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Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia. A detailed study was carried out of recovery of arm function after acute stroke, and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning. In a single-blind randomised trial, 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups. At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength, range and speed of movement. This effect seemed concentrated amongst those who had a milder initial impairment. More work is needed to discover the reasons for this improved recovery, and whether further development of this therapeutic approach might offer clinically significant gains for some patients.first three months after stroke appeared to lead to better recovery of the range of active movement in the arm and leg. However, the patient groups in this study were

Patients and methods PATIENTSNinety seven (73%) of the 132 patients who had been in the treatment trial were reassessed close to one year after stroke (mean time since stroke 52 (SD4) weeks; range 39-64). Death or further major strokes were the most common reasons for drop out. There were 48 patients who had received enhanced therapy (22 women, 26 men; 21 left sided weakness, 27 right; mean age 66 (SD1 1) years), and 49 who had received conventional therapy (27 women, 22 men; 23 left sided weakness, 26 right; mean age 69 (SD9) years). As at the earlier assessments, the groups were similar at one year in their functional independence as assessed by the Barthel activities of daily living scale (enhanced therapy group mean 17 (SD3); conventional therapy group mean 17 (SD3)). ASSESSMENT METHODSThe tests of arm function were the same as reported previously. 1-3 These were (a) Range and strength of active movement (extended motricity index and motor club assessments) (b) motor skills (nine-hole peg test and Frenchay arm test). Also, there was clinical assessment of resistance and pain on passive movement of the arm.

Previous comparisons of constructional apraxia after right and left hemisphere damage have not investigated the influence of time since onset. This paper reports some preliminary findings from stroke patients in a physical rehabilitation trial. Fifty-five patients with right hemisphere damage and 65 with left hemisphere damage were assessed on the WAIS-R Block Design test at 1 month and 6 months post stroke. The groups were similar at 1 month but the left hemisphere group showed better average recovery by 6 months. There was great variability in amount of recovery within the left hemisphere group, suggesting individual differences in initial reasons for failing Block Design, and corresponding differences in the recovery process. Compensation by the right hemisphere is discussed as one possible process. Future detailed longitudinal studies may be useful in contrasting the cognitive deficits which underlie constructional apraxia after right-sided and left-sided lesions, and would provide evidence on mechanisms of recovery and adaptation.