A Paradigm Shift: Rehabilitation Robotics, Cognitive Skills Training, and Function After Stroke.

Introduction: Robot-assisted therapy for upper extremity (UE) impairments post-stroke has yielded modest gains in motor capacity and little evidence of improved UE performance during activities of daily living. A paradigm shift that embodies principles of motor learning and exercise dependent neuroplasticity may improve robot therapy outcomes by incorporating active problem solving, salience of trained tasks, and strategies to facilitate the transfer of acquired motor skills to use of the paretic arm and hand during everyday activities. Objective: To pilot and test the feasibility of a novel therapy protocol, the Active Learning Program for Stroke (ALPS), designed to complement repetitive, robot-assisted therapy for the paretic UE. Key ALPS ingredients included training in the use of cognitive strategies (e.g., STOP, THINK, DO, CHECK) and a goal-directed home action plan (HAP) to facilitate UE self-management and skill transfer. Methods: Ten participants with moderate impairments in UE function >6 months after stroke received eighteen 1-h treatment sessions 2-3/x week over 6-8 weeks. In addition to ALPS training, individuals were randomly assigned to either robot-assisted therapy (RT) or robot therapy and task-oriented training (RT-TOT) to trial whether the inclusion of TOT reinforced participants' understanding and implementation of ALPS strategies. Results: Statistically significant group differences were found for the upper limb subtest of the Fugl-Meyer Assessment (FMA-UE) at discharge and one-month follow-up favoring the RT group. Analyses to examine overall effects of the ALPS protocol in addition to RT and RT-TOT showed significant and moderate to large effects on the FMA-UE, Motor Activity Log, Wolf Motor Function Test, and hand portion of the Stroke Impact Scale. Conclusion: The ALPS protocol was the first to extend cognitive strategy training to robot-assisted therapy. The intervention in this development of concept pilot trial was feasible and well-tolerated, with good potential to optimize paretic UE performance following robot-assisted therapy.

Estratégias de aplicação do aprendido: análise baseada em TRI / Implementation strategies for learning: an item response theory (IRT)-based analysis

Este estudo teve como objetivo analisar as características psicométricas da escala "Estratégias para Aplicação no Trabalho do Aprendido em Treinamento" por meio da teoria de resposta ao item. Com um banco de dados secundário composto por 1241 participantes, foram calibrados dezoito itens, por meio do uso do modelo de resposta gradual. Dez itens pertencem à subescala Estratégias Comportamentais e oito à subescala Estratégias Cognitivo-afetivas. Os resultados sugerem que ambas as subescalas apresentaram boa acuracidade nos seus intervalos especialmente válidos, com nível de informação de moderado a alto. O instrumento apresenta evidências de validade de construto adequadas. Pode ser utilizado em pesquisas futuras, notadamente no campo da psicologia organizacional e do trabalho.(AU)

This study aimed to analyze the psychometric features of the "Strategies for Implementation at Work of Learning at Training" scale through the Item Response Theory. With a secondary database composed of 1,241 participants, eighteen items were calibrated by using the gradual response model. Ten items belong to the Behavioral Strategies subscale and eight to the Cognitive-affective Strategies subscale. The results suggest good accuracy for both subscales, especially in their valid ranges, with an informational level from moderate to high. The instrument shows appropriate evidence of construct validity. It may be used in future research, especially in the field of organizational and work psychology.(AU)

Estratégias de aplicação do aprendido: análise baseada em TRI / Implementation strategies for learning: an item response theory (IRT)-based analysis

Este estudo teve como objetivo analisar as características psicométricas da escala "Estratégias para Aplicação no Trabalho do Aprendido em Treinamento" por meio da teoria de resposta ao item. Com um banco de dados secundário composto por 1241 participantes, foram calibrados dezoito itens, por meio do uso do modelo de resposta gradual. Dez itens pertencem à subescala Estratégias Comportamentais e oito à subescala Estratégias Cognitivo-afetivas. Os resultados sugerem que ambas as subescalas apresentaram boa acuracidade nos seus intervalos especialmente válidos, com nível de informação de moderado a alto. O instrumento apresenta evidências de validade de construto adequadas. Pode ser utilizado em pesquisas futuras, notadamente no campo da psicologia organizacional e do trabalho.

This study aimed to analyze the psychometric features of the "Strategies for Implementation at Work of Learning at Training" scale through the Item Response Theory. With a secondary database composed of 1,241 participants, eighteen items were calibrated by using the gradual response model. Ten items belong to the Behavioral Strategies subscale and eight to the Cognitive-affective Strategies subscale. The results suggest good accuracy for both subscales, especially in their valid ranges, with an informational level from moderate to high. The instrument shows appropriate evidence of construct validity. It may be used in future research, especially in the field of organizational and work psychology.