tween the intervention and control groups obtained by
preventing these patients from an active motor learning
process may have contributed to a relatively larger effect
size for leg training compared with other studies. Finally,
when considering the impact of intensity of rehabilitation
on stroke outcome, it should be realized that the intensity
of rehabilitation programs is often limited.49,50 For example,
in stroke units the usual direct contact time may be as
little as 4% of the total waking time. Ten hours of therapy
per week (2 hours daily) represents only 9% of the waking
time.51 It should also be acknowledged that "2 hours of
therapy each day is not feasible for every patient or clinical
setting because of inability to tolerate the extra therapy
sessions or to limited personnel. Several studies have shown,
however, that augmentation of functional oriented therapy may be
achieved by applying “constraints” to the less affected arm, forcing
the affected limb to be used during ADL for 6 hours per day during
2 weeks (ie, augmentation of 60 hours).52 From these studies, it may
be hypothesized that a high dose of task-specific exercise training
should be applied over a shorter period of time. Recent studies have