THE EFFECT OF BILATERAL TRAINING AND IMPACT OF TYPE AND DOSE ON UPPER LIMB IN (SUB)ACUTE STROKE: A META-ANALYSIS

D. Justine1, T. Lisa Tedesco1, A. Amanzonwé2, K. Oyéné1, S. Annemie1
1Uhasselt, Hasselt, Belgium, 2Hasselt, Hasselt, Belgium

Background: Integrating high dosage bilateral movements to improve upper limb (UL) recovery after stroke, is a rehabilitation strategy that could potentially improve bimanual activities.

Purpose: to compare the effectiveness of bilateral and unilateral UL training in the (sub)acute stroke and to evaluate the influence of the best recovery factors.

Methods: Five electronic databases (MEDLINE/PubMed, Scopus, PEDro, ScienceDirect, Web of Science) were used. Randomized controlled trials comparing the effect of bilateral training to unilateral training in stroke survivors (<6 months poststroke) were included. Primary measures were impairment and activities. The methodological quality of selected papers was assessed. A meta-analysis was conducted.

Results: The systematic review included 14 studies involving 706 participants. Bilateral UL training yielded a significant UL impairment improvement of standard mean difference (Fugl Meyer Assessment-Upper Extremity score; (SMD 0.48; 95% CI: 0.08-0.88; P=0.02), and in functional independence (SMD= 0.45; 95% CI -0.13 - 0.78; P=0.006). In subgroup analysis, bilateral training resulted in a more beneficial effect on UL impairment in the group with a higher dose (SMD=0.64; 95%CI 0.08 to 1.20; P=0.03) and “no motor capacity” (SMD=0.66; 95%CI 0.16 to 1.15; P=0.009). No significant difference on UL activities was found but regarding type, bimanual training seems to give better results.

Conclusions: Bilateral UL training was superior to unilateral training in improving impairments and functional independence in (sub)acute stroke. The optimal effect of bilateral training on the UL may depend on a higher dose and the severity of paresis in the early stroke. Due to bilateral training and performing bimanual tasks, use of bimanual outcome measures is needed.

Implications:
  • Bilateral training promotes recovery of impairment in the (sub)acute phase of stroke, especially a high dose and in persons with no motor capacity
  • Bimanual training and training without technical assistance tends to have better improvement on UL activities of daily living over unilateral training
  • Bimanual outcome measures should be used to measure the effect on activities

Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Keywords:
Stroke
Bilateral training
Upper lim rehabilitation

Topics:
Neurology: stroke


Did this work require ethics approval? No
Reason: Because our study is a systematic review and meta-analysis

All authors, affiliations and abstracts have been published as submitted.

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