BACKGROUND: The purpose of the present study was to investigate the effects of different intensities of upper extremity (UE) and lower extremity rehabilitation (LE) on the functional recovery of ADL, walking ability and dexterity of the paretic arm, in a single-blinded randomised controlled trial. METHODS: Within 14 days post stroke onst, 101 severely disabled stroke patients with a primary middle cerebral artery (MCA) stroke were randomly distributed into (1) a rehabilitation programme with an emphasis on UE, (2) a rehabilitation programme with an emphasis on LE, or (3) a control condition in which upper and lower extremity were immobilized with an inflatable pressure splint (CT). Each treatment regime was applied for 30 minutes 5 days a week during the first 20 weeks post stroke onset. In addition, all stroke patients received 5 days a week a basic rehabilitation programme comprising of 15 minutes for UE, 15 minutes for LE and each week 1.5 hour for ADL-training. Differences in efficacy between the 3 treatment regimes were evaluated in terms of ADL, walking ability and dexterity of the paretic arm at 6, 12, 20 and 26 weeks post stroke. In addition, differences in efficacy were studied in terms of improvements in walking velocity and number of applied walking devices. The changes in health related functional status were evaluated at baseline, 12 and 26 weeks post stroke, whereas changes in extended ADLs were evaluated at baseline and 26 weeks. RESULTS: Intention-to-treat analysis during the first 20 weeks post stroke revealed that LE compared to CT significantly improved ADL (19 versus 16 on BI, p < 0.05), dexterity (2 versus 0 points on ARA, p < 0.01), walking ability (4 versus 3 points on FAC, p < 0.05), maximal (0.88 versus 0.52 m/s, p < 0.05) and comfortable walking speeds (0.65 versus 0.37 m/s, p < 0.05). At 20 weeks post stroke, LE showed no significant differences in ADL, walking ability and walking speeds compared to UE. In addition, it was found that UE significantly improved the recovery of dexterity compared to CT from week 12 onwards (9 versus 0 points on ARA at week 20, p < 0.01). Finally, it was found that the effects of LE compared to CT significantly improved the items of the health related functional status referring to the physical health status of stroke patients during the first 3 months. INTERPRETATION: Higher intensity of lower extremity rehabilitation improves functional recovery as well as health related functional status, whereas higher intensity of upper extremity rehabilitation results in small improvements in dexterity, providing further evidence for the claim that exercise therapy primarily induces treatment effects on parameters specifically trained.

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