OBJECTIVE: To evaluate the immediate and long-term effects of 2 upper-extremity 
rehabilitation approaches for stroke compared with standard care in participants 
stratified by stroke severity.
DESIGN: Nonblinded, randomized controlled trial (baseline, postintervention, 
9mo) design.
SETTING: Inpatient rehabilitation hospital and outpatient clinic.
PARTICIPANTS: Sixty-four patients with recent stroke admitted for inpatient 
rehabilitation were randomized within severity strata (Orpington Prognostic 
Scale) into 1 of 3 intervention groups. Forty-four patients completed the 
9-month follow-up.
INTERVENTIONS: Standard care (SC), functional task practice (FT), and strength 
training (ST). The FT and ST groups received 20 additional hours of 
upper-extremity therapy beyond standard care distributed over a 4- to 6-week 
period.
MAIN OUTCOME MEASURES: Performance measures of impairment (Fugl-Meyer 
Assessment), strength (isometric torque), and function (Functional Test of the 
Hemiparetic Upper Extremity [FTHUE]).
RESULTS: Compared with SC participants, those in the FT and ST groups had 
significantly greater increases in Fugl-Meyer motor scores (P=.04) and isometric 
torque (P=.02) posttreatment. Treatment benefit was primarily in the less severe 
participants, where improvement in FT and ST group Fugl-Meyer motor scores more 
than doubled that of the SC group. Similar results were found for the FTHEU and 
isometric torque. During the long term, at 9 months, the less severe FT group 
continued to make gains in isometric muscle torque, significantly exceeding 
those of the ST group (P<.05).
CONCLUSIONS: Task specificity and stroke severity are important factors for 
rehabilitation of arm use in acute stroke. Twenty hours of upper 
extremity-specific therapy over 4 to 6 weeks significantly affected functional 
outcomes. The immediate benefits of a functional task approach were similar to 
those of a resistance-strength approach, however, the former was more beneficial 
in the long-term.