Repetitive training of complex hand and arm movements with shaping is beneficial for motor improvement in patients after stroke.

OBJECTIVE Repetitive training of simple upper limb movements is effective in stroke rehabilitation. For the repetitive training of complex movements, however, results are inconsistent. The aim of this study was to determine whether repetitive training of complex upper limb movements, focussing on strength and velocity as shaping elements, is effective in stroke rehabilitation. DESIGN Longitudinal study, A-B-A design. PATIENTS Fifteen first-ever stroke patients. METHODS Phases (A): "house-typical" therapy and repetitive training of: (i) grasping and transport movements; and (ii) sawing movements of the affected arm with shaping elements and focussing on velocity over 10 min each, twice daily, 5 days per week. Phase B: "house-typical" occupational and physiotherapy. Each phase lasted 3 weeks. RESULTS Patients experienced continuous functional improvement. Voluntary forces improved significantly during the first training phase. Sawing movement improved significantly only during phases A. The grasping and transport movement improved considerably during phase A with a trend of further improvement during the other phases. The transported weight clearly increases only during phases A. CONCLUSION Repetitive training of complex movements results in motor improvement in stroke patients without relevant transfer to functional improvement if strength and velocity are to be enhanced as shaping elements.