Is the repetitive training of complex hand and arm movements beneficial for motor recovery in stroke patients?

Objective: To determine whether a repetitive training of complex movements of arm and hand contributes to functional recovery in stroke patients. Design: Prospective, longitudinal, multiple baseline design across individuals. Setting: Neurological rehabilitation centre. Subjects: Twenty-one patients with stroke in the middle cerebral artery territory. Interventions: Baseline phase: 'house-typical' occupational and physiotherapy; training phase: 'house-typical' therapy supplemented by repetitive training of (1) grasping and transport movements and (2) sawing movements of the affected arm over 10 minutes each, twice daily, five days per week. Main outcome measures: Rivermead Motor Assessment (RMA, arm section), grip strength, rapid isotonic hand extension, three-dimensional motion analysis. Results: Patients experienced a continuous functional improvement of the affected arm (RMA score from initial 4.9+/-2.1 to 8.0+/-4.6, p<0.001) and an increase of grip strength during the baseline and the training phase (from initial 102.4±43.3 N to 150.6±118.9 N, p<0.05). Movement analysis revealed a trend to a more precise movement execution. The repetitive training of complex movements did not result in an additional benefit. Conclusion: The repetitive training of complex movements does not further enhance the functional recovery of the affected arm and hand in stroke patients compared with functionally based occupational and physiotherapy.