Type of Article:  Original Research

Volume 5; Issue 1 (February 2017)

Page No.: 1885-1892

DOI: https://dx.doi.org/10.16965/ijpr.2016.214


Hoda M. Zakaria 1  ,Walaa M. Ragab 2, Olfat I. Ali *3.

1 Assistant professor at  Department of physical therapy for neuromuscular disorders and its surgery, Faculty of Physical Therapy, Cairo University, Egypt.

2 Lecturer at Department of physical therapy for neuromuscular disorders and its surgery, Faculty of Physical Therapy, Cairo University, Egypt.

*3 lecturer at Basic science department for Physical Therapy. Faculty of Physical Therapy, Cairo University. Egypt

Corresponding  author address: Dr. Olfat I. Ali, lecturer at Basic science department for Physical Therapy. Faculty of Physical Therapy, Cairo University. Egypt E-Mail: olfat_ib @yahoo.com


Background: Hand dysfunction is a common problem of stroke patients and it is the main cause of impairment of the upper limb. Finding new method to improve hand performance will decrease the disability of chronic stroke patients.

Aim of the study: to study the effect of bilateral hand training with weight on the non paretic hand on the hand performance and time of performance in chronic stroke patients.

Materials and Methods: Thirty left chronic stroke patients participated in this study. The patients were assigned randomly into two equal groups. Group one (G1) received unilateral hand training and group two (G2) received bilateral hand training with weight on non affected hand. Both groups assessed two times before starting training program and after two months of training by Fugl meyer assessment scale, Wolf motor function test and hand dynamometer for the motor performance, time of performance and hand grip  respectively.

Results: the patients in G2 showed significant improvement in the hand performance (P<.0001) and significant decrease in the time of performance (P<.001) and also significant improvement of hand grip (P<.0001).

Conclusion: Bilateral hand movement with weight on the non affected hand has a significant effect on improving hand performance and decreasing the time of performance and increasing hand grip than unilateral hand movement.

Key words:  bilateral hand training, hand function, stroke.


  1. Cauraugh James, Kathye Light, Sangbum Kim, Mary Thigpen , Andrea Behrman. Chronic Motor Dysfunction After Stroke Recovering Wrist and Finger Extension by Electromyography-Triggered Neuromuscular Stimulation. 2000;31:1360-1364.
  2. Heidi C. Fischer, Kathy Stubblefield, Tiffany Kline, Xun Luo, Robert V. Kenyon, Derek G. Kamper. Hand Rehabilitation Following Stroke: A Pilot Study of Assisted Finger Extension Training in a Virtual Environment. Top Stroke Rehabil. 2007;14(1):1–12.
  3. Deutsch JE, Merians AS, Adamovich S, Poizner H, Burdea GC. Development and application of virtual reality technology to improve hand use and gait of individuals post-stroke. Restor Neurol Neurosci. 2004;22(3-5):371–386.
  4. Kyoung Ju Han and Jin Young Kim. The effects of bilateral movement training on upper limb function in chronic stroke patients. J Phys Ther Sci. 2016;28(8): 2299–2302.
  5. Mudie MH , Matyas TA. Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke? Disabil Rehabil. 2000;22:23–37.
  6. Lin Jau-Hong, Hsu Miao-Ju, Sheu Ching-Fan, Wu Tzung-Shian, Lin Ruey-Tay, Chen Chia-Hsin , Hsieh Ching-Lin. Psychometric Comparisons of 4 Measures for Assessing Upper-Extremity Function in People With Stroke. PHYS THER. 2009;89:840-850.
  7. Cauraugh James H, Coombes Stephen A, Lodha Neha, Naik Sagar K, Summers Jeffery J. Upper extremity improvements in chronic stroke: Coupled bilateral load training. Restor Neurol Neurosci. 2009;27(1):17–25.
  8. Debaere F, Wenderoth N, Sunaert S, Van Hecke P , Swinnen SP. Changes in brain activation during the acquisition of a new bimanual coordination task. Neuro psychologia .2004;42:855–867.
  9. Regnaux JP, Pradon D , Roche N, Robertson J , Bussel B , Dobkin B. Effects of loading the unaffected limb for one session of locomotor training on laboratory measures of gait in stroke. Clinical Biomechanics.2008;23(6):762–768.
  10. Velozo Craig A, Woodbur Michelle L. Translating measurement findings into rehabilitation practice: An example using Fugl-Meyer Assessment-Upper Extremity with patients following stroke. Journal of rehabilitation research and development(JRRD). 2011;48(10):1211-1222.
  11. Cauraugh James H, Lodha Neha, Naik Sagar K, Summers Jeffery J. Bilateral Movement Training and Stroke Motor Recovery Progress: A Structured Review and Meta-Analysis. Hum MovSci .2010;29(5):853–870.
  12. Marusteri Marius, Bacarea Vladimir. Comparing groups for statistical differences: how to choose the right statistical test? Biochemia Medica 2010;20(1):15-32.
  13. Wu CY, Trombly CA, Lin KC, Tickle Degnen L. A kinematic study of contextual effects on reaching performance in person with and without stroke: influences of object availability. Arch Phys Med Rehabil. 2000;81:95-101.
  14. Levy CE, Nichols DS, Schmalbrock PM, Keller P , Chakeres DW. Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraint-induced movement therapy. Am J Phys Med Rehabil. 2001;80:4-12.
  15. Ströckens F, Güntürkün O, Ocklenburg S. Limb preferences in non-human vertebrates. Laterality .2013;18:536–575.
  16. Langan J , Van Donkelaar P. The influence of hand dominance on the response to a constraint-induced therapy program following stroke. Neurorehabil Neural Repair. 2008;22(3):298-304.
  17. Takeuchi Naoyuki , Oouchida Yutaka , Izumi Shin-Ichi  . Motor Control and Neural Plasticity through Interhemispheric Interactions. Neural Plasticity. 2012;10:1155-13.
  18. Van Der Knaap LJ, Van Der Ham IJM. How does the corpus callosum mediate interhemispheric transfer? A review. Behavioural Brain Research.2011;(223)1:211–221.
  19. Nowicka A, Tacikowski P.  Transcallosal transfer of information and functional asymmetry of the human brain.  Laterality.2011;16(1):35-74.
  20. Ameli M, Grefkes C, Kemper F, Riegg FP, Rehme AK, Karbe H, Fink GR, Nowak DA. Differential effects of high-frequency repetitive transcranial magnetic stimulation over ipsilesional primary motor cortex in cortical and subcortical middle cerebral artery stroke. Annals of Neurology.2009;66(3):298–309.
  21. Takeuchi N, Tada T, Toshima M, Chuma T, Matsuo Y, Ikoma K. Inhibition of the unaffected motor cortex by 1 HZ repetitive transcranial magnetic stimulation enhances motor performance and training effect of the paretic hand in patients with chronic stroke. .Journal of Rehabilitation Medicine. 2008;40(4):298–303.
  22. Rizzo V, Siebner HR, Morgante F, Mastroeni C, Girlanda P, Quartarone A. Paired associative stimulation of left and right human motor cortex shapes interhemispheric motor inhibition based on a hebbian mechanism. Cerebral Cortex. 2009;19(4):907-915.
  23. Takeuchi N, Ikoma K. 1 Hz rTMS over unaffected hemisphere in stroke patients alters bilateral movements and coupling between motor areas. Clinical Neurophysiology. 2010;121(1):316.
  24. Di Lazzaro V, Profice P, Pilato F, Capone F, Ranieri F, Pasqualetti P, Colosimo C, Pravatà E, Cianfoni A ,Dileone M. Motor cortex plasticity predicts recovery in acute stroke. Cerebral Cortex.2010;20(7):1523–1528.
  25. McCombe Waller S, Harris-Love M, Liu W , Whitall J. Temporal coordination of the arms during bilateral simultaneous and sequential movements in patients with chronic hemiparesis. Exp Brain Res. 2006;168:450-454.
  26. Stoykov ME, Lewis GN , Corcos DM. Comparison of bilateral and unilateral training for upper extremity hemiparesis in stroke. Neurorehabil Neural Repair .2009;23:945-953.
  27. Lin Chorng-Horng, Chen Michael,  Sun Mu-Chien. Circulating apoptotic factors in patients with acute cerebral infarction.clinical biochemistry.2010;43(9):761-763.
  28. Kwakkel G, Kollen BJ, Krebs HI. Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabil Neural Repair. 2008;22:111-121.
  29. Cauraugh JH, Kim SB. Two coupled motor recovery protocols are better than one: electromyogram-triggered neuromuscular stimulation and bilateral movements. Stroke. 2002;33:1589-1594.
  30. Van Dieen JH, Futoshi O , De Haan A. Reduced neural drive in bilateral exertions: A performance-limiting factor. Med Sci Sports Exerc. 2003;35(1):111-118.
  31. YangChieh-Ling, LinKeh-Chung,  ChenHsieh-Ching,  WuChing-Yi,  ChenChia-Ling . Pilot Comparative Study of Unilateral and Bilateral Robot-Assisted Training on Upper-Extremity Performance in Patients With Stroke. American Journal of Occupational Therapy.2012;66:198-206.
  32. McCombe Waller S, Liu W , Whitall J. Temporal and spatial control following bilateral versus unilateral training. Hum Mov Sci. 2008;27:749-758.
  33. Wu CY, Chuang LL, Lin KC, Chen HC , Tsay PK. Randomized trial of distributed constraint-induced therapy versus bilateral arm training for the rehabilitation of upper-limb motor control and function after stroke. Neurorehabil Neural Repair .2011;25:130-139.

Cite this article: Hoda M. Zakaria, Walaa M. Ragab, Olfat I. Ali. EFFECT OF WEIGHTED HAND MOVEMENTS ON HAND FUNCTION IN CHRONIC STROKE PATIENTS. Int J Physiother Res 2017;5(1):1885-1892. DOI: 10.16965/ijpr.2016.214