Bilateral movement training and stroke motor recovery progress: A structured review and meta-analysis

The purpose was to conduct a structured review and meta-analysis to determine the cumulative effect of bilateral arm training on motor capabilities post stroke. Forty-eight stroke studies were selected from three databases with 25 comparisons qualifying for inclusion in our meta-analysis. We identified and coded four types of bilateral arm interventions with 366 stroke patients. A random effects model using the standardized mean difference technique determined a large and significant effect size (0.734; SE = 0.125), high fail-safe N (532), and medium variability in the studies (12 = 63%). Moderator variable analysis on the type of bilateral training revealed two large and significant effects: (a) BATRAC (0.842; SE = 0.155) and (b) coupled bilateral and EMG-triggered neuromuscular stimulation (1.142; SE = 0.176). These novel findings provide strong evidence supporting bilateral arm training with the caveat that two coupled protocols, rhythmic alternating movements and active stimulation, are most effective. (C) 2009 Elsevier B.V. All rights reserved.