Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness. Unilateral hand training and upregulation of the nonlesioned hemisphere might also be tried in this population.

Treadmill training offers the advantages of task-oriented training with numerous repetitions of a supervised gait pattern. It proved powerful in gait restoration of nonambulatory patients with chronic hemiparesis. Treadmill training could therefore become an adjunctive tool to regain walking ability in a shorter period of time.

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Repetitive locomotor training with an electromechanical gait trainer may improve gait velocity, endurance, spatiotemporal, and kinematic gait parameters in patients with cerebral palsy.

Background and Purpose-To compare a computerized arm trainer (AT), allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle, and electromyography-initiated electrical stimulation (ES) of the paretic wrist extensor in severely affected subacute stroke patients. Method-A total of 44 patients, 4 to 8 weeks after stroke causing severe arm paresis 0 to 66] Ͻ18), were randomly assigned to either AT or ES. All patients practiced 20 minutes every workday for 6 weeks.AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session. The primary outcome measure was the blindly assessed FM (0 to 66), and the secondary measures were the upper limb muscle power (Medical Research Council [MRC] sum, 0 to 45) and muscle tone (Ashworth score sum, 0 to 25), assessed at the beginning and end of treatment and at 3-month follow-up. Results-The AT group had a higher Barthel Index score at baseline, but the groups were otherwise homogenous. As expected, FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group. The initial Barthel Index score had no influence. In the robot AT group, FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group. MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group. Muscle tone remained unchanged, and no side effects occurred. Conclusion-The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients. This is probably attributable to the greater number of repetitions and the bilateral approach. Key Words: rehabilitation Ⅲ stroke E ach year, Ͼ1 million patients experience a stroke in the European community, and Ϸ30% of the survivors experience a severe upper limb paresis without volitional distal activity. 1 Their prognosis for regaining functional hand activity 6 months later is very poor. 2 More Bobath therapy does not improve outcome, 3 and the patients do not meet the criteria for entering active training programs. 4 Electromyography (EMG) biofeedback 5 and treatment on a rocking chair 6 showed positive effects on upper limb motor control for this subgroup of severely affected patients.Robots are a new treatment option. The MIT-Manus 7 and the MIME robots 8 work on shoulder-elbow movement, and randomized studies have shown a positive effect on motor power of the affected shoulder and elbow muscles, although motor control improved to a lesser extent. 9,10 The Bi-Manu-Track robotic arm trainer (AT) works on more distal arm movements, practicing bilateral elbow prosupination and wrist flexion-extension. 11 In chronic patients, a 4-week training program reduced wrist and finger spasticity.The present trial studied the effect of the Bi-Manu-Track on subacute stroke patients experiencing severe arm paresis. The control group received electrical muscle stimulation (E...

Intensive locomotor training plus physiotherapy resulted in a significantly better gait ability and daily living competence in subacute stroke patients compared with physiotherapy alone.

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Technical possibilities are one aspect, but multi-centre trials and a consideration of the unsubstantiated fears among therapists of being replaced by machines will decide on the successful implementation of this most promising field to the benefit of patients.