Computerized Arm Training Improves the Motor Control of the Severely Affected Arm After Stroke A Single-Blinded Randomized Trial in Two Centers

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 (Fugl–Meyer Motor Score [FM, 0 to 66] <18), 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 baselin...