Background and Purpose: The upper extremity (UE) ipsilateral to the brain lesion is mildly affected poststroke. It is unclear whether patients perceive this, and the association between less-affected hand function and independence in activities of daily living (ADL) is unknown. We aimed to (1) assess longitudinal changes in function, dexterity, grip strength, and self-perception of the less-affected UE, (2) compare them to the normative data, and (3) determine the association of both UEs to ADL during the first 6 months poststroke. Methods: Consecutive adults following a first stroke were assessed on rehabilitation admission (T1), 6 weeks (T2), and 6 months (T3) poststroke onset. Box and block test assessed function of both UEs. The functional dexterity test (FDT) and Jamar Dynamometer assessed dexterity and grip strength of the less-affected UE. The functional independence measure assessed ADL, and instrumental ADL was assessed at T3. Spearman correlations and multiple regression models were used. Results: Participants were assessed at T1 (N=87), T2 (N=82), and T3 (N=68). At T1, less-affected UE deficits were apparent (median [interquartile range] box and block test-45 [35–53] blocks, FDT-44.5 [33.3–60.8] seconds, grip-25.5 [16.2–33.9] kilograms), but only 19.5% of the participants self-perceived this. Less-affected hand function significantly improved with 32% and 33% achieving a minimal clinically important difference for box and block test at T2 and T3, respectively. Dexterity improved significantly between T1 and T2 ( P <0.001, no established minimal clinically important difference) and grip strength improved significantly between T2 and T3; 3.4% achieving a minimal clinically important difference ( P <0.01). At T3, most participants did not reach the norms (box and block test-67.4 blocks, FDT-32.2 seconds, grip-40.5 kilograms). Both the less- and more-affected UEs explained a large portion of the variance of ADL at all time-points, after controlling for age, days-since-stroke-onset, stroke type, and cognition. Conclusions: Despite some improvement, the less-affected UE at 6 months poststroke remained below norms, explaining difficulties in ADL and instrumental ADL. Further research is needed.

Background The impact of hand dominance on the expected (motor and functional ability and daily use) improvement of the affected upper extremity (UE) in subacute stroke has not yet been investigated. Objectives To compare between the affected dominant and affected nondominant UE (1) on rehabilitation admission (T1) for motor and sensory abilities, functional ability, and daily use and (2) 6 weeks poststroke onset (T2) and the UE recovery between T1 and T2 regarding percent change, improvement effect size, and percent of participants achieving minimal clinical important difference (MCID). Methods Multicenter longitudinal study. Results Thirty-eight participants with affected dominant and 51 participants with affected nondominant UE were recruited. On T1 and T2, between-group differences were not seen for all UE variables. Significant improvement in the motor and functional ability, daily use, and perceived recovery between T1 and T2 were seen for the affected dominant ( z = −3.01 to −4.13, P < .01) and nondominant UEs ( z = −4.59 to −5.32, P < .01). Effect size improvement values were moderate and large in the affected dominant and nondominant UE (respectively). In addition, 14% to 40% of the participants in both UEs achieved MCID. Conclusions Significant and similar clinical meaningfulness in UE improvement can be expected during subacute rehabilitation; however, improvement magnitude and percent improvement is different for the UE domains of the affected dominant and the affected nondominant UEs. These findings highlight the distinct roles of the dominant and nondominant hands during bimanual daily activities, which can guide clinicians during stroke rehabilitation.

Stroke is a major cause of long‐term functional disability and requires physical rehabilitation. Due to population aging, the number of people post stroke is going to rise. Robotically neurorehabilitation has a great potential to improve outcome measurements. Error Augmentation training using a robotic interface is thought to promote motor recovery by enhancing proprioceptive feedback, which motivates and challenges patients to optimize their performance during training. Here, we investigated the effectiveness of robotic Error Augmentation training on motor recovery after a stroke, compared to standard robotic training in a null field. Post‐stroke patients were randomly assigned to one of two groups: a study group (n = 9) that was trained on a 3D robotic system applying Error Augmentation forces, and a control group (n = 7) that carried out the same protocol in null field conditions. The robotic rehabilitation intervention was applied in addition to the standard rehabilitation protocol of the rehabilitation center. Error Augmentation training increased clinical scores compared to standard robotic training by 266% on the Motor Assessment Scale, and 88% on the Fugl‐Meyer scale. The Motor Assessment Scale scores were significantly correlated with the Fugl‐Meyer scores (p = 0.03, r = 0.541). There were more movement errors on the initial trials of the game sequence using the DeXtreme robotic device with Error Augmentation compared to trials with no force field. This difference vanished however after 10 trials. Error Augmentation training decreased the number of movement units and jerkiness compared to the control treatment. There was a robust effect of magnifying the acceleration component of movement using EA on the smoothness of the movement. These findings suggest that EA training may enhance motor performance possibly through motor adaptation. Future study should include EMG to better elucidate the neural mechanisms involved in motor learning post CNS injury.

Error Augmentation training using a robotic interface is thought to promote motor recovery by enhancing proprioceptive feedback, which motivates and challenges patients to optimize their performance during training. Here, we investigated the effectiveness of robotic Error Augmentation training on motor recovery after a stroke, compared to standard robotic training in a null field. Post-stroke patients were randomly assigned to one of two groups: a study group (n=9) that was trained on a 3D robotic system applying Error Augmentation forces, and a control group (n=7) that carried out the same protocol in null field conditions. The robotic rehabilitation intervention was applied in addition to the standard rehabilitation protocol of the rehabilitation center. Error Augmentation training increased clinical scores compared to standard robotic training by 266% on the Motor Assessment Scale, and 88% on the Fugl-Meyer scale. The Motor Assessment Scale scores were significantly correlated with the Fugl-Meyer scores (p=0.03, r=0.541). There were more movement errors on the initial trials of the game sequence using the DeXtreme robotic device with Error Augmentation compared to trials with no force field. This difference vanished however after 10 trials. Error Augmentation training decreased the number of movement units and jerkiness compared to the control treatment. These findings suggest that Error Augmentation training may enhance motor performance possibly through motor adaptation.

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