Task Oriented Training For Stroke Rehabilitation: A Mini Review.

Stroke is the leading global cause of death and disability and the need for stroke rehabilitation services in increasing. The usual stroke rehabilitation protocol involves a combination of therapeutic exercises, occupational therapy, speech therapy and counselling sessions depending upon the severity of the deficit and associated co-morbidities. However, there is a need for better protocols and new therapies for improving outcomes after stroke rehabilitation. The term 'task-oriented training' (TOT) refers to guided rehabilitation training of patients' limb function using goal oriented tasks, which can be used to enhance neuroplasticity in brain after injury. Task oriented training could be modified with action selection and environmental enrichment to fulfill the limitations of stroke like, holistic approach, outcome/goal based intervention, proper dosage for desirable outcomes. This mini review provides an overview of the TOT and to identify gaps and challenges in stroke rehabilitation related to integrating TOT.

[Effects of Mirror Therapy Combined With Task-Oriented Training on Limb Function Recovery in Stroke Patients With Hemiplegia].

Objective: To explore the effects of mirror therapy combined with task-oriented training on limb function recovery in stroke patients with hemiplegia. Methods: A total of 304 older patients with post-stroke hemiplegia who received treatment in Nanyang Third People's Hospital between March 2020 and March 2022 were enrolled as the subjects. They were assigned to the intervention group and the control group through a systematic randomization method, with 152 patients in each group. The control group was treated with conventional medication and task-oriented training, while the intervention group received a combined mirror therapy in addition to the treatment given to the control group. Both groups received continuous treatment for 3 months. The pre-treatment findings and those obtained after 3 month of treatment were compared between the two groups in the following areas, the neurological functions, including the levels of neuron-specific enolase (NSE) and S100ß, a central nervous system specific protein, upper and lower limb motor function as reflected by Fugl-Meyer Assessment (FMA) score, balance ability as measured by Berg Balance Scale (BBS), and the integrated electromyography (iEMG) values of quadriceps femoris, gastrocnemius, and tibialis anterior muscles, three-dimensional gait spatiotemporal parameters, and quality of life as reflected by the assessment results for the National Institute of Stroke Scale (NIHSS) and Stroke-Specific Quality of Life Scale (SS-QOL). The findings were compared to identify changes. Results: After 3 months of treatment, the FMA and BBS scores and three-dimensional gait spatio-temporal parameters in the intervention group were significantly better than those in the control group (all P<0.05). Conclusion: Mirror therapy combined with task-oriented training promotes the function recovery of the affected limbs in older patients with post-stroke hemiplegia, effectively improves their motor function and quality of life, and helps improve patient prognosis.

Efficacy of task-oriented training for rehabilitation of stroke patients with hemiplegia in community / 中华全科医师杂志

Objective:To evaluate the efficacy of task-oriented training for rehabilitation of stroke patients with hemiplegia in the community.Methods:Eighty stroke patients with hemiplegia receiving rehabilitation in Shanghai Babsongyuan Subdistrict Community Health Service Center from January 2017 to December 2019 were enrolled in the study. According to the rehabilitation methods, the patients were divided into the observation group (42 cases) and the control group (38 cases). Both groups were given routine Bobath technique and motor relearning method for 3 months; on this basis the observation group was given additional task-oriented training. The Brunnstrum stage was used to evaluate the limb function, Bobath balance scale was used to evaluate the sitting and standing balance function, and modified Barthel Index (MBI) was used to evaluate the activities of daily living.Results:The Brunnstrum stage of upper limbs, hands and lower limbs, Bobath sitting and standing balance function classification and MBI score of the two groups were significantly improved after treatment (the observation group: Uc=5.037, 4.567, 5.228, 2.538, 6.508, t=36.215, P<0.05; the control group: Uc=2.483, 2.311, 2.335, 2.200, 4.102, t=29.260, P<0.05). While the Brunnstrum stage of upper limb, hand and lower limb, Bobath sitting and standing balance function grade of observation group were significantly better than those of control group, MBI score was significantly higher than that of control group ( Uc=2.592, 2.243, 2.897, 2.018, 2.825, t=8.375, P<0.05). Conclusion:Bobath technique and motor relearning method combined with task-oriented training can significantly enhance the recovery of limb motor function and the improvement of activities of daily living of stroke patients.

The effects of mental practice combined with modified constraint-induced therapy on corticospinal excitability, movement quality, function, and activities of daily living in persons with stroke.

PURPOSE: Studies on to what extent the combined therapy of modified constraint-induced movement therapy and mental practice is more effective than modified constraint-induced movement therapy alone are lacking. This study aims to compare the effects of the combined therapy with modified constraint-induced movement therapy alone on corticospinal excitability, quality of the movement of the affected upper extremity, upper motor functions, and performance of the affected arm in daily life of hemiplegic stroke patients. METHODS: The participants comprised 14 people who had suffered stroke and were randomly divided into two groups. All participants participated in modified constraint-induced movement therapy, while only the experimental group partook in additional mental practice. Both groups were tested for corticospinal excitability, quality of movement, hand function, and activities of daily living. RESULTS: Both groups showed significant improvement in the movement quality of reaching and performance of activities of daily living. In the experimental group, functional improvement of the upper limb was also observed. The improvements in corticospinal excitability, upper extremity function, and performance in daily activities were significantly greater in the experimental group compared to the control group. CONCLUSIONS: This study confirmed that the combined therapy produces more effective improvement in corticospinal excitability, upper limb function, and performance in daily activities. The combined therapy of mental practice and modified constraint-induced movement therapy could be used as a clinically useful intervention. Implications for rehabilitation Modified constraint-induced movement therapy could be used as an intervention method for people with stroke to make improvements in the quality of movement and performance in activities of daily livings with the affected side. With additional mental practice, upper extremity functions improve, and changes in neurological, functional and performance in daily lives are greater compared to modified constraint-induced movement therapy without mental practice. Impact of mental practice has on rehabilitation should not be underestimated.

Effects of Task-Oriented Training as an Added Treatment to Electromyogram-Triggered Neuromuscular Stimulation on Upper Extremity Function in Chronic Stroke Patients.

The purpose of the present study was to investigate the effects of electromyogram-triggered neuromuscular stimulation (EMG-stim) combined with task-oriented training (TOT) on upper extremity function in chronic stroke patients. Twenty chronic stroke patients were randomly assigned to either the intervention (n = 10) or control (n = 10) group. The intervention group conducted TOT with EMG-stim on the wrist and finger extensor of the affected arm for 30 minutes per day, 5 days per week, for 4 weeks. The control group was provided EMG-stim for 20 minutes per day for the same duration. The intervention group exhibited significant improvement relative to the control group in muscle activation, motor recovery (Fugl-Meyer assessment) and dexterity (Box and Block Test) (p < 0.05). Significant differences in hand function between the groups were detected in the writing of short sentences and in stacking checkers (p < 0.05). It is concluded that EMG-stim in combination with TOT may be better than EMG-stim alone for the treatment of arm paresis in stroke patients. Further research with a larger sample is recommended to examine neurologic changes or cerebral cortex reorganization. Copyright © 2016 John Wiley & Sons, Ltd.

Mirror therapy combined with biofeedback functional electrical stimulation for motor recovery of upper extremities after stroke: a pilot randomized controlled trial.

The objective of this study was to evaluate the effects of mirror therapy in combination with biofeedback functional electrical stimulation (BF-FES) on motor recovery of the upper extremities after stroke. Twenty-nine patients who suffered a stroke > 6 months prior participated in this study and were randomly allocated to three groups. The BF-FES + mirror therapy and FES + mirror therapy groups practiced training for 5 × 30 min sessions over a 4-week period. The control group received a conventional physical therapy program. The following clinical tools were used to assess motor recovery of the upper extremities: electrical muscle tester, electrogoniometer, dual-inclinometer, electrodynamometer, the Box and Block Test (BBT) and Jabsen Taylor Hand Function Test (JHFT), the Functional Independence Measure, the Modified Ashworth Scale, and the Stroke Specific Quality of Life (SSQOL) assessment. The BF-FES + mirror therapy group showed significant improvement in wrist extension as revealed by the Manual Muscle Test and Range of Motion (p < 0.05). The BF-FES + mirror therapy group showed significant improvement in the BBT, JTHT, and SSQOL compared with the FES + mirror therapy group and control group (p < 0.05). We found that BF-FES + mirror therapy induced motor recovery and improved quality of life. These results suggest that mirror therapy, in combination with BF-FES, is feasible and effective for motor recovery of the upper extremities after stroke.