Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke

Well shit, treating only the good candidates. What the fuck are those survivors supposed to do that don't have voluntary finger extension? Like me. They didn't even try mCIMT on unfavorable finger extension candidates. They are not even trying to solve the hard survivor cases. You better fucking hope you have a small stroke because researchers obviously do not even try to solve the hard cases.

Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke

The EXPLICIT-Stroke Randomized Clinical Trial

1. Gert Kwakkel, PhD1,2
2. Caroline Winters, MSc1
3. Erwin E. H. van Wegen, PhD1⇑
4. Rinske H. M. Nijland, PhD2
5. Annette A. A. van Kuijk, MD, PhD3
6. Anne Visser-Meily, MD, PhD4
7. Jurriaan de Groot, PhD5
8. Erwin de Vlugt, PhD6
9. J. Hans Arendzen, MD, PhD5
10. Alexander C. H. Geurts, MD, PhD3
11. Carel G. M. Meskers, MD, PhD1
12. on behalf of the EXPLICIT-Stroke Consortium

1. ¹Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
2. ²Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
3. ³Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
4. ⁴Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
5. ⁵Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
6. ⁶Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands

1. Erwin E. H. van Wegen, PhD, Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Email: e.vanwegen@vumc.nl

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 < .05), but not after 26 weeks. We did not find statistically significant differences between mCIMT and usual care on impairment measures, such as the Fugl-Meyer assessment of the arm (FMA-UE). EMG-NMS did not result in significant differences. Conclusions. Three weeks of early mCIMT is superior to usual care in terms of regaining upper limb capacity in patients with a favorable prognosis; 3 weeks of EMG-NMS in patients with an unfavorable prognosis is not beneficial. Despite meaningful improvements in upper limb capacity, no evidence was found that the time-dependent neurological improvements early poststroke are significantly influenced by either mCIMT or EMG-NMS.