Effect of intensive motor training with repetitive transcranial magnetic stimulation on upper limb motor function in chronic post-stroke patients with severe upper limb motor impairment

Background Intensive motor training with low-frequency repetitive transcranial magnetic stimulation (rTMS) has efficacy as a therapeutic method for motor dysfunction of the affected upper limb in patients with mild to moderate stroke. However, it is not clear whether this combination therapy has the same effect in chronic post-stroke patients with severe upper limb motor impairment.

Objectives The aim of this study was to test the treatment effects of intensive motor training with low-frequency rTMS in chronic post-stroke patients with severe upper limb motor impairment.

Methods A convenience sample of 26 chronic post-stroke patients with severe upper limb motor impairment participated in this study with the non-randomized, non-controlled clinical trial. All subjects were hospitalized to receive intensive motor training with low-frequency rTMS. During 2 weeks in which Sundays were excluded, a total of 24 sessions (2 sessions per day) of the intervention were conducted. The Fugl–Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were used to assess motor impairment and function of the affected upper limb, respectively, before and after intervention. Paired t-test was used to analyze the effects of the intervention.

Results The FMA total score and WMFT log performance time significantly improved from before to after intervention (FMA: 12.6–18.0; WMFT: 3.6–3.3, p < 0.001).

Conclusions The present results suggest that intensive motor training with low-frequency rTMS could improve motor impairment in chronic post-stroke patients with severe upper limb motor impairment and contribute to the expansion of the application range of this combination therapy.     

早期介入运动想象疗法对急性脑卒中偏瘫患者下肢运动功能及日常生活活动能力的影响

目的探讨早期介入运动想象疗法对急性脑卒中偏瘫患者下肢运动功能和日常生活活动能力的影响。方法将67例急性脑卒中偏瘫患者随机分为运动疗法组(34例)、对照组(33例)。对照组采用常规西药和基础康复治疗,运动疗法组在此基础上采用运动想象疗法进行早期干预。分别于入组时,治疗后2、4、8周以及90 d,采用简化的Fugl-Meyer运动量表(FMA)和改良Barthel指数量表(MBI)评定患者的下肢运动功能和日常生活活动能力。结果两组治疗前下肢FMA及MBI评分差异无统计学意义(P0.05)。至第8周,两组患者下肢FMA及MBI评分呈增高趋势,各时间点差异有统计学意义(均P0.05),两组患者第90 d与第8周差异无统计学意义(均P0.05)。运动疗法组第2、4、8周及第90 d的下肢FMA及MBI评分均高于对照组(均P0.05)。结论在常规康复治疗基础上,早期介入运动想象训练可显著促进急性脑卒中偏瘫患者下肢运动功能和日常生活活动能力的恢复。     

Efficacy of motor imagery additional to motor-based therapy in the recovery of motor function of the upper limb in post-stroke individuals: a systematic review

Background. Motor imagery (MI) consists of the mental simulation of repetitive movements with the intention of promoting the learning of a motor skill. It seems to be an additional useful tool for motor-based therapy to potentiate the rehabilitation of the upper limb function of post-stroke individuals. Objective. To investigate whether MI combined with motor-based therapy is effective in recovering motor deficits of upper limbs from post-stroke individuals. Method. A systematic review of the literature was performed in the PEDro, LILACS, Cochrane, SCOPUS, Medline/PubMed and SciELO databases. Randomized controlled trials (RCTs) investigating the efficacy of MI associated with motor-based therapy compared with isolated motor-based therapy were included. The included outcomes were gross motor function and functional activities of the upper limb of post-stroke individuals. The physiotherapy evidence database scale was applied for evaluation of methodological quality. Results. Four RCTs were included, with a total of 104 participants, with methodological quality varying from moderate to high. There was a statistically significant improvement in upper limb motor function in all studies. Gross motor function was higher in MI associated with motor-based therapy compared to controls, but only in one study there was superiority in the results of functional activities of the upper limb. Conclusion. There is evidence showing that MI associated with motor-based therapy is an effective tool in improving the motor function of upper limbs of post-stroke individuals. However, more studies are needed to establish criteria for frequency and duration of intervention, and what better type of MI should be used.     

Mental practice for upper limb motor restoration after stroke: an updated meta-analysis of randomized controlled trials

Objectives: Stroke is a common refractory disease that may cause dysfunctions in the motor system. The study aimed to evaluate the effects of mental practice (MP) compared with other methods on upper limb motor restoration after stroke.

Methods: Eligible studies were identified from Pubmed, Embase, and The Cochrane Library. The study quality was assessed with the Cochrane risk assessment tool and heterogeneity test was performed using I² statistic and Q test. Random- and fixed-effects models were used and data were reported as weighted mean difference (WMD) and 95% confidence intervals (CIs). The publication bias was examined by Egger’s test and the sensitivity analysis was conducted by ignoring one literature at a time to observe whether this document could reverse the merged results.

Results: Total of 12 randomized controlled trials were identified. No evidence of publication bias was found. In a fixed-effect model, MP (experimental group) resulted in a significantly larger increase in Fugl-Meyer assessment (FMA) compared with other exercise methods (control group) (WMD = 2.0702, 95% CI: 1.2354–2.905, Z = 4.8606, P < 0.001). In a random-effect model, a significant pooled outcome was obtained for action research arm test (ARAT) (WMD = 4.0936, 95% CI: 1.9900–6.1971, Z = 3.8141, P < 0.001). Sensitivity analysis revealed that the merged WMDs of FMA and ARAT were not reversed.

Conclusions: Mental practice is effective on upper limb motor restoration after stroke. It is recommended to treat with MP to improve the outcome of stroke.     

Cortical reorganization after motor stroke: A pilot study on differences between the upper and lower limbs

Stroke patients suffering from hemiparesis may show substantial recovery in the first months poststroke due to neural reorganization. While reorganization driving improvement of upper hand motor function has been frequently investigated, much less is known about the changes underlying recovery of lower limb function. We, therefore, investigated neural network dynamics giving rise to movements of both the hands and feet in 12 well‐recovered left‐hemispheric chronic stroke patients and 12 healthy participants using a functional magnetic resonance imaging sparse sampling design and dynamic causal modeling (DCM). We found that the level of neural activity underlying movements of the affected right hand and foot positively correlated with residual motor impairment, in both ipsilesional and contralesional premotor as well as left primary motor (M1) regions. Furthermore, M1 representations of the affected limb showed significantly stronger increase in BOLD activity compared to healthy controls and compared to the respective other limb. DCM revealed reduced endogenous connectivity of M1 of both limbs in patients compared to controls. However, when testing for the specific effect of movement on interregional connectivity, interhemispheric inhibition of the contralesional M1 during movements of the affected hand was not detected in patients whereas no differences in condition‐dependent connectivity were found for foot movements compared to controls. In contrast, both groups featured positive interhemispheric M1 coupling, that is, facilitation of neural activity, mediating movements of the affected foot. These exploratory findings help to explain why functional recovery of the upper and lower limbs often develops differently after stroke, supporting limb‐specific rehabilitative strategies.     

镜像训练引导的运动想象疗法对急性缺血性脑卒中偏瘫患者上肢功能的康复效果

目的:本研究旨在对镜像训练引导的运动想象疗法是否能够更有效地改善急性缺血性脑卒中后偏瘫患者的上肢功能以及日常生活能力进行评价。方法:研究对象为2014年1月1日—2016年6月30日符合病例选择标准的76例急性缺血性脑卒中后偏瘫患者。将76例患者随机分入镜像训练引导的运动想象疗法组(38例)和单纯的运动想象疗法组(38例),在常规康复训练的基础上,分别接受镜像训练引导的运动想象疗法和单纯的运动想象疗法,共治疗4周。对2组治疗前后的美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、Barthel指数、上肢动作研究量表(Action Research Arm Test,ARAT)评分和Fugl-Meyer上肢运动功能评分进行比较。结果:2组患者治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分均较治疗前显著改善(P值均0.05)。镜像训练引导的运动想象疗法组治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分的改善幅度均显著大于单纯的运动想象疗法组(P值均0.05)。结论:镜像训练引导的运动想象疗法应用于急性缺血性脑卒中后偏瘫患者上肢功能的康复治疗,与单纯的运动想象疗法相比,可以更好地改善患者的上肢功能和生活自理能力。     

Factors affecting rehabilitation and use of upper limb after stroke: views from healthcare professionals and stroke survivors

Background: Training of the upper limb (UL) is limited in stroke rehabilitation, and about 50% of stroke survivors do not regain useful function in their upper limb.

Objectives: This study explored what factors affect rehabilitation and use of upper limb after stroke from a stroke survivor and healthcare professional perspective to better understand low engagement in UL rehabilitation in the chronic stages of stroke.

Method: Eight chronic stroke survivors and 21 healthcare professionals took part in semi-structured interviews or in one of three focus groups, respectively.

Results: Thematic analysis revealed three main themes: Availability of resources, Healthcare professional–patient relationship, and Psychosocial factors. Availability of resources and Healthcare professional–patient relationship indicated that due to resource pressures and a lack of communication and education, positive upper limb rehabilitation behaviors (e.g. engaging and integrating the upper limb in daily activity) were not always established in the early stages post-stroke. Psychosocial factors illustrated the cognitive and psychological barriers to sustained engagement with upper limb rehabilitation.

Conclusion: The findings indicate that stroke survivors and healthcare professionals have very similar understandings of barriers to UL activity, and positive upper limb rehabilitation behaviors are not always established early in recovery post-stroke. Increased resources and healthcare professional–patient relationships seem key factors to establishing positive perceptions of UL rehabilitation. Addressing psychosocial issues and resource limitations may help sustain engagement with UL rehabilitation.     

Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke

The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains un- clear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-week follow-up, and then compared with healthy subjects. The FugI-Meyer Assessment and Wolf Motor Function Test scores of the hemiplegic upper limbs of stroke patients were significantly increased 3 weeks after training and at the 12-week follow-up. Functional MRI results showed that contralateral primary sensorimotor cortex was activated after Kinect-based virtual reality training in the stroke patients compared with the healthy subjects. Contralateral primary sensorimotor cortex, the bilateral supplementary motor area and the ipsilateral cerebellum were also activated during hand-clenching in all 18 healthy subjects. Our findings indicate that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sen- sorimotor cortex.     

Functional magnetic resonance imaging evaluation of brain function reorganization in cerebral stroke patients after constraint-induced movement therapy

In this study, stroke patients received constraint-induced movement therapy for 3 weeks. Before and after constraint-induced movement therapy, the flexibility of their upper limbs on the affected side was assessed using the Wolf motor function test, and daily use of their affected limbs was assessed using the movement activities log, and cerebral functional reorganization was assessed by functional magnetic resonance imaging. The Wolf motor function test score and the movement activities log quantity and quality scores were significantly increased, while action performance time in the Wolf motor function test was significantly decreased after constraint-induced movement therapy. By functional magnetic resonance imaging examination, only scattered activation points were visible on the affected side before therapy. In contrast, the volume of the activated area was increased after therapy. The activation volume in the sensorimotor area was significantly different before and after therapy, and the activation area increased and appeared adjusted. In addition to the activated area around the lesions being decreased, there were also some new activated areas, including the supplementary movement area, premotor area and the ipsilateral sensorimotor area. Our findings indicate that constraint-induced movement therapy significantly improves the movement ability and daily use of the affected upper limbs in stroke patients and promotes cerebral functional reorganization.     

三级康复训练对脑出血后上肢运动功能的改善情况

目的 探讨三级康复训练对脑出血后上肢运动功能的改善情况。方法 采用随机、对照与双盲研究方法选择本院2013年2月-2017年1月收治的脑出血患者220例,以随机方法将患者分为对照组和观察组,均为110例,对于对照组患者开展常规康复训练,而对于观察组患者,不仅开展常规康复训练,同时还给予三级康复训练,记录上肢运动功能改善情况。结果 康复后观察组与对照组的上肢运动功能评分分别为(49.44±5.69)和(43.49±6.14)分,都高于康复前的(36.23±6.19)和(37.10±5.69)分(P<0.05),且康复后观察组的评分高于对照组(P<0.05); 在肩手综合征的发生率方面观察组为0.9%,而对照组为10.9%,观察组低于对照组(P<0.05); 观察组康复期间的生活作息、正规服药、复诊随访、均衡饮食、康复训练依从性评分高于对照组(P<0.05); 康复后观察组的活力、总体健康、躯体疼痛等方面评分显著高于对照组(P<0.05)。结论 三级康复训练在脑出血患者中的应用能改善患者上肢运动功能状况,降低发生肩手综合征的概率,提升患者康复的依从性,进而提升患者的生活质量。     

Early motor network connectivity after stroke: An interplay of general reorganization and state‐specific compensation

Motor recovery after stroke relies on functional reorganization of the motor network, which is commonly assessed via functional magnetic resonance imaging (fMRI)‐based resting‐state functional connectivity (rsFC) or task‐related effective connectivity (trEC). Measures of either connectivity mode have been shown to successfully explain motor impairment post‐stroke, posing the question whether motor impairment is more closely reflected by rsFC or trEC. Moreover, highly similar changes in ipsilesional and interhemispheric motor network connectivity have been reported for both rsFC and trEC after stroke, suggesting that altered rsFC and trEC may capture similar aspects of information integration in the motor network reflecting principle, state‐independent mechanisms of network reorganization rather than state‐specific compensation strategies. To address this question, we conducted the first direct comparison of rsFC and trEC in a sample of early subacute stroke patients (n = 26, included on average 7.3 days post‐stroke). We found that both rsFC and trEC explained motor impairment across patients, stressing the clinical potential of fMRI‐based connectivity. Importantly, intrahemispheric connectivity between ipsilesional M1 and premotor areas depended on the activation state, whereas interhemispheric connectivity between homologs was state‐independent. From a mechanistic perspective, our results may thus arise from two distinct aspects of motor network plasticity: task‐specific compensation within the ipsilesional hemisphere and a more fundamental form of reorganization between hemispheres.     

虚拟现实技术结合肢体协调辅助装置训练对缺血性脑卒中患者脑灰质含量及肢体运动功能的影响

目的 探讨虚拟现实（VR）技术结合肢体协调辅助装置训练对缺血性脑卒中患者脑灰质含量、运动功能、认知功能和日常生活能力的影响。方法 选取2022年2月至2023年1月合肥市第二人民医院收治的122例缺血性脑卒中患者作为研究对象,按照随机数字表法分为对照组（61例）和观察组（61例）,其中对照组患者采取肢体协调辅助装置训练,观察组采取VR结合肢体协调辅助装置训练,治疗周期为2个月。对比治疗前后2组患者睁眼1 min轨迹面积、睁眼1 min摆动长度、上下肢运动功能、神经功能、认知功能和日常生活能力。结果 治疗后2组的睁眼1 min轨迹面积、睁眼1 min摆动长度均较治疗前显著减少（P<0.05）,且观察组的轨迹面积和摆动长度均小于对照组（P<0.05）。治疗后2组的上下肢运动评分、脑灰质含量、蒙特利尔认知评估量表（MoCA）评分和日常生活能力均较治疗前显著提高（P<0.05）,且观察组的这些指标水平均高于对照组（P<0.05）。治疗后神经功能评分均较治疗前显著降低（P<0.05）,且观察组的该评分低于对照组（P<0.05）。结论 VR结合肢体协调辅助装置训练可有效促进缺血性脑卒中患者平衡功能的恢复,提高患者肢体运动功能,改善患者神经功能、认知功能和日常生活能力。 [国际神经病学神经外科学杂志, 2023, 50(6): 19-23]     

Effect of upper limb deformities on gross motor and upper limb functions in children with spastic cerebral palsy

The aims of this study were to investigate the nature and extent of upper limb deformities via the use of various classifications, and to analyze the relationship between upper limb deformities and gross motor or upper limb functionality levels. Upper extremity data were collected from 234 children with spastic cerebral palsy (CP) who were admitted to the university hospital for intensive rehabilitation. Upper limb deformities were classified according to the Zancolli classification for finger and wrist extension ability, the Gshwind and Tonkin classification for supination ability, and the House classification for thumb-in-palm deformity. Digital deformity was also classified. Upper limb function was assessed using the Upper Extremity Rating Scale (UERS) and the Upper Limb Physician's Rating Scale (ULPRS). Gross motor function was assessed using the Gross Motor Functional Classification System (GMFCS). Among the 234 children observed, 70.5% had a limitation in forearm supination, and 62.8% had problems with wrist and finger extension in at least one limb. Thumb-in-palm deformity of at least one hand was found in 47.0% of patients. Swan neck deformity was the most common finger deformity. Upper limb functional measures, the ULPRS and the UERS, significantly correlated with the degree of upper limb deformity, as assessed by the Gschwind and Tonkin, Zancolli, and House classifications. Further, the degree of upper limb deformity was significantly related to the GMFCS level in children with bilateral CP, but not in children with unilateral CP. Limitation of forearm supination was the most common upper limb deformity in children with spastic CP. The degree of upper limb deformity significantly affected upper limb function in these children.     

Imaging functional motor connectivity in hemiparetic children with perinatal stroke

Perinatal stroke causes lifelong disability, particularly hemiparetic cerebral palsy. Arterial ischemic strokes (AIS) are large, cortical, and subcortical injuries acquired near birth due to acute occlusion of the middle cerebral artery. Periventricular venous infarctions (PVI) are smaller, subcortical strokes acquired prior to 34 weeks gestation involving injury to the periventricular white matter. Both stroke types can damage motor pathways, thus, we investigated resulting alterations in functional motor networks and probed function. We measured blood oxygen level dependent (BOLD) fluctuations at rest in 38 participants [10 arterial patients (age = 14.7 ± 4.1 years), 10 venous patients (age = 13.5 ± 3.7 years), and 18 typically developing controls (TDCs) (age = 15.3 ± 5.1 years)] and explored strength and laterality of functional connectivity in the motor network. Inclusion criteria included MRI‐confirmed, unilateral perinatal stroke, symptomatic hemiparetic cerebral palsy, and 6–19 years old at time of imaging. Seed‐based functional connectivity analyses measured temporal correlations in BOLD response over the whole brain using primary motor cortices as seeds. Laterality indices based on mean z‐scores in lesioned and nonlesioned hemispheres explored laterality. In AIS patients, significant differences in both strength and laterality of motor network connections were observed compared with TDCs. In PVI patients, motor networks largely resembled those of healthy controls, albeit slightly weaker and asymmetric, despite subcortical damage and hemiparesis. Functional connectivity strengths were not related to motor outcome scores for either stroke group. This study serves as a foundation to better understand how resting‐state fMRI can assess motor functional connectivity and potentially be applied to explore mechanisms of interventional therapies after perinatal stroke.     

Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study

The use of activity-dependent interventions has shown some success in promoting recovery of upper limb function in chronic stroke patients. This study compared the neurophysiological and behavioural changes associated with two such rehabilitation protocols: unilateral and bilateral movement training. Twelve chronic stroke patients were randomly assigned to the two training protocols involving six daily practice sessions. Each session consisted of 50 trials of a dowel placement task performed either with both impaired and unimpaired arm moving synchronously (bilateral training group) or with only the impaired arm moving (unilateral training). Kinematic measurements of upper limb movements were made in four unilateral test trials performed prior to and following each practice session. Functional assessments of the impaired upper limb and neurophysiological assessments, using transcranial magnetic stimulation (TMS), of the affected and non-affected cortical hemispheres were made prior to and following the intervention sessions. Individuals receiving bilateral training showed a reduction in movement time of the impaired limb and increased upper limb functional ability compared to individuals receiving unilateral training. In some patients changes to upper limb function were associated with changes to the cortical representation of a target muscle in the non-affected hemisphere. Overall, these findings suggest that a short-term bilateral training intervention may be effective in facilitating upper limb motor function in chronic stroke patients.     

针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效

目的观察针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效。方法选择我院2015-09-2016-11收治的脑卒中合并上肢功能障碍患者112例,根据随机数字表法将所有患者分为2组,每组56例。对照组给予常规康复训练,观察组在此基础上联合针刺治疗,比较2组临床疗效、日常生活能力评分、疼痛评分、上肢运动功能评分及神经功能评分。结果治疗后2组临床疗效相比,观察组优于对照组,差异具有统计学意义(P0.05);2组治疗前ADL、FMA、VAS、NDS评分相比,差异无统计学意义(P0.05);治疗后ADL、FMA、VAS、NDS评分均优于治疗前,组间相比,观察组优于对照组,差异具有统计学意义(P0.05)。结论针刺结合康复训练可改善老年脑卒中后上肢功能障碍,减少神经功能损伤和疼痛,提高日常生活能力。     

早期综合康复治疗对急性脑卒中患者运动功能的影响

目的:探讨早期康复治疗对急性脑卒中患者运动功能的影响。方法:将219例急性脑卒中患者随机分为康复治疗组和对照组。康复治疗组116例,对照组103例。两组患者均采用常规药物治疗,而康复治疗组在患者生命体征稳定24-48小时内采用神经肌肉促进技术、功能性电刺激、心理治疗等综合康复治疗措施,于治疗前及治疗3个月时采用Fugl-Meyer(Fugl-Meyer Assessment,FMA)评分评定患者的运动功能;用Barthel指数(Modified Barthel Index,MBI)评定患者的日常生活活动功能(ADL)。结果:康复治疗组患者的FMA评分及MBI评分均较对照组明显提高,其差异具有非常显著性意义(P<0.01)。结论:早期康复治疗可明显改善急性脑卒中患者的运动功能及日常生活活动能力。     

Effects of active and passive training apparatus combined with rehabilitation training on lower limb function of stroke patients during recovery period

BACKGROUND: Stroke patients always spontaneously do some learning and training of motor functions; however, learning and training are not prompt and right, while patients do not have enough activity amounts. Active and passive motor training apparatus is aimed directly at lower limb training so as to stimulate nerve function through stimulating muscular movement. Based on motor mileage, motor time, various power supplies and velocity of active and passive training apparatus, we can understand the training condition and adjust training program. OBJECTIVE: To observe the effects of grade-Ⅲ rehabilitation training combining with active and passive training apparatus on lower limb function, muscle strength and activity of daily living (ADL) in stroke patients during recovery period. DESIGN: Contrast observation. SETTING: Department of Rehabilitation, Jilin Academic Institute of Traditional Chinese Medicine. PARTICIPANTS: A total of 80 patients with stroke-induced hemiplegia after stabilizing vital signs for 2 weeks were selected from Department of Rehabilitation, Jilin Academic Institute of Traditional Chinese Medicine from January to June 2007. There were 47 males and 33 females, and their ages ranged from 41 to 75 years. All patients met the diagnostic criteria of the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were diagnosed as cerebral hemorrhage or cerebral infarction through CT or MRI examinations in clinic. Patients and their parents provided the confirmed consent. Based on therapeutic orders of hospitalization, patients were randomly divided into treatment group and control group with 40 patients in each group. METHODS: Patients in the control group received physical therapy and occupational therapy combining with rehabilitative treatment based on grade-Ⅲ rehabilitative treatment program, which was set by the National Cerebrovascular Disease Topic Group. In addition, patients in the treatment group were trained with active and passive motor training apparatus based on therapeutic procedures in the control group. The active and passive motor training apparatus was designed as the therapeutic style of nervous system; otherwise, the treatment was performed once a day, 30 minutes once and 6 times per week. Four weeks were regarded as a course. MAIN OUTCOME MEASURES: Before treatment, at 2 weeks after treatment and after the first course, bare-handed muscle strength examination was used to check muscle strength and muscular tension; in addition, simple Fugl-Meyer assessment (FMA) and diagnostic criteria which were set by the Fourth National Cerebrovascular Disease Academic Meeting were used to evaluate motor function of limbs and total ADL. RESULTS: All 80 stroke patients were involved in the final analysis. ① Muscle strength of lower limbs was improved in both treatment group and control group. After the first course, muscle strength in the treatment group was obviously superior to that in the control group (χ2=6.64, P < 0.05). ② After the first course, Fugl-Meyer scores in the treatment group were higher than those in the control group, and there was significant difference (t =2.82, P < 0.05). ③ Muscular tension of lower limbs was not changed in both treatment group and control group after treatment (P > 0.05). ④ After the first course, ADL in the treatment group was superior to that in the control group (P < 0.05). Among patients in the treatment group, 24 cases (60%) had obvious progress, 16 (40%) had progress, and 0 (0%) did not have any changes. On the other hand, among patients in the control group, 13 cases (32.5%) had obvious progress, 26 (65%) had progress, and 1 (2.5%) did not have any changes. CONCLUSION: Rehabilitation training combining with active and passive motor training apparatus can promote the recovery of lower limb disorder, increase muscle strength, control spasm, improve ADL and cause satisfactorily clinical effects in stroke patients during recovery period.