Abstract TP349: Bimanual Therapy for Post Stroke Individuals: A Scoping Review of Evidence, Protocols, and Outcomes

Background/Rationale: Bimanual therapy (BT), engaging both hands simultaneously in functional or task specific activities, is increasingly used to target post stroke upper limb deficits. Evidence, however, is scattered across heterogeneous protocols, patient populations, and outcome metrics, making clinical translation challenging. Objective: To map adult post stroke bilateral training literature, summarizing approaches, populations, outcomes, effects (efficacy, feasibility, safety), and gaps to inform practice and research. Methods: Scoping review (PRISMA ScR) of PubMed/MEDLINE, CENTRAL, trial registries; backward snowballing from recent meta analyses. Included adults with post ischemic/hemorrhagic stroke upper limb impairment receiving structured bilateral training (e.g., bilateral arm training, bimanual functional tasks, mirror based bimanual paradigms, robotic assisted bimanual rehab). Outcomes: motor function, ADLs, neuroplasticity, QoL, adherence, and safety. Results: Meta analyses of 14-25 RCTs (~700-840 patients) show that bilateral training (BT) improves motor impairment (FMA UE +4-8 points) more than conventional therapy, especially in chronic, mildly impaired, and high dose settings. Benefits over unilateral training are modest overall, but significant in subacute stroke for motor and ADL outcomes. BT approaches include bilateral functional tasks, rhythmic auditory cueing (BATRAC), robotic devices (e.g., Bi Manu Track, exoskeletons), and mirror-based paradigms. Trials show BT can enhance motor outcomes, distal hand function, and even cortical reorganization, with high repetition protocols (2–6 weeks, several sessions/week) and minimal adverse events. Common outcomes are motor impairment (FMA UE, ARAT, WMFT), activity/ADL scales, QoL measures, and neuroplasticity markers. Motor impairment improves most consistently; functional and QoL results are mixed. Key gaps: heterogeneous protocols/dosing, small samples, limited long-term data, sparse reporting of QoL, adherence, and safety, and few stratified or pragmatic head to head trials. Conclusions: BT is a feasible and generally safe post stroke strategy with consistent motor impairment benefits and selective functional advantages, particularly with BFTT, appropriate dosing, and phase/severity informed selection. Priority areas include standardized protocols and dosing, pragmatic trials powered for ADL/QoL, and integration of neurophysiological markers to refine for whom/what dose/which protocol decisions.