Stinear et al. conducted a single center controlled randomized trial, recently published online in stroke, to evaluate the hypothesis of promoting re-balancing of cortico-motor cortex excitability, which in turn leads to accelerated upper extremities recovery post stroke, utilizing bilateral priming with active-passive movements before upper limb physiotherapy. This study shed a light on a key question, as the recovery of the upper limb function is a predictor of the ability of living independently post-stroke.


Patients, a total of 57, in this prospective controlled and randomized trial were randomized during the sub-acute phase post-stroke to either a priming group, who received a device-assisted mirror symmetric bimanual movements every weekday for 4 weeks, or a control group, who received intermittent cutaneous electrical stimulation of the paretic forearm for the same period of time. Assessment at 6, 12, and 26 weeks, measured with the Action Research Arm Test showed that the priming group were 3 times more likely than controls to achieve their recovery plateau by 12 weeks. Also, primed participants had greater re-balancing of cortico-motor excitability than controls at 12 and 26 weeks and inter-hemispheric inhibition at 26 weeks.

In short, this trial suggests that patients who receive bilateral priming using device-assisted mirror symmetric bimanual movements have a faster recovery of upper extremity function in the initial weeks post-stroke, which will lead to a better chance of living independently. This is yet to be proven by larger scale randomized trials.