroke. High quality research in the form of well-designed randomised trials are urgently required.