BY conventional, wisdom, people who still have a weak arm a year after a stroke are unlikely to regain use of it. Might that prognosis change with intensive therapy that includes restricting use of the stronger arm?

A study involved 41 people who had had a stroke an average of 4 1/2 years earlier that had left them with restricted mobility in one arm. Twenty-one received one-on-one therapy, six hours a day each weekday for two weeks, involving tasks that steadily became more difficult. For 90% of the time they were awake during those weeks, they also wore a splint or sling that immobilised their stronger arm. People in the other group were given general fitness training for strength, balance and stamina as well as cognitive and relaxation exercises.

After two weeks, people who had had an arm constrained had improved about two points on an 11-point scale in the ability to do such things as hold a book, brush their teeth or open a door; others reported no change. Another test showed an 87% increase in arm use for the constrained group, compared with a 20% decrease for the others. Two years later, the changes had been maintained.

Who may be affected by these findings? People with an arm weakened by a stroke. Because a stroke damages parts of the brain, survivors often need to re-learn skills that have been lost.

Caveats: Participants worked with a physical therapist on tasks tailored to their specific motor deficits; variations in therapy may produce different results.

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