Effects of Bimanual Functional Practice Training versus Unimanual Functional Practice Training on Functional Performance of Upper Extremity in Chronic Stroke

ABSTRACT

Objective- To compare the effects of bimanual functional practice training versus unimanual functional practice training on functional performance of upper extremity in chronic stroke.

Design:-Pre-test and Post test design.

Setting: - Inpatient and rehabilitation hospital.

Participants: - Patients were randomized to receive bimanual functional practice (n=15) or unimanual functional practice training (n-=15) at 3-4 months post-stroke onset.

Intervention:- Supervised bimanual or unimanual practice training for 25 minutes on 5 days week over 2 weeks using a standardized program.

Main Outcome Measures: - Upper extremity outcomes were assessed by Graded Wolf-Motor Function Test (GWMFT) and Fugl-Meyer scale (F.M.S).

Results: - No significant differences were found between the group on any measure (GWMFT-MPT.p=0.75 & GWMFT-FAS. P=0.31 & FMS-p=0.43). But within the group there were significant changes in mean performance time (Bimanual group-p=0.002 & Unimanual group-p=0.029) and there were significant difference found in functional ability scale (GWMFT-FAS Bimanual group p=0.00 & Unimanual group p=0.00), similarly, there were significant changes in Fugl-Meyer score (Bimanual group- p=0.00 & Unimanual group-p=0.00)  

Conclusion- This study suggest that 20 minutes a day of bilateral training of functionally related tasks is no more effective than unilateral training for upper limb functional recovery in chronic stroke patients, regardless of the initial severity of the impairment. Furthermore, for recovery of functional motor performance, unimanual training appears less beneficial than bimanual practices. Several other studies have found benefits of bimanual training: therefore, this approach can be accepted as an upper limb intervention in stroke on the basis of finding this study. The study does not suggest the training characteristics, such as the nature of the tasks and strength of inter limb coupling required for effects, may influenced outcomes: therefore future work should examine the optimal timing, dose and training tasks that might optimize the already known facilitatory effects of interlimb coupling.

Keywords: Motor performance, stroke, uni-manual, bi-manual