Posts Tagged task-oriented training

[ARTICLE] Comparison Between Movement-Based and Task-Based Mirror Therapies on Improving Upper Limb Functions in Patients With Stroke: A Pilot Randomized Controlled Trial – Full Text


Objective: The aim of this trial was to compare the effect of movement-based mirror therapy (MMT) and task-based mirror therapy (TMT) on improving upper limb functions in patients with stroke.

Methods: A total of 34 patients with sub-acute stroke with mildly to moderately impaired upper limb motor functions. The participants were randomly allocated to one of three groups: MMT, TMT, and conventional treatment (CT). The MMT group underwent movement-based mirror therapy for around 30 min/day, 5 days/week, for 4 weeks, whereas the TMT group underwent dose-matched TMT. The CT group underwent only conventional rehabilitation. The MMT and TMT groups underwent CT in addition to their mirror therapy. Blinded assessments were administered at baseline and immediately after the intervention. Upper limb motor functions, measured using Fugl-Meyer Assessment-upper extremity (FMA-UE), Wolf Motor Function Test (WMFT), and hand grip strength; upper limb spasticity, measured using the modified Ashworth scale (MAS); and activities of daily living, measured using the modified Barthel index (MBI).

Results: A significant time-by-group interaction effect was noted in FMA-UE. Post-hoc analysis of change scores showed that MMT yielded a better effect on improving FMA-UE than the other two therapies, at a marginally significant level (P = 0.050 and 0.022, respectively). No significant interaction effect was noted in WMFT, hand grip strength, MAS, and MBI.

Conclusion: Both MMT and TMT are effective in improving the upper limb function of patients with mild to moderate hemiplegia due to stroke. Nevertheless, MMT seems to be superior to TMT in improving hemiplegic upper extremity impairment. Further studies with larger stroke cohorts are expected to be inspired by this pilot trial.


Mirror therapy (MT) has been shown to be a useful intervention for rehabilitation of upper limb functions following stroke, since the first attempt by Altschuler et al. (1). The neural correlate of MT remains under investigation. Three main theories explaining the neural mechanism underlying the clinical efficacy of MT have been proposed (2).

The first theory hypothesizes that the neural correlate of MT is the mirror neuron system (MNS), which is defined as a class of neurons that fire during action observation and action execution (3). It is assumed that the MNS can be triggered when people are observing mirror visual feedback (MVF) generated in MT (45). The affected cortical motor system can be accessed via the MNS owing to their functional connections (6). The second theory, supported by several studies with transcranial magnetic stimulation (TMS), suggests that a potential neural mechanism underlying the effect of MT can be the recruitment of the ipsilesional corticospinal pathway. Indeed, many TMS studies have demonstrated the increment of motor-evoked potentials of the ipsilesional primary motor cortex in participants with stroke when viewing MVF (7), which indicates a facilitatory effect of MVF on the ipsilesional corticospinal pathway. The last theory attributes the effect of MT to the compensation of restricted proprioception input from the affected limb and the enhancement of attention toward the paretic upper limb (8), which may contribute to the reduction of the learned non-use in patients with stroke (1).

A substantial number of randomized controlled trials (RCTs) have demonstrated that MT is useful in improving upper limb functions after stroke (912). A recently published meta-analytic review identified a moderate level of evidence supporting the effects of MT on improving upper limb motor functions (Hedges’ g = 0.47) and activities of daily living (ADLs) (Hedges’ g = 0.48) in patients with stroke (13). In the meta-analysis (13), the heterogeneity of conducting MT was obvious across studies. One major category of MT is movement-based MT (MMT), in which participants practice simple movements such as wrist flexion and extension, or finger flexion and extension, with their unaffected hands when viewing the MVF generated by a physical mirror placed at their mid-sagittal plane (1416). Another category of MT is task-based MT (TMT), in which participants perform specific motor tasks with their unaffected hands, such as squeezing sponges, placing pegs in holes, and flipping a card, while they are viewing the MVF (1217). In some studies, researchers applied MMT in the first few sessions and subsequently applied TMT in the following sessions, constituting a hybrid MT protocol (91018). MMT and TMT were also described as intransitive and transitive movements in some studies (910). However, a sub-group meta-analysis comparing MMT and TMT was not carried out in the meta-analysis study (13).

Initially, MMT was used for alleviating phantom pain after amputation and for treating upper limb hemiplegia after stroke (119). Subsequently, the effect of MMT in stroke upper limb rehabilitation has been systematically investigated by many clinical trials (141620). Arya et al. were the first to compare the effects of TMT with those of conventional rehabilitation on upper limb motor recovery after stroke, and they found a superior effect of TMT (12). The main rationale that Arya et al. mentioned was that the response of the MNS was better for object-directed actions than for non-object actions (1221). In a recent study comparing the effects of action observation training and MT on gait and balance in patients with stroke, the results showed that action observation training had significantly better effects on the improvement of balance functions than MT (22), indicating that action observation may be different from MT in terms of their neural mechanisms. In other studies in which TMT was introduced or combined with MMT, the authors did not explain why they employed TMT (911).

Thus far, no RCT has systematically investigated the difference between the effects of MMT and TMT. Therefore, we aimed to conduct an RCT to directly compare the effect of MMT and TMT, on improving hemiplegic upper limb motor functions, spasticity, and ADLs, in a group of patients with stroke.[…]


Continue —> Frontiers | Comparison Between Movement-Based and Task-Based Mirror Therapies on Improving Upper Limb Functions in Patients With Stroke: A Pilot Randomized Controlled Trial | Neurology

Figure 3. An example of the process of “fault and correction.” The given task is that participants are required to transfer an object placed in the No. 3 hole (in orange color) to the No. 2 hole (Step 1). However, participants usually move the object to the No. 4 hole when they are viewing the mirror reflection (Step 2). Then, participants realize the fault and transfer the object it to the No. 2 hole (Steps 3, 4).

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[Abstract + References] Synergy-Based FES for Post-Stroke Rehabilitation of Upper-Limb Motor Functions


Functional electrical stimulation (FES) is capable of activating muscles that are under-recruited in neurological diseases, such as stroke. Therefore, FES provides a promising technology for assisting upper-limb motor functions in rehabilitation following stroke. However, the full benefits of FES may be limited due to lack of a systematic approach to formulate the pattern of stimulation. Our preliminary work demonstrated that it is feasible to use muscle synergy to guide the generation of FES patterns.In this paper, we present a methodology of formulating FES patterns based on muscle synergies of a normal subject using a programmable multi-channel FES device. The effectiveness of the synergy-based FES was tested in two sets of experiments. In experiment one, the instantaneous effects of FES to improve movement kinematics were tested in three patients post ischemic stroke. Patients performed frontal reaching and lateral reaching tasks, which involved coordinated movements in the elbow and shoulder joints. The FES pattern was adjusted in amplitude and time profile for each subject in each task. In experiment two, a 5-day session of intervention using synergy-based FES was delivered to another three patients, in which patients performed task-oriented training in the same reaching movements in one-hour-per-day dose. The outcome of the short-term intervention was measured by changes in Fugl–Meyer scores and movement kinematics. Results on instantaneous effects showed that FES assistance was effective to increase the peak hand velocity in both or one of the tasks. In short-term intervention, evaluations prior to and post intervention showed improvements in both Fugl–Meyer scores and movement kinematics. The muscle synergy of patients also tended to evolve towards that of the normal subject. These results provide promising evidence of benefits using synergy-based FES for upper-limb rehabilitation following stroke. This is the first step towards a clinical protocol of applying FES as therapeutic intervention in stroke rehabilitation.

I. Introduction

Muscle activation during movement is commonly disrupted due to neural injuries from stroke. A major challenge for stroke rehabilitation is to re-establish the normal ways of muscle activation through a general restoration of motor control, otherwise impairments may be compensated by the motor system through a substitution strategy of task control [1]. In post-stroke intervention, new technologies such as neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES) offer advantages for non-invasively targeting specific groups of muscles [2]–[4] to restore the pattern of muscle activation. Nevertheless, their effectiveness is limited by lack of a systematic methodology to optimize the stimulation pattern, to implement the optimal strategy in clinical settings, and to design a protocol of training towards the goal of restoring motor functions. This pioneer study addresses these issues in clinical application with a non-invasive FES technology.

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[Abstract+References] Six hours of task-oriented training optimizes walking competency post stroke: a randomized controlled trial in the public health-care system of South Africa

To evaluate a minimal dose intervention of six 1-hour sessions of task-oriented circuit gait training including a caregiver over a 12-week period to persons post stroke in the South African public health sector.

Stratified, single blinded, randomized controlled trial with three intervention groups.

Persons post stroke (n = 144, mean age 50 years, 72 women), mean 9.5 weeks post stroke.

Task group (n = 51)—accompanied by a caregiver; task-oriented circuit gait training (to improve strength, balance, and task performance while standing and walking). Strength group (n = 45); strength training of lower extremities while sitting and lying. Control group (n = 48); one 90-minute educational session on stroke management.

The six-minute walk test (6MinWT) was the primary outcome; the secondary outcomes included comfortable and fast gait speeds, Berg Balance Scale (BBS), and Timed Up and Go (TUG). Particpants evaluated at baseline, post intervention (12 weeks), and at follow-up 12 weeks later. Change scores were compared using generalized repeated measures analysis of variance (ANOVA).

Task group change scores for all outcomes post intervention and at follow-up were improved compared to the other groups (P-values between 0.000005 and 0.04). The change scores (mean, 1SD) between baseline and follow-up for the Task, Strength, and Control groups, respectively, were as follows: 6MinWT:119.52 m (81.92), 81.05 m (79.53), and 60.99 m (68.38); comfortable speed 0.35 m/s (0.23), 0.24 m/s (0.22), and 0.19 m/s (0.21); BBS: 9.94 (7.72), 6.93 (6.01), and 5.19 (4.80); and TUG: –14.24 seconds (16.86), –6.49 seconds (9.88), and –5.65 seconds (8.10).

Results support the efficacy of a minimal dose task-oriented circuit training program with caregiver help to enhance locomotor recovery and walking competency in these persons with stroke.

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via Six hours of task-oriented training optimizes walking competency post stroke: a randomized controlled trial in the public health-care system of South Africa – Megan Knox, Aimee Stewart, Carol L Richards, 2018

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[Case study] The effect of task-oriented training on the muscle activation of the upper extremity in chronic stroke patients – Full Text


[Purpose] The aim of this study was to determine the effects of task-oriented training on upper extremity muscle activation in daily activities performed by chronic stoke patients.

[Subjects and Methods] In this research, task-oriented training was conducted by 2 chronic hemiplegic stroke patients. Task-oriented training was conducted 5 times a week, 30 minutes per day, for 2 weeks. Evaluation was conducted 3 times before and after the intervention. The Change of muscle activation in the upper extremity was measured using a BTS FreeEMG 300.

[Results] The subjects’ root mean square values for agonistic muscles for the reaching activity increased after the intervention. All subjects’ co-coordination ratios decreased after the intervention in all movements of reaching activity.

[Conclusion] Through this research, task-oriented training was proven to be effective in improving the muscle activation of the upper extremity in chronic hemiplegic stroke patients.

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

Cover image for Vol. 23 Issue 1Abstract

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.

Source: Effects of Task-Oriented Training as an Added Treatment to Electromyogram-Triggered Neuromuscular Stimulation on Upper Extremity Function in Chronic Stroke Patients – Kim – 2016 – Occupational Therapy International – Wiley Online Library

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[ARTICLE] Combining rTMS and task-oriented training to enhance arm function after stroke


Repetitive transcranial magnetic stimulation (rTMS) is a promising technique for enhancing rehabilitation of upper extremity function after stroke. The objective of this study is to evaluate the feasibility of conducting a randomized controlled trial aimed at determining the efficacy of rTMS as an adjunct to task-oriented therapy in facilitating restoration of arm and hand function after stroke.


Eleven individuals living in the community (Montreal, Canada) with mild to severe arm deficits following a stroke were recruited and randomized. The experimental intervention consisted in a session of real-rTMS immediately followed by ninety minutes of arm and hand functional tasks designed to improve function. The control intervention involved a session of sham-rTMS followed by ninety minutes of arm and hand functional tasks. Subjects in both groups attended sessions twice weekly for four weeks. The main outcome measures were: The Box and Block Test (BBT), the Wolf Motor Function Test (WMFT), the Stroke Impact Scale (SIS) and neurophysiological measures.


Medium to large, statistically significant effect sizes (0.49 to 1.63) were observed in both groups on the BBT, the SIS and the functional score of the WMFT at the post-intervention evaluation. Three out of four subjects in the real-TMS condition showed an increase in baseline levels of corticomotor excitability after the first stimulation session.


It is possible to conduct a study comprising two ninety-minute therapy sessions weekly for arm function. However, preliminary evidence suggests that an rTMS protocol potent enough to induce transient increases in cortical excitability of the lesioned hemisphere did not show promising results as an adjunct to task-oriented training for improving upper extremity function.

Source: Combining rTMS and task-oriented training to enhance arm function after stroke

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[THESIS] Arm function and constraint-induced movement in early post-stroke rehabilitation – Full Txt PDF


Constraint-induced movement therapy (CIMT) is a treatment for mild-to-moderate upper extremity motor dysfunction in post-stroke patients. The key treatment goal of this therapy is overcoming learned nonuse of the more affected arm. It consists of the following 3 components: (1) repetitive task-oriented training; (2) adherence-enhancing behavioral strategies (transfer package); and (3) constraining use of the less affected arm, usually achieved with a restraining mitt. Behavioral procedures such as behavioral contract, systematic feedback, and encouraging real-world problem solving are used to enhance the transfer of gained motor skills to daily activities. However, as the ideal time to initiate post-stroke treatment remains uncertain, more information is needed regarding the effects of CIMT and arm use in the early stages of stroke recovery. This thesis aimed to:

  1. examine the correlations between arm motor impairment and real world arm use and its relationship with dependency in self-care activities in patients in the stroke unit. (Paper I)
  2. assess the effects of modified CIMT applied within 28 days after stroke occurrence (Paper II)
  3. review existing literature for the effects of CIMT on body function, activity, and participation in post-stroke patients (Paper III)

In Paper I, we found a high correlation between motor impairment and the patient’s actual use of the more affected arm. Further findings revealed that both the Fugl-Meyer motor assessment scores and arm use are related to dependency in self-care activities, but the finding might be confounded by lower extremity motor function. In Paper II, we found that CIMT initiated within 28 days after stroke occurrence was safe and feasible but did not improve long-term motor function. However, there was a significant effect on movement speed immediately after the treatment, and CIMT might promote a faster recovery compared to standard care. There were no differences between the groups with respect to reduced arm motor impairment or increased arm use. In the systematic review and metaanalysis conducted in Paper III, we found that CIMT can improve arm motor function and arm motor activities and may have a lasting effect on arm motor activity. The effects were especially stable in the sub-acute and chronic groups, and CIMT is therefore advocated for selected patients in these post-stroke stages.

Taken together, our study revealed that early CMIT has an immediate effect on timed measures of arm activity but does not improve long-term motor activity. The meta-analysis also showed uncertain effects of CIMT in the early post-stroke phase. This rehabilitative treatment should preferably be offered to patients in sub-acute and chronic stages after stroke. As learned nonuse might not be pronounced in the acute stage of stroke, the treatment should be aimed at preventing its development.

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[ARTICLE] Impact of task-oriented training on hand function and activities of daily living after stroke.


[Purpose] We examined the improvement of hand function and activities of daily living in stroke patients after carrying out task-oriented training.

[Subjects] Thirty-two patients who had been diagnosed with stroke and underwent rehabilitation therapy participated in the task-oriented training.

[Methods] The participants carried out task-oriented training for 30 min per day for 4 weeks. Their hand function and activities of daily living were evaluated before and after the training.

[Results] The task-oriented training had a significant impact in terms of improving hand function and activities of daily living.

[Conclusion] According to the results of this study, task-oriented training resulted in improved hand function and activities of daily living in stroke patients.

For access to this entire article and additional high quality information, please check with your college/university library, local public library, or affiliated institution.

Source: EBSCOhost | 109081587 | Impact of task-oriented training on hand function and activities of daily living after stroke.

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