Date of Award

Winter 12-5-2019

Degree Type


Degree Name

PhD Health Sciences


Health and Medical Sciences


Genevieve Pinto Zipp, Ed.D.

Committee Member

Fortunato Battaglia, Ph.D.

Committee Member

Preeti Raghavan, M.D.


Bimanual arm trainer, Stroke, Upper extremity.


Background and purpose

There are few evidence-based treatment options to address recovery in patients with severe upper extremity impairment post-stroke. Although robotic treatment options have been widely explored with variable outcomes, the contribution of bimanual training to improve upper extremity control and coordination has not yet been fully explored. To date, the mirrored motion Bimanual Arm Trainer (BAT) has not specifically been investigated for its effectiveness in stroke patients. This study explored the usefulness of the bimanual arm trainer in improving upper extremity function in stroke patients with severe deficits and its impact on quality of life.


Twenty-three patients poststroke underwent 1 hour of training over 12 sessions provided two to three times a week on the bimanual arm trainer. The training consisted of bimanual simultaneous movements interspersed with unimanual affected arm training using the bimanual arm trainer (Mirrored Motion Works, Inc.). The Fugl- Meyer Assessment of Motor Recovery after Stroke (FMA-UE), the streamlined Wolf Motor Function Test (WMFT), the Stroke Impact Scale (SIS), and the Modified Rankin Scale (MRS- SI) were assessed pre and post intervention.

Results of study

Upper extremity arm motor impairment as measured by FMA-UE showed statistically significant change from Pre1 (M = 23.59, SD = 10.11) to Pre-2 (M = 25.00, SD = 10.57) to post bimanual arm training intervention (M = 27.45, SD = 10.22). The mean increase was 3.86, 95% CI [-1.68, -6.05], p0.05). However, a paired samples t-test comparing SIS post intervention (220.97 ±19.46) to the Pre1 (213.52 ±21.04) showed a statistically significant increase of 6.652 (95% CI, -12.933 to -.371), t (22) = 2.196, p < 0.05). The Modified Rankin Scale did not change from Pre1 (M = 2.05, SD = 0.29) to Pre2 (M = 2.05, SD = 0.29) to post-intervention (M = 2.05, SD = 0.29).

Discussion and conclusion

Both measures of upper extremity motor impairment and function indicated a significant increase with only 12 sessions of bimanual arm training using the bimanual arm trainer as a treatment intervention. However, although function improved, participants’ perceptions of changes in quality of life were not observed, perhaps because the changes were not yet assimilated into daily life activities to impact quality of life.