Ipsilesional Arm Remediation
(2026)Objective
To determine whether training of the less impaired ipsilesional arm improves motor performance in chronic stroke patients with severe contralesional arm paresis
Study Summary
• Improvement sustained at 3-week and 6-month follow-up; no significant effects on Barthel Index, Fugl-Meyer, or ABILHAND-Stroke
Intervention
Ipsilesional virtual reality and manipulation training (5 weeks, 15 sessions) vs dose-matched best practice contralesional arm therapy
Inclusion Criteria
Adults with radiologically confirmed unilateral MCA stroke, severe contralesional upper-extremity impairment (Fugl-Meyer ≤28), and ipsilesional motor deficits
Study Design
Arms: Ipsilesional VR + manipulation training vs Best practice contralesional arm therapy
Patients per Arm: Ipsilesional: 25, Contralesional: 28
Outcome
• Improvement sustained at 3-week and 6-month follow-up
• No significant effects on Barthel Index, Fugl-Meyer, or ABILHAND-Stroke
Bottom Line
Targeted ipsilesional arm training with virtual reality and manipulation significantly improved ipsilesional hand function (12% faster on JTHFT, p=0.003) in chronic stroke patients with severe hemiparesis, with benefits sustained at 6 months. This identifies the ipsilesional arm as an important and modifiable rehabilitation target.
Major Points
- First RCT demonstrating that ipsilesional arm motor deficits are modifiable even years after stroke
- Significant improvement in Jebsen-Taylor Hand Function Test: −5.87 seconds (95% CI −8.89 to −2.85, P=0.003), representing a 12% reduction in completion time
- Improvements sustained at both 3-week and 6-month follow-up in the ipsilesional training group only
- No improvement in functional independence (Barthel), contralesional impairment (Fugl-Meyer), or perceived manual ability (ABILHAND-Stroke)
- Supports the ipsilesional arm as an underrecognized rehabilitation target for patients with severe hemiparesis who depend on that limb for daily independence
Study Design
- Study Type
- Two-site, parallel-group, randomized clinical trial with blinded outcome assessment
- Randomization
- Yes
- Blinding
- Blinded outcome assessment (assessor-blinded)
- Sample Size
- 53
- Follow-up
- 6 months post-treatment
- Centers
- 2
- Countries
- USA
Primary Outcome
Definition: Jebsen-Taylor Hand Function Test (excluding writing) — ipsilesional motor performance
| Control | Intervention | HR/OR | P-value |
|---|---|---|---|
| No significant improvement | Significant improvement | - (−8.89 to −2.85) | 0.003 |
Limitations & Criticisms
- Small sample size (n=53) limits generalizability
- Only 2 sites in the USA
- No improvement in functional independence or patient-reported outcomes despite motor performance gains
- Assessor-blinded but not participant- or therapist-blinded, which may introduce performance bias
- Specific to patients with severe hemiparesis (Fugl-Meyer ≤28) — findings may not generalize to mild/moderate deficits
Citation
Maenza C et al. JAMA Neurol. 2026;83(3):223-230. DOI: 10.1001/jamaneurol.2025.5496