EXPLICIT-stroke

Prospective cohort studies show that about 80% of all stroke survivors have an upper limb paresis immediately after stroke. Only one third of all stroke patients will regain some dexterity, whereas well-researched evidence based therapies for effective treatment of the upper limb are lacking. However, the main claim of the literature is that functional recovery of the upper paretic limb is mainly defined within the first month post-stroke and that rehabilitation services should be applied preferably within this time window. Furthermore, it is known that exercise-related interventions are most effective when they are applied intensively and in a task-oriented way. EXPLICIT-stroke aims to obtain better functional outcome by early intensive rehabilitation. Next to clinical tests to measure improvement in function, neuroplasticity is assessed by fMRI, TMS, kinematics and haptic robots. The combination of clinical outcome measures and neuro-imaging will serve as a template for understanding basic mechanisms of functional recovery after stroke. EXPLICIT-stroke will provide an answer to the key question whether therapy induced improvements are due to either a reduction of basic motor impairment by neural repair or the use of behavioral compensation strategies.

1. Early rehabilitation intervention, i.e. Constraint Induced Movement Therapy (CIMT) or Elektromyography triggered neuromuscular stimulation (EMG-NMS), has a positive effect on functional outcome of upper limb paresis post stroke (A project)

2. Observed therapy-induced changes in upper limb function can be related to changes in (sub)cortical reorganisation, corticospinal tract integrity, peripheral neuromechanics and compensation strategies (B project).

15-09-2008: start inclusion of patients

31-12-2012: end of inclusion of patients

group A1: good prognosis: Constraint Induced Movement Therapy (CIMT) for 3 consecutive weeks, 5 days a week versus conventional therapy

group A2: poor prognosis:
Elektromyography-triggered neuromuscular stimulation (EMG-NMS) for 3 consecutive weeks, 5 days a week versus conventional therapy