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Objective: The purpose of this study was to compare the impact of unilateral (U) and bilateral (B) contrast training on lower limb explosiveness, agility, and balance in college basketball athletes. Methods: Twenty male college basketball players were randomly assigned to either a unilateral group (U, n = 10) or a bilateral group (B, n = 10). Both groups underwent an 8week strength training program, with sessions held twice a week. The unilateral group performed six Bulgarian split squats and ten reverse lunge jump squats, while the bilateral group performed six barbell rear squats and ten double-leg vertical jumps. To comprehensively assess the training effects, the study utilized one-repetition maximum (1RM), countermovement jump (CMJ), 20m sprint, and single-leg hop tests to evaluate explosive power; the 505 and t -test to assess change-of-direction ability; and the Y-balance test (YBT) to evaluate dynamic balance. Paired sample t-tests were used to evaluate within-group changes, and a 2 (pre- and post-) × 2 (experimental and control groups) repeated measures analysis of variance (ANOVA) was used to assess between-group differences. Results: Within-group comparisons indicated that both unilateral and bilateral contrast training significantly improved all performance metrics. Between-group comparisons revealed that bilateral training was superior to unilateral training in improvements in 1RM and CMJ (p > 0.05) (growth rate of 1RM: B: 8.4%, U: 5.15%; growth rate of CMJ: B: 15.63%, U: 6.74%). Unilateral training showed greater improvements in the 20m sprint, dominant leg single-leg hop, YBT left, and YBT right (p > 0.05) (growth rate of 20m sprint: B: 5.43%, U: 10.41%; growth rate of advantage foot touch high: B: 4.56%, U: 9.35%; growth rate of YBT left: B: 3.77%, U: 8.53%; growth rate of YBT right: B: 4.72%, U: 13.8%). Unilateral training also significantly outperformed bilateral training in non-dominant leg single-leg hop, t -test, 505 left, and 505 right improvements (p < 0.05). Conclusion: Unilateral contrast training may offer advantages for enhancing change-of-direction ability and explosive power in the non-dominant leg, and it may also provide benefits for improving short-distance sprinting ability, explosive power in the dominant leg, and dynamic balance. In contrast, bilateral contrast training appears to be more effective for enhancing bilateral explosive power and may be more advantageous for increasing maximal strength. [ABSTRACT FROM AUTHOR]

Purpose: The aims of the present study were to: (1) investigate the magnitude and direction of the cross-education effect in a unilateral sport skill (overhand throw) and (2) to establish which practice condition (dominant hand only or alternating hands) would yield the best results. Methods: The study involved three experimental groups of 11-year-old children (n = 59). The first group (n = 20) used only the dominant hand to throw the ball. The second group (n = 19) used the nondominant hand only, while the third (n = 20) alternated hands for each throw. A pre- and post-testing of both hands preceded and followed the intervention period. Results: The results of our study revealed no asymmetry in cross-education effect between the limbs for children's overhand ball throwing. It was also shown that training both hands is superior to training the dominant hand alone. Conclusion: Our findings would be of particular interest to physical education teachers and coaches of unilateral sports who are advised to review their unilateral skill teaching methods as bilateral training offers a superior approach to augmenting the process of motor learning and performance. [ABSTRACT FROM AUTHOR]

Context: Contralateral training in the early stages after surgery can improve the balance of the reconstructed knee, which is impaired following anterior cruciate ligament reconstruction (ACLR). However, little is known about the neuromuscular cross exercise after ACLR. Objective: To investigate the effects of an 8-week cross exercise on balance and function of the reconstructed knee following ACLR. Design: A single-blind randomized clinical trial. Participants: Thirty athletic males who underwent ACLR were randomly divided into intervention (n = 15) and control groups (n = 15). Intervention: The intervention and control groups received a routine physiotherapy program. In addition, the intervention group performed neuromuscular exercises on the nonoperated limb. Outcome Measures: Before and 9 weeks after ACLR, dynamic and static balance, function, and pain in the reconstructed knee were measured by Star Excursion Balance Test (SEBT), stork balance stand test, balance error scoring system (BESS), Lysholm questionnaire, and visual analog scale. Data were analyzed by SPSS using 2-independent sample t test, paired t test, and analysis of covariance. Results: Between-group comparison showed that, contralateral knee neuromuscular exercises significantly increased in the reaching distance in SEBT in the anterior (P <.001), posterior (P <.001), posteromedial (P =.010), and posterolateral directions (P =.007), decreased the number of errors in 4 stance positions of BESS including single stance on the firm (P ≤.001) and foam surface (P ≤.001), and tandem stance on the firm (P =.028) and foam surface (P ≤.001). It also increased the time of standing of the stork stand test (P =.044) and decreased the pain intensity (P =.014). Conclusion: Neuromuscular exercise of the nonsurgical knee could improve the dynamic and static balance, and pain in the early stages following ACLR in the surgical leg. These findings may be potentially valuable for current rehabilitation protocols. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the impact of unilateral (U) and bilateral (B) contrast training on lower limb explosiveness, agility, and balance in college basketball athletes.Methods: Twenty male college basketball players were randomly assigned to either a unilateral group (U, n = 10) or a bilateral group (B, n = 10). Both groups underwent an 8week strength training program, with sessions held twice a week. The unilateral group performed six Bulgarian split squats and ten reverse lunge jump squats, while the bilateral group performed six barbell rear squats and ten double-leg vertical jumps. To comprehensively assess the training effects, the study utilized one-repetition maximum (1RM), countermovement jump (CMJ), 20m sprint, and single-leg hop tests to evaluate explosive power; the 505 and t-test to assess change-of-direction ability; and the Y-balance test (YBT) to evaluate dynamic balance. Paired sample t-tests were used to evaluate within-group changes, and a 2 (pre- and post-) × 2 (experimental and control groups) repeated measures analysis of variance (ANOVA) was used to assess between-group differences.Results: Within-group comparisons indicated that both unilateral and bilateral contrast training significantly improved all performance metrics. Between-group comparisons revealed that bilateral training was superior to unilateral training in improvements in 1RM and CMJ (p > 0.05) (growth rate of 1RM: B: 8.4%, U: 5.15%; growth rate of CMJ: B: 15.63%, U: 6.74%). Unilateral training showed greater improvements in the 20m sprint, dominant leg single-leg hop, YBT left, and YBT right (p > 0.05) (growth rate of 20m sprint: B: 5.43%, U: 10.41%; growth rate of advantage foot touch high: B: 4.56%, U: 9.35%; growth rate of YBT left: B: 3.77%, U: 8.53%; growth rate of YBT right: B: 4.72%, U: 13.8%). Unilateral training also significantly outperformed bilateral training in non-dominant leg single-leg hop, t-test, 505 left, and 505 right improvements (p < 0.05).Conclusion: Unilateral contrast training may offer advantages for enhancing change-of-direction ability and explosive power in the non-dominant leg, and it may also provide benefits for improving short-distance sprinting ability, explosive power in the dominant leg, and dynamic balance. In contrast, bilateral contrast training appears to be more effective for enhancing bilateral explosive power and may be more advantageous for increasing maximal strength.

Objective: To assess the effects of 8 weeks of unilateral (UNI), bilateral (BI), and combined unilateral + bilateral (UNI + BI) resistance training on bench press and squat strength in adolescent boxers. Methods: Using the Gym Aware linear accelerometer, free-weight squat and bench press strength exercises were evaluated after an 8-week training intervention. Thirty adolescent boxers were randomly assigned to three groups: UNI, height: 1.73 ± 0.08 m, weight: 55.42 ± 5.85 kg; UNI + BI, height: 1.7 ± 0.06 m, weight: 54.73 ± 5.33 kg; and BI, height: 1.74 ± 0.06 m, weight: 59.67 ± 8.39 kg. Each group followed their designated UNI/BI/UNI + BI compound resistance training protocols, and the effects of 8 weeks of single-sided and bilateral intervention training on the performance of free-weight squat and bench press exercises at 30%, 50%, and 80% of 1-repetition maximum (1RM) were evaluated. Results: Significant improvements were observed in the 30% 1RM, 50% 1RM, and 80% 1RM outcomes for both squat and bench press exercises before and after the interventions (p < 0.05, p < 0.01). In the intergroup comparison, GymAware measurements revealed that the UNI and UNI + BI groups exhibited superior peak power values for squat and bench press exercises at 30% 1RM compared to the BI group. Discussion: UNI and UNI + BI training led to significantly higher output power values in bench press and squat exercises at 30% 1RM compared to the BI training group. [ABSTRACT FROM AUTHOR]

Traumatic peripheral nerve damage from Road Traffic Accidents (RTA) can cause severe impairment and loss of function in the upper and lower limbs. A significant portion of acute peripheral nerve injuries affects the upper limb, particularly the brachial plexus. The treatment for complete brachial plexus injury may involve surgery and intensive physiotherapy to help the nerves regenerate and reinnervate the muscles. A 17-year-old male was referred to the Neurology department from a primary healthcare centre after being involved in RTA that resulted in a fall on the right-side. Investigatory findings revealed a head injury with Subarachnoid Haemorrhage (SAH), fractures of the right tibia shaft, right clavicle lateral shaft, and right lower limb. Following surgery, the patient experienced difficulty in performing movements with the right upper limb, along with pain and tingling sensations. As a result, the patient was referred to physiotherapy. During physiotherapy, the patient received sensory re-education sessions lasting 15-20 minutes each, as well as bilateral training sessions lasting 20 minutes each, for a total of four weeks. Over the course of the treatment, the patient demonstrated overall improvement in hand function, including proper grasp and opposition. This improvement was reflected in the brachial assessment tool, Upper Extremity (UE) functional index, and functional independence measure. These positive outcomes underscore the importance of early neuro-physiotherapeutic rehabilitation for patients with brachial plexus injuries, as it can significantly enhance their overall well-being and quality of life.

A bilateral wrist joint training and rehabilitation mechanism is designed to meet the requirements of bilateral passive training better than unilateral active training. The rehabilitation mechanism adopts two spatial reverse double crank parallel sub mechanisms. The forward kinematics of the mechanism is analyzed in the spherical coordinate system, and the motion relationship of the two platforms is obtained. The Euler angles of the rolling, pitching and virtual yaw motions of the two platforms are measured, and the front and back muscles are measured simultaneously in the three motion modes. The experimental data shows that when the mechanism is rolling, the angular displacements of both platforms are equal in magnitude and opposite in direction, while the mechanism is pitching, the angular displacements of both platforms are the same in magnitude and direction. The maximum and average electromyography （EMG） values of anterior and posterior muscles measured during the bilateral active training are 319.65 mV and 352.2 mV higher than those measured during the resting state, and 155.9 mV and 184 mV higher than those measured during the unilateral passive training, respectively. The above results show that the developed bilateral training machine has mirror symmetry, can play a training effect on the wrist joint, and the training effect is better than that of the unilateral training.

Background: Integrating high dosage bilateral movements to improve upper limb (UL) recovery after stroke is a rehabilitation strategy that could potentially improve bimanual activities. Objectives: This study aims to compare the effects of bilateral with unilateral UL training on upper limb impairments and functional independence in (sub)acute stroke. Method: Five electronic databases (PubMed, Scopus, PEDro, ScienceDirect, Web of Science) were systematically searched from inception to June 2023. Randomised controlled trials comparing the effect of bilateral training to unilateral training in stroke survivors (< 6 months poststroke) were included. The treatment effect was computed by the standard mean differences (SMDs). Results: The review included 14 studies involving 706 participants. Bilateral training yielded a significant improvement on UL impairments measured by FMA-UE compared to unilateral training (SMD = 0.48; 95% CI: 0.08 to 0.88; P = 0.02). In addition, subgroup analysis based on the severity of UL impairments reported significant results in favour of bilateral UL training in improving UL impairments compared to unilateral training in "no motor capacity" patients (SMD = 0.66; 95% CI: 0.16 to 1.15; P = 0.009). Furthermore, a significant difference was observed in favour of bilateral UL training compared to unilateral UL training on daily activities measured by Functional Independence Measure (SMD = 0.45; 0.13 to 0.78; P = 0.006). Conclusion: Bilateral UL training was superior to unilateral training in improving impairments measured by FMA-UE and functional independence in daily activities measured by Functional Independence Measure in (sub)acute stroke. Clinical implications: Bilateral upper limb training promotes recovery of impairments and daily activities in (sub)acute phase of stroke. [ABSTRACT FROM AUTHOR]

Traumatic peripheral nerve damage from Road Traffic Accidents (RTA) can cause severe impairment and loss of function in the upper and lower limbs. A significant portion of acute peripheral nerve injuries affects the upper limb, particularly the brachial plexus. The treatment for complete brachial plexus injury may involve surgery and intensive physiotherapy to help the nerves regenerate and reinnervate the muscles. A 17-year-old male was referred to the Neurology department from a primary healthcare centre after being involved in RTA that resulted in a fall on the right-side. Investigatory findings revealed a head injury with Subarachnoid Haemorrhage (SAH), fractures of the right tibia shaft, right clavicle lateral shaft, and right lower limb. Following surgery, the patient experienced difficulty in performing movements with the right upper limb, along with pain and tingling sensations. As a result, the patient was referred to physiotherapy. During physiotherapy, the patient received sensory re-education sessions lasting 15-20 minutes each, as well as bilateral training sessions lasting 20 minutes each, for a total of four weeks. Over the course of the treatment, the patient demonstrated overall improvement in hand function, including proper grasp and opposition. This improvement was reflected in the brachial assessment tool, Upper Extremity (UE) functional index, and functional independence measure. These positive outcomes underscore the importance of early neuro-physiotherapeutic rehabilitation for patients with brachial plexus injuries, as it can significantly enhance their overall well-being and quality of life. [ABSTRACT FROM AUTHOR]

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Purpose: Knowing the patterns of brain activation that occur and networks involved under different interventions is important for motor recovery in subjects with stroke. This study aimed to study the patterns of brain activation and networks in two interventions, affected upper limb side and bilateral exercise training, using concurrent functional near‐infrared spectroscopy (fNIRS) imaging. Methods: Thirty‐two patients in the early subacute stage were randomly divided into two groups: unilateral and bilateral groups. The patients in the unilateral group underwent isokinetic muscle strength training on the affected upper limb side and patients in the bilateral group underwent bilateral upper limb training. Oxyhemoglobin and deoxyhemoglobin concentration changes (ΔHbO2 and ΔHbR, respectively) were recorded in the ipsilateral and contralateral prefrontal cortex (IPFC and CPFC, respectively) and ipsilateral and contralateral motor cortex (IMC and CMC, respectively) by fNIRS equipment in the resting state and training conditions. The phase information of a 0.01–0.08 Hz fNIRS signal was extracted by the wavelet transform method. Dynamic Bayesian inference was adopted to calculate the coupling strength and direction of effective connectivity. The network threshold was determined by surrogate signal method, the global (weighted clustering coefficient, global efficiency, and small‐worldness) and local (degree, betweenness centrality, and local efficiency) network metrics were calculated. The degree of cerebral lateralization was also compared between the two groups. Results: The results of covariance analysis showed that, compared with bilateral training, the coupling effect of CMC → IMC was significantly enhanced (p = 0.03); also, the local efficiency of the IMC (p = 0.01), IPFC (p < 0.001), and CPFC (p = 0.006) and the hemispheric autonomy index of IPFC (p = 0.007) were significantly increased in unilateral training. In addition, there was a significant positive correlation between the coupling intensity of the inter‐hemispheric motor area and the shifted local efficiency. Conclusions: The results indicated that unilateral upper limb training could more effectively promote the interaction and balance of bilateral motor hemispheres and help brain reorganization in the IMC and prefrontal cortex in stroke patients. The method provided in this study could be used to evaluate dynamic brain activation and network reorganization under different interventions, thus improving the strategy of rehabilitation intervention in a timely manner and resulting in better motor recovery. [ABSTRACT FROM AUTHOR]

Patients with hemiplegia are usually restricted to performing general bilateral activities of daily life (gbADLs). Bilateral training has been verified to contribute to the rehabilitation of physical functions. Although robotic systems are gradually being employed in the field of rehabilitation, few studies have performed simulations with regards to gbADLs for training. Therefore, a novel end-effector bilateral rehabilitation robotic system (EBReRS) for the upper limb is developed in this article for the task rendering of gbADLs, in which the gbADL-corresponding workspace is obtained via modularly designed bilateral parallelogram mechanisms. In addition, the interaction rendering of multiple bimanual modes (uncoupled, trans-soft-coupled, trans-semi-coupled, and rotation-coupled) is achieved by implementing the admittance model, the inner force field between robotic end-effectors, and the outer force field distributed around. Experiments of the proposed four rehabilitation training modes were carried out on the healthy subject, with the results showing a feasible method of the EBReRS in the simulation of multiple bimanual coordinated rehabilitation training tasks. In the future, the constructed EBReRS is expected to be exploited for home rehabilitation as a coordinated training device. • A novel robotic system EBReRS with stretchable structure and modular design is built. • The active rehabilitation training with controllable difficulty is achieved. • Multifold bilateral training modes are achieved under inner and outer force fields. • Patient-centered adjustment of training intensity for the affected side is achieved. • Practical validation of the built prototype EBReRS is conducted. [ABSTRACT FROM AUTHOR]

Bilateral motor training is a useful method for modifying corticospinal excitability. The effects of bilateral movement that are caused by artificial stimulation on corticospinal excitability have not been reported. We compared motor-evoked potentials (MEPs) of the primary motor cortex (M1) after conventional bilateral motor training and artificial bilateral movements generated by electromyogram activity of abductor pollicis brevis (APB) muscle-triggered peripheral nerve stimulation (c-MNS) and transcranial magnetic stimulation of the ipsilateral M1 (i-TMS). A total of three protocols with different interventions—bilateral finger training, APB-triggered c-MNS, and APB-triggered i-TMS—were administered to 12 healthy participants. Each protocol consisted of 360 trials of 30 min for each trial. MEPs that were induced by single-pulse TMS, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) that were induced by paired-pulse TMS were assessed as outcome measures at baseline and at 0, 20, 40, and 60 min after intervention. MEP amplitude significantly increased up to 40 min post-intervention in all protocols compared to that at the baseline, although there were some differences in the changing pattern of ICF and SICI in each protocol. These findings suggest that artificial bilateral movement has the potential to increase the ipsilateral cortical excitability of the moving finger.

Traditional rigid exoskeletons can be challenging to the comfort of wearers and can have large pressure, which can even alter natural hand motion patterns. In this paper, we propose a low-cost soft exoskeleton glove (SExoG) system driven by surface electromyography (sEMG) signals from non-paretic hand for bilateral training. A customization method of geometrical parameters of soft actuators was presented, and their structure was redesigned. Then, the corresponding pressure values of air-pump to generate different angles of actuators were determined to support four hand motions (extension, rest, spherical grip, and fist). A two-step hybrid model combining the neural network and the state exclusion algorithm was proposed to recognize four hand motions via sEMG signals from the healthy limb. Four subjects were recruited to participate in the experiments. The experimental results show that the pressure values for the four hand motions were about −2, 0, 40, and 70 KPa, and the hybrid model can yield a mean accuracy of 98.7% across four hand motions. It can be concluded that the novel SExoG system can mirror the hand motions of non-paretic hand with good performance.

Upper limb strength deficits are frequently observed following breast cancer (BC) and its treatments. It is currently unknown whether these unilateral deficits can be corrected by a standard bilateral strength training intervention. Twenty-three survivors of BC were included in this analysis. Fourteen performed a 16-week resistance training (RT) intervention, 9 were assigned to a usual care waitlist control group. Electromyographic analysis of the pectoralis major and triceps brachii were monitored during 3 maximal isometric contractions and a fatiguing endurance task. Muscular strength was significantly different between limbs at the start of the intervention (p = 0.02). Electromyographic amplitude and median frequency did not differ between limbs at the start of the intervention. Muscular strength was significantly different between limbs in the RT group at the end of the intervention (p = 0.01). Electromyographic amplitude did not differ between limbs or groups at the end of the intervention. Bilateral strength training did not correct the unilateral strength deficit observed in this group of survivors of breast cancer. Periods of unilateral strength training should be implemented into periodized RT programs in this cohort. [ABSTRACT FROM AUTHOR]

Corticobasal degeneration (CBD) is a neurodegenerative disorder characterized by a combination of cortical and basal ganglia signs. We reported two cases treated with a bilateral upper limb rehabilitation tool with videogame based feedback for 3 time per week for 8 weeks. Both patients showed an improvement of pinch and grasp forces and motor function. However, both of them reported an increased upper limb pain. Bilateral upper limb mechanical device with exergame feedback was effective also in the two patients suffering of CBD for limiting the effects of apraxia by performing intensive purposeful task training. [ABSTRACT FROM AUTHOR]

Rehabilitation and mobility training of post-stroke patients is crucial for their functional recovery. While traditional methods can still help patients, new rehabilitation and mobility training methods are necessary to facilitate better recovery at lower costs. In this work, our objective was to design and develop a rehabilitation training system targeting the functional recovery of post-stroke users with high efficiency. To accomplish this goal, we applied a bilateral training method, which proved to be effective in enhancing motor recovery using tactile feedback for the training. One participant with hemiparesis underwent six weeks of training. Two protocols, “contralateral arm matching” and “both arms moving together”, were carried out by the participant. Each of the protocols consisted of “shoulder abduction” and “shoulder flexion” at angles close to 30 and 60 degrees. The participant carried out 15 repetitions at each angle for each task. For example, in the “contralateral arm matching” protocol, the unaffected arm of the participant was set to an angle close to 30 degrees. He was then requested to keep the unaffected arm at the specified angle while trying to match the position with the affected arm. Whenever the two arms matched, a vibration was given on both brachialis muscles. For the “both arms moving together” protocol, the two arms were first set approximately to an angle of either 30 or 60 degrees. The participant was asked to return both arms to a relaxed position before moving both arms back to the remembered specified angle. The arm that was slower in moving to the specified angle received a vibration. We performed clinical assessments before, midway through, and after the training period using a Fugl-Meyer assessment (FMA), a Wolf motor function test (WMFT), and a proprioceptive assessment. For the assessments, two ipsilateral and contralateral arm matching tasks, each consisting of three movements (shoulder abduction, shoulder flexion, and elbow flexion), were used. Movements were performed at two angles, 30 and 60 degrees. For both tasks, the same procedure was used. For example, in the case of the ipsilateral arm matching task, an experimenter positioned the affected arm of the participant at 30 degrees of shoulder abduction. The participant was requested to keep the arm in that position for ~5 s before returning to a relaxed initial position. Then, after another ~5-s delay, the participant moved the affected arm back to the remembered position. An experimenter measured this shoulder abduction angle manually using a goniometer. The same procedure was repeated for the 60 degree angle and for the other two movements. We applied a low-cost Kinect to extract the participant’s body joint position data. Tactile feedback was given based on the arm position detected by the Kinect sensor. By using a Kinect sensor, we demonstrated the feasibility of the system for the training of a post-stroke user. The proposed system can further be employed for self-training of patients at home. The results of the FMA, WMFT, and goniometer angle measurements showed improvements in several tasks, suggesting a positive effect of the training system and its feasibility for further application for stroke survivors’ rehabilitation.

BACKGROUND:The differential effects of bilateral and unilateral training on upper extremity (UE) function remain unclear. OBJECTIVE: To compare the effectiveness of bilateral and unilateral training on UE function and activities of daily living (ADL) after stroke. METHODS: Randomized controlled trials (RCTs) were selected for inclusion by two reviewers after searching the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and KoreaMed. Methodological qualities were assessed using the PEDro scale. Effect size was estimated by calculating the standardized mean difference (SMD). RESULTS: Eleven RCTs of sufficient quality were included in our meta-analysis. The effect size on UE capacity was statistically significant in favor of the Constraint-Induced Movement Therapy (CIMT) groups (SMD [fixed], g: -0.34; 95% CI: -0.59-0.08; p = 0.01; I2 = 0%). No other SMDs were significant. CONCLUSION: The CIMT tasks were more effective than bilateral training with regard to increased UE capacity; however, this result should be cautiously interpreted since the evaluation tools were designed for assessment of unilateral UE function, not bilateral UE function. Further, the effect of the CIMT tasks on UE capacity was not translated into ADL. Considering the disadvantages of CIMT such as fatigue, bilateral training may be more appropriate for improving ADL. [ABSTRACT FROM AUTHOR]

According to the neuro-rehabilitation theory, compared with unilateral training, bilateral training is proven to be an effective method for hemiparesis, which affects the most part of stroke patients. In this study, a novel bilateral rehabilitation training system, which incorporates a lightweight exoskeleton device worn on the affected limb; a haptic device (Phantom Premium), which is used for generating a desired tactile feedback for the affected limb; and a VR (virtual reality) graphic interface, has been developed. The use of VR technology during rehabilitation can provide goal directed tasks with rewards and motivate the patient to undertake extended rehabilitation. This paper is mainly focused on elbow joint training, and other independent joints can be trained by easily changing the VR training interface. The haptic device is adopted to enable patients to use their own decision making abilities with a tactical feedback. Integrated with a VR-based graphic interface, the goal-oriented task can help to gradually recovery their motor function with a coordinative motion between two limbs. In particular, the proposed system can accelerate neural plasticity and motor recovery in those patients with little muscle strength by using the exoskeleton device. The exoskeleton device can provide from relatively high joint impedance to near-zero impedance, and can provide a partial assist as the patient requires.

Benefits of bilateral practice both for the non-dominant and for the dominant body side have been shown in several studies. Thereby, most of the studies included movement tasks of the upper extremity or investigated sports games in which the ability of acting bilaterally is an essential basis for success and, thus, a bilateral practice is reasonable anyway. Individual unilaterally performed sports including movement tasks of the lower extremity are rarely investigated. Therefore, the aim of our study was to test if contralateral transfer due to bilateral practice can be found in an unilaterally performed sport including the lower extremity. We trained and tested 61 adolescent athletes in long jump to compare the jumping performance of the dominant leg after a 12-week practice period between two groups: a bilateral practice group that practiced specific long jump exercises with both the dominant and non-dominant leg and an unilateral practice group that practiced specific long jump exercises only with the dominant leg. Results showed a superior effect of bilateral practice compared to unilateral practice regarding the jumping performance of the dominant leg. The performance increase at post-test and retention-test for the dominant limb was significantly higher for the bilateral practice group (pre-to-post: 5.2%, pre-to-retention: 7.4%) compared to the unilateral practice group (pre-to-post: 3.4%, pre-to-retention: 4.5%). Thus, bilateral practice should be established in the early practice programmes of track and field athletes to improve the performance of the dominant takeoff leg. [ABSTRACT FROM AUTHOR]

Robot-assisted bilateral upper-limb training grows abundantly for stroke rehabilitation in recent years and an increasing number of devices and robots have been developed. This paper aims to provide a systematic overview and evaluation of existing bilateral upper-limb rehabilitation devices and robots based on their mechanisms and clinical-outcomes. Most of the articles studied here were searched from nine online databases and the China National Knowledge Infrastructure (CNKI) from year 1993 to 2015. Devices and robots were categorized as end-effectors, exoskeletons and industrial robots. Totally ten end-effectors, one exoskeleton and one industrial robot were evaluated in terms of their mechanical characteristics, degrees of freedom (DOF), supported control modes, clinical applicability and outcomes. Preliminary clinical results of these studies showed that all participants could gain certain improvements in terms of range of motion, strength or physical function after training. Only four studies supported that bilateral training was better than unilateral training. However, most of clinical results cannot definitely verify the effectiveness of mechanisms and clinical protocols used in robotic therapies. To explore the actual value of these robots and devices, further research on ingenious mechanisms, dose-matched clinical protocols and universal evaluation criteria should be conducted in the future. [ABSTRACT FROM AUTHOR]

Introduction: Erb's palsy is a paralysis of the arm caused by injury to the upper trunk (C5-C6) of the brachial plexus sustained during delivery as a result of a birth emergency known as shoulder dystocia. The other possible causes of this injury could be due to excessive pulling on the shoulder during vertex presentation, by the pressure on the raised arms during breech delivery or due to clavicle fracture unrelated to dystocia. The signs of it are sensory loss in the arm and paralysis & atrophy of the deltoid, biceps & brachialis muscles. The position of the limb is arm adducted & internally rotated, elbow extended, forearm pronated, wrist flexed & fingers extended. It is been documented by the results of a recent systemic review, where McNeekly & Drake (2003) found that there was no conclusive evidence showing a benefit of surgery in children with Obstetric Brachial Plexus Palsy (OBPP). Occupational therapy treatment of such patients aims at positioning, splinting, strengthening, facilitation & sensory reeducation. Hence it is very important to establish an effective & comprehensive management for such children. Aim of the study: To develop a protocol for the management of erb's palsy. Methodology: Eleven Congenital Erb's palsy patients, age not more than 2weeks who Clinically presented with typical policeman's tip hand and had no bony injury detected or reported were selected from SVNIRTAR occupational therapy department. All the patients were followed up at the age of one year. Study design was Pretest post test study design. The outcome measure used was Active movement scale (AMS). Results: the results showed a significant improvement in the patients in all the components of active movement scale at pd"0.05 except in the components in shoulder internal rotation & forearm supination. Conclusion: From the present study it can be concluded that the therapeutic intervention along with the splinting is effective in enhancing recovery in the erb's palsy patients. [ABSTRACT FROM AUTHOR]

Purpose: We examined the feasibility and outcome of electromyographically triggered electrical muscle stimulation (EMG-ES) plus unilateral or bilateral task specific practice on arm function in chronic stroke survivors with moderate-severe hemiplegia. Transcranial magnetic stimulation was used to examine inter-hemispheric inhibition (IHI) acting on the stroke-affected hemisphere in a subset of eight participants. Methods: Twenty-one stroke survivors (14 males; mean time post stroke 57.9 months) participated in this pilot investigation. Participants underwent a six-week program of daily EMG-ES training with random assignment to concurrent task practice using the stroke-affected hand only or both hands. The upper-extremity subscale of the Fugl-Meyer (FMUE) and the Arm Motor Ability Test (AMAT) were completed at baseline, 0-, 1-, and 3-months post-intervention. Results: Following the intervention, FMUE (F(3, 57) = 3.89, p = .01, ηp2 = .17) and AMAT (F(3, 57) = 12.6, p = .01, ηp2 = .39) scores improved, and remained better than baseline at three months re-assessment. The difference between groups was not significant. A non-significant decrease in IHI was observed post-intervention. Conclusions: An intensive program of EMG-ES assisted functional training is feasible, well tolerated, and leads to improvements in moderate-severe deficits of arm function post stroke. Larger placebo controlled studies are needed to explore any advantage of bilateral over unilateral EMG-ES assisted training. [ABSTRACT FROM AUTHOR]

Background and objective While designing the rehabilitation regime of a hemiplegic patient, most physiotherapists focus on the affected/hemiparetic side. The less affected/unaffected side remains unused and loses its properties, i.e., muscle strength, girth, balance, and gait, thus causing deconditioning effects in patients' overall rehabilitation. To enhance the recovery process, the focus should be drawn to training both sides equally to fasten the recovery process. The rationale behind designing this study was to maintain the integrity of the unaffected side along with rehabilitation of the affected side in hemiplegic patients. Many proven studies focus on bimanual upper-limb training in post-stroke survivors, but there is a lack of literature regarding the same in the lower limbs. This clinical trial was designed to study the effect of bilateral lower-limb training over unilateral lower-limb training on balance and walking in post-stroke survivors. Methods 40 hemiplegic patients were selected and randomly divided into two groups: Group A (unilateral training group (UTG)) and Group B (bilateral training group (BTG)). Patients in Group A underwent approach-oriented training using the motor relearning program (MRP) and proprioceptive neuromuscular facilitation (PNF) for the affected side, while those in Group B underwent strength training for the lower-limb muscles using DeLorme's principle for the unaffected side and approach-oriented training using the MRP and PNF for the affected side for a period of six weeks, five days per week. A strengthening regimen was designed for the unaffected side, considering the frequency, intensity, time, and type (FITTs) principle provided by the American College of Sports Medicine (ACSM). The static and dynamic balance along with gait parameters were measured using the functional reach test (FRT), one-leg stance test (OLST), Berg balance scale (BBS), Dynamic Gait Index (DGI), gait parameters (stride length, gait velocity, and cadence), and Brunnstrom recovery stages (BRS) at the baseline and post rehabilitation. Results Both groups significantly improved following therapy (p<0.05). Group B showed more significant results both statistically and clinically. The enhancement in the FRT (2.25, p<0.03), OLST (5.12. p<0.0001), BBS (0.68, p<0.020), and DGI (1.70, p<0.030) scores indicated improvement in static and dynamic balance in the two groups. Patients showed improvement in the stereotyped sequence of movements indicating recovery on the BRS (4.62, p<0.0001). The overall gait parameters in patients, i.e., gait velocity (6.78, p<0.0001), stride length (3.59, p<0.001) and cadence (6.15, p<0.0001), improved post rehabilitation. Conclusion The results of this study showed that the BTG had positive impacts on the postural balance and walking capacities of subacute hemiparetic stroke patients, promoting early recovery in comparison to the UTG. This study also helped to design a strengthening protocol for the unaffected side according to DeLorme's principle in line with the FITTs principle., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Harjpal et al.)

Stroke is one of the most disabling conditions affecting the middle-aged population all around the world. This study aims to explore the rehabilitation of stroke patients using bibliometric analysis, which includes statistical analysis of recent articles, books, and other kinds of publications, to assess scientific output and determine the significance of scientific investigations in terms of both quality and quantity. In this study, an analysis of global trends in research in bilateral lower limb training for training balance and walking for patients in the subacute stage post-stroke between 1988 and 2021 was done. All the articles were obtained from PubMed databases. CiteSpace software was used to analyze the relationship between publications and country, journals, institutions, authors, references, and the keywords used. A total of 160 publications were included in the analysis. There was a tremendous increase in the research of physiotherapy intervention in patients who had residual disability post-stroke with a publication rate of 7.1 articles per year of publications. The use of the sophisticated PubMed database to extract articles allowed for a thorough and powerful bibliometric analysis of stroke rehabilitation research published between 1988 and 2020. In general, the number of studies on bilateral training has increased in recent decades. This historical overview of rehabilitation for post-stroke survivors will serve as a valuable starting point for future study into possible collaborators, focus issues, and trends. This bibliometric analysis highlights the potential value of exercise therapy for stroke survivors in creating more effective hemiplegia rehabilitation programs. This research may encourage the use of strengthening in the therapeutic therapy of hemiplegia balance. The groundwork will be laid for future research on strengthening stroke to be organized and given top priority., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Harjpal et al.)

Abstract: Objective: To determine if a modified form of repetitive rhythmic bilateral training will generalize to two reach to target tasks. Setting: Testing and training were performed at the Brain Rehabilitation Research Center, Malcom Randall VAMC in Gainesville, Florida. Subjects: Fourteen subjects with chronic stroke completed this study: 9 male, 5 female, mean age 64.4years, and a mean of 5.5years post-stroke. Intervention: Modified Bilateral Arm Training with Rhythmic Auditory Cueing (modBATRAC) was performed 4 sessions/week of 2.25h/session for 2weeks. Main measures: End-point kinematic measures; hand path curvature, time to peak velocity, peak velocity, smoothness of the curve and acceleration using the Vicon motion analysis system during two reach to target tasks: (1) similar spatial demands (2) dissimilar spatial demands. An individual analysis was performed to investigate if there was any pattern of responding. Additionally, correlation analyses of kinematic and functional measures taken pre- and post-test were performed. Results: Improvements were found at post-test for hand path curvature, smoothness of the curve, and peak velocity and were equivalent across two reach to target tasks. Discussion: Generalization was found for both reach to target tasks for end-point kinematic aspects (PV, HPC, and number of Peaks) during modBATRAC training. There was a positive correlation with the significant kinematic variables (HPC and PV) and the functional measures used pre- and post-test in this study. This suggests that generalization may be possible through the practice of basic coordinated movements after stroke. These basic movements may provide the building blocks for more complex movement behaviors. [Copyright &y& Elsevier]

Upper extremity hemiparesis is the most common post-stroke disability. Longitudinal studies have indicated that 30–66% of stroke survivors do not have full arm function 6 months post-stroke. The current gold standard for treatment of mild post-stroke upper limb impairment is constraint-induced therapy but, because of the inclusion criteria, alternative treatments are needed which target more impaired subjects. Bilateral arm training has been investigated as a potential rehabilitation intervention. Bilateral arm training encompasses a number of methods including: (1) bilateral isokinematic training; (2) mirror therapy using bilateral training; (3) device-driven bilateral training; and (4) bilateral motor priming. Neural mechanisms mediating bilateral training are first reviewed. The key bilateral training studies that have demonstrated evidence of efficacy will then be discussed. Finally, conclusions are drawn concerning clinical implications based on the reviewed literature. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Motor impairment in children with hemiplegic cerebral palsy leads to a predominance of use of the unaffected hand. This impedes development of bimanual skills and deprives the affected side of the stimulus needed for normal growth. Occupational therapists aim to improve use of the affected hand, traditionally using Neurodevelopmental Therapy. Empirical evidence is needed to support this treatment choice. Studies examining interlimb coupling in children with hemiplegia and other studies in adult stroke support a bilateral treatment approach. These single-case time-series experiments examined the effects of Neurodevelopmental Therapy and Bilateral Isokinematic Training on hand use in three children with hemiplegic cerebral palsy. Two of the three subjects displayed positive changes in use and movement of the affected hand in some tasks with Bilateral Isokinematic Training. Bilateral Isokinematic Training might be a potentially useful means of increasing frequency of use of the affected hand in some children with hemiplegic cerebral palsy. [ABSTRACT FROM AUTHOR]

Bilateral motor training is a useful method for modifying corticospinal excitability. The effects of bilateral movement that are caused by artificial stimulation on corticospinal excitability have not been reported. We compared motor-evoked potentials (MEPs) of the primary motor cortex (M1) after conventional bilateral motor training and artificial bilateral movements generated by electromyogram activity of abductor pollicis brevis (APB) muscle-triggered peripheral nerve stimulation (c-MNS) and transcranial magnetic stimulation of the ipsilateral M1 (i-TMS). A total of three protocols with different interventions—bilateral finger training, APB-triggered c-MNS, and APB-triggered i-TMS—were administered to 12 healthy participants. Each protocol consisted of 360 trials of 30 min for each trial. MEPs that were induced by single-pulse TMS, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) that were induced by paired-pulse TMS were assessed as outcome measures at baseline and at 0, 20, 40, and 60 min after intervention. MEP amplitude significantly increased up to 40 min post-intervention in all protocols compared to that at the baseline, although there were some differences in the changing pattern of ICF and SICI in each protocol. These findings suggest that artificial bilateral movement has the potential to increase the ipsilateral cortical excitability of the moving finger. [ABSTRACT FROM AUTHOR]

Background: Dual transcranial direct current stimulation (dual tDCS) can be combined with stroke rehabilitation interventions to promote excitatory changes in the cerebral cortex.Objective: To investigate how the combined intervention of dual tDCS and modified constraint-induced movement therapy (mCIMT) using both anodal and cathodal stimulation affects on the recovery of upper limb function in chronic stroke patients.Methods: This study was a double-blind randomized controlled trial. A total of 30 patients were randomly assigned to the experimental group (dual tDCS and mCIMT) or control group (sham dual tDCS and mCIMT). The experimental and control group performed mCIMT immediately after applying dual tDCS for 20 min, but the control group also performed mCIMT after applying sham tDCS for 20 min in a state where no current flows. The total intervention period was performed 5 times a week for 4 weeks. The outcome was assessed using Fugle-Meyer Assessment (FMA) Motor Activity Log (MAL) Accelerometer.Results: There was a significant improvement in AOU of MAL and usage of unaffected side in the experimental group compared to the control group, and the experimental group showed more than a small effect difference compared to the control group in the effect size of all evaluations.Conclusions: This study has clinical significance in that it presents the possibility of convergence intervention that considers the therapeutic efficiency in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: Rehabilitation goals for chronic stroke patients are largely focused around regaining functional ability and independence, with particular focus on upper limb motor function. Unilateral and Bilateral motor training may help achieve this. Our objective was to evaluate and compare the effects of unilateral and bilateral motor training on upper limb motor function in chronic stroke patients.Materials and Methods: A comprehensive literature search was conducted until June 2020 through several electronic databases (CENTRAL, Medline, CINAHL, EBSCO, AMED and PEDro) to identify relevant studies. Studies that used the Fugl Meyer Assessment (FMA) as a minimum, to assess upper limb motor function following unilateral versus bilateral training in chronic stroke patients, qualified for inclusion within the review. Randomised controlled trial (RCT), cohort study and cross-sectional study designs were considered. The Cochrane risk of bias tool was used to assess Randomised Controlled Trials (RCTs). The findings were qualitatively synthesised.Results: From a total of 838 studies identified, 7 RCTs were included in this review. All except one of the studies included reported an unclear risk of bias, with one low risk of bias reported. Overall, the studies reported that unilateral and bilateral training improved upper limb function in chronic stroke patients. Improvements between interventions were equivocal. Bilateral upper limb training however may be more efficacious for increasing upper limb strength and quality of movement, with unilateral training more beneficial for recovering functional ability for activities of daily living.Conclusion: While the findings of the included studies support the use of unilateral and bilateral motor training post chronic stroke, the seven studies that were included methodologically all presented with limitations, hence strong conclusions cannot be drawn and further research is warranted. [ABSTRACT FROM AUTHOR]

Traditional rigid exoskeletons can be challenging to the comfort of wearers and can have large pressure, which can even alter natural hand motion patterns. In this paper, we propose a low-cost soft exoskeleton glove (SExoG) system driven by surface electromyography (sEMG) signals from non-paretic hand for bilateral training. A customization method of geometrical parameters of soft actuators was presented, and their structure was redesigned. Then, the corresponding pressure values of air-pump to generate different angles of actuators were determined to support four hand motions (extension, rest, spherical grip, and fist). A two-step hybrid model combining the neural network and the state exclusion algorithm was proposed to recognize four hand motions via sEMG signals from the healthy limb. Four subjects were recruited to participate in the experiments. The experimental results show that the pressure values for the four hand motions were about −2, 0, 40, and 70 KPa, and the hybrid model can yield a mean accuracy of 98.7% across four hand motions. It can be concluded that the novel SExoG system can mirror the hand motions of non-paretic hand with good performance. [ABSTRACT FROM AUTHOR]

Background: Occupation used in occupation-based intervention requires the use of 2 naturally coordinated hands.Objective: To investigate by implementing occupation-based bilateral upper extremity training in medical setting to stroke patients and determine its effect in patients' bilateral upper extremity function recovery.Methods: A total of 20 patients were randomly assigned to the experimental group (occupation-based bilateral upper extremity training) or control group (task-based bilateral upper extremity training). The intervention of the 2 groups was conducted 30 minutes a day, 5 times a week, and 4 weeks long. The outcome was assessed using the Canadian Occupational Performance Measure, Stroke Impact Scale, Action Research Arm Test, the Yonsei-Bilateral Activity Test, Accelerometer, and participants were assessed at baseline and after 4 weeks.Results: There was a significant change in the satisfaction and performance status of occupational performance, strength, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), emotion, participant recovery in stroke recovery, gross movement in the function of the affected side, satisfaction in perform bilateral upper extremity in the experimental group compared to the control group.Conclusions: The clinical significance of this study is that this study demonstrated the effectiveness and usefulness of the training in the actual medical setting in improving upper extremity function and psychosocial factors. [ABSTRACT FROM AUTHOR]

According to the neuro-rehabilitation theory, compared with unilateral training, bilateral training is proven to be an effective method for hemiparesis, which affects the most part of stroke patients. In this study, a novel bilateral rehabilitation training system, which incorporates a lightweight exoskeleton device worn on the affected limb; a haptic device (Phantom Premium), which is used for generating a desired tactile feedback for the affected limb; and a VR (virtual reality) graphic interface, has been developed. The use of VR technology during rehabilitation can provide goal directed tasks with rewards and motivate the patient to undertake extended rehabilitation. This paper is mainly focused on elbow joint training, and other independent joints can be trained by easily changing the VR training interface. The haptic device is adopted to enable patients to use their own decision making abilities with a tactical feedback. Integrated with a VR-based graphic interface, the goal-oriented task can help to gradually recovery their motor function with a coordinative motion between two limbs. In particular, the proposed system can accelerate neural plasticity and motor recovery in those patients with little muscle strength by using the exoskeleton device. The exoskeleton device can provide from relatively high joint impedance to near-zero impedance, and can provide a partial assist as the patient requires. [ABSTRACT FROM AUTHOR]

[Purpose] The purpose of this study was to investigate the effects of task-oriented bilateral arm training and repetitive bilateral arm training on upper limb function and activities of daily living in stroke patients. [Subjects] Forty patients with hemiplegia resulting from stroke were divided into a task orientied bilateral arm training group (n=20) and a repetitive bilateral arm training group (n=20). [Methods] The task-oriented group underwent bilateral arm training with 5 functional tasks, and the repetitive group underwent bilateral arm training with rhythmin auditory cueing for 30 minutes/day, 5 times/week, for 12 weeks. [Results] The upper limb function and the ability to perform activities of daily living improved significantly in both groups. Although there were significant differences between the groups, the task-oriented group showed greater improvement in upper limb function and activities of daily living. [Conclusion] We recommend bilateral arm training as well as adding functional task training as a clinical intervention to improve upper limb function activities of daily living in patients with hemiplegia.

Bilateral movement rehabilitation is gaining popularity as an approach to improve the recovery not only of bimanual function but also of unilateral motor tasks. While the neural mechanisms mediating the transfer of bilateral training gains into unimanual contexts are not fully understood, converging evidence from behavioral, neurophysiological, and imaging studies suggests that bimanual movements are not simply the superposition of unimanual tasks undertaken with both (upper) limbs. Here we investigated the neural responses in both hemispheres to bilateral ballistic motor training and the extent to which performance improvements transferred to a unimanual task. Since aging influences interhemispheric interactions during movement production, both young (n = 9; mean age 19.4 yr; 6 women, 3 men) and older (n = 9; 66.3 yr; 7 women, 2 men) adults practiced a bilateral motor task requiring simultaneous "fast-as-possible" abductions of their left and right index fingers. Changes in bilateral and unilateral performance, and in corticospinal excitability and intracortical inhibition, were assessed. Strong transfer was observed between bimanual and unimanual contexts for both age groups. However, in contrast to previous reports of substantial bilateral cortical adaptations following unilateral training, increases in corticospinal excitability following bilateral training were not statistically reliable, and a release of intracortical inhibition was only observed for older adults. The results indicate that the neural mechanisms of motor learning for bilateral ballistic tasks differ from those that underlie unimanual ballistic performance improvement but that aging results in a greater overlap of the neural mechanisms mediating bilateral and unilateral ballistic motor performance.