Posts Tagged task-oriented training

[POSTER Abstract] Effects of Bilateral Transcutaneous Electrical Nerve Stimulation Combined With Task-Oriented Training on the Recovery of Upper Limb Motor Impairment in People With Chronic Stroke


Background: Transcutaneous electrical nerve stimulation(TENS) is an effective physiological intervention for people with stroke which aims at reducing muscle spasticity, enhancing muscle strength, and improving motor control and function. In view of the potentials to enhance greater cortical activation of the lesion side by eliciting spare neural pathways through bilateral intervention, this study examined whether the combined use of bilateral TENS (Bi-TENS) and task-oriented training (TOT) was superior to unilateral TENS(Uni-TENS)+TOT, placebo-TENS+TOT and no active treatment to improve the motor impairment of upper limb function in people with stroke.

Method: There were 120 subjects with stroke(44 females, mean age=61.52±6.73 years, post-stroke duration=6.04±3.12years) being randomly allocated into 4 groups, including the Bi-group (n=30), Uni-group (n=30), placebo group (n=30) and control group (n=30). Subjects in the Bi-group, Uni-group and placebo group got 60 minutes TENS and TOT simultaneously per time for 20 times(3 times per week for 7 weeks). In the Bi-group, TENS stimulated the radial and median nerves of the bilateral upper limbs. In the Uni-group, TENS and placebo-TENS stimulated the affected and unaffected side, respectively. In the placebo group, placebo-TENS were placed on bilateral sides. In the control group, subjects did not receive any active treatment. Level of motor impairment was assessed by the Fugl-Meyer Assessment of Upper Extremity (FMA-UE).

Result: The Bi-group had a significant greater improvement in FMA-UE than the Uni-group(mean change=2.02, p=0.005), placebo group (mean change=2.49, p=0.001) and control group(mean change=3.08, p<0.001) at post-intervention. The Bi-group(mean change=3.25, p<0.001) and Uni-group(mean change=1.23, p=0.015) showed a significant within-group improvement in FMA-UE since 10 sessions of treatment. No significant change was found in the placebo and control groups.

Conclusion: Bi-TENS is superior to Uni-TENS, placebo-TENS and no active treatment in augmenting the recovery of upper limb motor impairment in people with chronic stroke.


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[Abstract] Transcutaneous Electrical Nerve Stimulation in Conjunction with Task-oriented Training in the Management of Chronic Post-stroke Spasticity of the Upper Limb: A Case Report – Full Text PDF


Background: Post-stroke spasticity is a major contributor to functional impairment and disability among stroke survivors as it negatively affects recovery and interferes with quality of life.

Case presentation: We present a 45-year-old man with a 6-year history of stroke affecting the right side of the body. He presented with chronic upper limb spasticity and walk with hemiplegic gait without support. The patient received Transcutaneous Electrical Nerve Stimulation (TENS) to the belly of elbow flexors of the right upper limb using a frequency of 100HZ and pulse duration of 200μs for 60 minutes. Six sets of 100 repetitions of task-oriented training were also performed for 60 minutes. All treatments were administered twice weekly for 12 weeks. The patient’s spasticity and motor function were assessed using Modified Ashworth Scale (MAS) and Brunnstrom Recovery Stages (BRS), respectively, before treatment, and 6 weeks and 12 weeks post treatment. There was reduction in spasticity post treatment with more reduction being recorded at 12 weeks. The patient’s motor function also improved post treatment but no difference was observed between the 6 weeks and 12 weeks of treatment.

Conclusions: The findings of this study demonstrated the beneficial effect of TENS in conjunction with task-oriented training in reducing chronic post-stroke spasticity and motor function of the upper limb.

Full Text: PDF


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[ARTICLE] Effects of a specific task-oriented training versus its combination with manual therapy on balance and mobility in people post stroke at the chronic stage: study protocol for a pilot randomised controlled trial – Full Text


Background: Large studies have shown that stroke is among the most relevant causes of acquired adult disability. Walking and balance impairment in stroke survivors often contribute to a restriction in daily activities and social participation. Task-oriented training (TOT) is an effective treatment strategy and manual therapy (MT) is used successfully to enhance ankle joint flexibility in this population. No study, however, has compared TOT against its combination with MT in a randomised controlled trial. Aims of this pilot study are therefore to explore the feasibility of a full-scale RCT and the preliminary effects of specific TOT with a combined specific TOT-MT versus a control group in people post stroke.

Methods: This is a protocol of a 4-week prospective randomised controlled parallel pilot trial in people post stroke at the chronic stage with limited upper ankle joint mobility and an impairment in balance and mobility. At a German outpatient therapy centre using 1:1:1 allocation, 36 patients will be randomised into one of three groups: 15-minute talocrural joint MT plus 30-minute specific TOT (Group A); 45-minute specific TOT (Group B); controls (Group C). Training will be goal-oriented including tasks that are based on daily activities and increased in difficulty ulilising predefined progression criteria. Interventions will be provided face-to-face 2 times per week, for 4 weeks, in addition to 20-minute concurrent x4 weekly homebased training sessions. Data will be collected by blinded assessors at baseline, post-intervention and 4-week follow-up. The primary outcome will be feasibility assessed by recruitment, retention and adherence rates, compliance, adverse events, falls and the acceptability of the intervention. Secondary outcomes will be walking speed, single and dual tasking functional mobility, ankle range of motion, disability and health-related quality of life.

Discussion: Results from this study will inform a larger randomised controlled trial to investigate the effects of specific TOT and specific TOT-MT compared to a post stroke control group. We hope that the study findings help to enhance stroke rehabilitation.


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[Abstract] The Effect of Priming on Outcomes of Task-Oriented Training for the Upper Extremity in Chronic Stroke: A Systematic Review and Meta-analysis

Background. Priming results in a type of implicit memory that prepares the brain for a more plastic response, thereby changing behavior. New evidence in neurorehabilitation points to the use of priming interventions to optimize functional gains of the upper extremity in poststroke individuals. Objective. To determine the effects of priming on task-oriented training on upper extremity outcomes (body function and activity) in chronic stroke.

Methods. The PubMed, CINAHL, Web of Science, EMBASE, and PEDro databases were searched in October 2019. Outcome data were pooled into categories of measures considering the International Classification Functional (ICF) classifications of body function and activity. Means and standard deviations for each group were used to determine group effect sizes by calculating mean differences (MDs) and 95% confidence intervals via a fixed effects model. Heterogeneity among the included studies for each factor evaluated was measured using the I2 statistic.

Results. Thirty-six studies with 814 patients undergoing various types of task-oriented training were included in the analysis. Of these studies, 17 were associated with stimulation priming, 12 with sensory priming, 4 with movement priming, and 3 with action observation priming. Stimulation priming showed moderate-quality evidence of body function. Only the Wolf Motor Function Test (time) in the activity domain showed low-quality evidence. However, gains in motor function and in use of extremity members were measured by the Fugl-Meyer Assessment (UE-FMA). Regarding sensory priming, we found moderate-quality evidence and effect size for UE-FMA, corresponding to the body function domain (MD 4.77, 95% CI 3.25-6.29, Z = 6.15, P < .0001), and for the Action Research Arm Test, corresponding to the activity domain (MD 7.47, 95% CI 4.52-10.42, Z = 4.96, P < .0001). Despite the low-quality evidence, we found an effect size (MD 8.64, 95% CI 10.85-16.43, Z = 2.17, P = .003) in movement priming. Evidence for action observation priming was inconclusive.

Conclusion. Combining priming and task-oriented training for the upper extremities of chronic stroke patients can be a promising intervention strategy. Studies that identify which priming techniques combined with task-oriented training for upper extremity function in chronic stroke yield effective outcomes in each ICF domain are needed and may be beneficial for the recovery of upper extremities poststroke.

via The Effect of Priming on Outcomes of Task-Oriented Training for the Upper Extremity in Chronic Stroke: A Systematic Review and Meta-analysis – Erika Shirley Moreira da Silva, Gabriela Nagai Ocamoto, Gabriela Lopes dos Santos-Maia, Roberta de Fátima Carreira Moreira Padovez, Claudia Trevisan, Marcos Amaral de Noronha, Natalia Duarte Pereira, Alexandra Borstad, Thiago Luiz Russo,

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[ARTICLE] Multi-sensory feedback therapy combined with task-oriented training on the hemiparetic upper limb in chronic stroke: study protocol for a pilot randomized controlled trial – Full Text


Background An important reason for the difficulty in recovering sensorimotor dysfunction of the upper extremity in chronic stroke survivors, is the lack of sensory function, such as tactile and proprioception feedback. In clinical practice, single sensory training is only for the restoration of sensory function. Increasing evidence suggests that use of task-oriented training (TOT) is a useful approach to hand motor rehabilitation. However, neither approach is optimal since both methods are trained only for specific functional recovery. Our hypothesis is that multi-sensory feedback therapy (MSFT) combined with TOT has the potential to provide stimulating tasks to restore both sensory and motor functions. The objective of the trial is to investigate whether novel MSFT is more effective in improving arm sensorimotor function in chronic stroke phase than single TOT.

Methods/Design: The study will be conducted as a multicenter, randomized, double blind controlled trial. Participants (n = 90) will be randomised into three groups to compare the effect of the multi-sensory feedback therapy group against task-oriented training group and conventional group. Participants will receive treatment at the same intensity (60 min, 5 days a week, 4 weeks, 20 hours total). Primary outcome measures for assessment of sensory function are the Semmes Weinstein monofilaments examination (SWME),two-point discrimination test (2PD) test. Secondary measures are the Action Research Arm Test (ARAT)༌Nine-Hole Peg Test (NHPT), Wolf Motor Function Test (WMFT), Box and Blocks Test (BBT), Modified Barthel Index (MBI), Instrumental activities of daily living (IADL) and Generalized Anxiety Disorder 7-Item Scale (GAD-7). Outcome mearsures will be evaluated at baseline, post treatment, and two months follow-up. All assessments will be conducted by trained assessors blinded to treatment allocation.

Discussion This study will determine the acceptability and efficacy of the intervention on the hemiparetic upper limb, it may be promising tools for sensorimotor functional recovery after stroke.

Figure 2

Figure 2. The multi-sensory feedback therapy system used in the present study. Step 1:Patients will undergo multi-sensory training under a visual feedback device, including (A) Tactile training for patients with different materials, textures, objects; (B) Proprioceptive control of hand gestures; (C) 2-point discrimination with tools. Step 2:All sensory stimuli will be visually blocked and visually exposed in all patients. Step 3:The multi-sensory feedback therapy combined with task-oriented training will increase motivation for sensorimotor tasks.


Stroke is a major cause of serious long-term disability in chronic stroke [12]. In China alone, the age-standardized prevalence, incidence, and mortality rates were approximately 1114.8/100 000 people, 246.8 and 114.8/100 000 person-years, respectively [3]. More than two thirds of all patients experience impaired function in the upper extremity [45], and many of chronic stroke patients require continued rehabilitation for hand disability from hospitals. Sensory impairments of all modalities are thought to be common during the chronic stage of stroke [6].

Although tactile loss is more frequent than proprioceptive dysfunction, especially in the hand. Approximately 80% of chronic stroke patients experience tactile loss, over 69% without proprioceptive discriminations [7]. Somatosensory deficits are associated with the degree of weakness and stroke severity, and they are also related to mobility, mental health, independence in activities of daily living, and recovery [8]. Sensory function is an important composition of widely used physiotherapy approaches such as Bobath (known as Neurodevelopment Therapy in the United States) and Brunnstrom, and it is considered a precursor to the recovery of movement and functional activities of daily living in patients with stroke [9]. Poor motor function is associated with reduced sensory experience and processing after stroke [1011]. Joint position sensation of the upper extremity is closely related to motor ability due to stroke-related reduced discrimination in proprioception [9], it causes disturbances in the arm movement trajectory. The relation between sensory and motor dysfunction is unsurprising since biomechanics and motor control of human movement require bidirectional interaction between cortex and periphery [12].

Sensory disorders include light touch, temperature, joint position, two-point discrimination, object discrimination, spatial orientation [5]. Different types of sensory disorders have different inefficiencies to perform daily activities and social participation [12]. Thermohypesthesia is the reason leading to scalding and freezing injury [6]. Scalding injuries often occur as the result of spilled food or beverages. They are also unable to feel pain, which means that they can’t retract arms and hands actively. In addition, bleeding often happens after touching acupuncture or sharp objects. Stroke is also a major global mental health problem. The sensory impairment has negative implications to explore environment, and lower the effect of rehabilitation outcomes. Anxiety, depressive symptoms, general psychological distress and social isolation are prevalent if chronic patients have sensory disorders [13]. Psychosocial difficulties may impact significantly on long-term functioning and quality of life [1415], and it reduces the effects of rehabilitation services and bring about higher mortality rates [16].

The purpose of this study is to determine whether multi-sensory feedback therapy (MSFT) can promote upper limb motor function, daily life activities, social participation and help to relieve anxiety in patients with chronic stroke.[…]

Continue —->  Multi-sensory feedback therapy combined with task-oriented training on the hemiparetic upper limb in chronic stroke: study protocol for a pilot randomized controlled trial | Research Square

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[ARTICLE] Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients – Full Text

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery Cover ImageAbstract


Approximately half of stroke patients show impaired upper limb and hand function. Task-oriented training focuses on functional tasks, while joint mobilization technique aims to restore the accessory movements of the joints.


To investigate the effect of adding joint mobilization to task-oriented training to help the patients in reaching a satisfactory level of recovery for their hand function.

Patients and methods

Thirty chronic stroke patients with paretic hand participated in the study; they were divided equally into study and control groups. The study group received joint mobilization followed by task-oriented training for the affected hand. Meanwhile, the control group received task-oriented training only. Both groups received their treatment in the form of 3 sessions per week for 6 successive weeks. The primary outcome measures were hand function that was assessed by Jebsen-Taylor hand function test (JTT) and active and passive wrist extension range of motion (ROM) that was measured by a standard goniometer. The secondary outcome measure was the grip strength of the hand that was assessed by a JAMAR adjustable hand dynamometer.


There was a significant improvement in all the outcome measurements in both groups that were more evident in the study group.


Combining joint mobilization with task-oriented training had a highly significant effect in improving the hand function in chronic stroke patients compared to task-oriented training alone.


Stroke is defined as a neurological deficit attributed to an acute vascular focal injury of the central nervous system [1]. It is a worldwide common disease that leads to serious disabilities [2]. Hemiparesis is the most common motor impairment after a stroke and frequently leads to persistent hand dysfunction [3]. Nearly about 50% of stroke patients show impaired upper limb and hand function and up to 74% rely on long-term help to perform their activities of daily living (ADL) [45]. The hand functions are complex as we use our hands in a vast variety of tasks such as grasping, pushing, holding objects, and expressing emotions [6].

Task-oriented training is a type of physiotherapy that encourages the active participation and focuses on functional tasks rather than simple repetitive training of normal motion patterns [7]. Joint mobilizations are used as an intervention to improve the range of motion (ROM), decreasing pain, and ultimately improving the upper extremity functions [8]. Joint mobilization technique proposed by Maitland is based on a graded system and is intended to restore the accessory movements of the joints by performing passive, rhythmic, and oscillatory movements [9].

After stroke, reduced ROM at joints occurs and it can be complicated by joint contractures. This occurs due to many factors such as reduced muscle length and increased stiffness of muscle and/or connective tissue. Such post stroke consequences can be solved by moving the joints through a full ROM with pressure at the end of range using the manual therapy [10]. Mobilization may help stroke patients in reducing the joint stiffness [11]. Moreover, it provides afferent input that can be used in facilitating the motor activity [1213]. Accordingly, we aimed to investigate the effect of adding joint mobilization to task-oriented training in order to help those patients in reaching a satisfactory level of recovery for their hand functions.[…]

Continue —-> Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text


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[Abstract] Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication


Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program.

Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed.

Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject’s upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.

Article Highlights

Robotic neurorehabilitation has the potential to improve the quality and intensity of rehabilitation treatments in order to promote motor-cognitive recovery following a central nervous system disease.

Controversial results in literature maybe generated by confusion in the use of robots related to many technological and clinical features, and emphasized by excessive optimism or scepticism about this technology.

Budgets spent for robots in rehabilitation are expected to grow dramatically in the next future, but there is the need of evidence-based proofs to balance the business push.

There is need of further researches in motor-cognitive technological rehabilitation in order to better understand the gain that robotic therapy could add to conventional therapy in relation to the patient’s cognitive reserve.

There is a need for clinical consensus conferences that might give clinical indication to end users.
via Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication: Expert Review of Medical Devices: Vol 0, No 0

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[Dissertation] Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis


Stroke remains a leading cause of long-term disability in the United States. While significant medical advances have led to decreased stroke mortality rates, incidence of stroke has remained roughly the same. This has resulted in an increased number of stroke survivors living with upper extremity (UE) hemiparesis requiring occupational therapy (OT). Despite a significant increase in the number of stroke rehabilitation trials over the past decade, a recent systematic review and meta-analysis found insufficient evidence that any experimental interventions were superior to conventional rehabilitation for improving UE motor function post-stroke. While it may be true that novel interventions are no more effective than conventional rehabilitation, an equally probable reason is the large disparities in dosage, frequency, and interventions used across control groups in clinical trials.
In the stroke rehabilitation literature, control interventions are often referred to as standard care or conventional rehabilitation. Concerningly, the majority of stroke rehabilitation trials lack an empirically based rationale for how control interventions are comparable to standard care rehabilitation. Inadequate descriptions of, and rationales for, control interventions across stroke rehabilitation trials are significant barriers to the advancement of evidence-based practice. Without a true understanding of `standard care’ in real-world practice, there is no way to know if the control intervention is truly comparable. There is an urgent need to characterize `standard care’ rehabilitation to inform control intervention development and improve interpretability of clinical trial results. The purpose of this study was to investigate current practices of occupational therapy practitioners in outpatient rehabilitation settings to address upper extremity hemiparesis in adult stroke survivors.
In Chapter 2, a cross-sectional e-mail survey was sent to OT practitioners across the United States to determine current practice patterns of therapists working in outpatient stroke rehabilitation nationwide. The results of this study (n=269) revealed that stretching, bilateral upper extremity training, strength training, weightbearing, manual therapy and task-oriented training were used by more than 85% of OT practitioners in our sample. Poor patient compliance (84%), medical complexity (64%), and spasticity (63%) were the most commonly reported barriers to patients meeting their OT goals in outpatient rehabilitation.
Chapters 3 and 4 present the results of a video-based observational study of outpatient OT sessions at an academic medical center. The Rehabilitation Treatment Specification System (RTSS) was used to analyze 30 OT treatment sessions. The average total session time was 52 ± 4.7 minutes with 36.2 ± 7.4 minutes of active time and 15.8 ± 7.1 minutes of inactive time per session. Interventions in the RTSS categories of `Skills and Habits’ (e.g., task-oriented activities) and `Organ Function’ (e.g., stretching, weightbearing) were used in the majority of OT sessions with `Skills and Habits’ activities accounting for 59% of active time and `Organ Function’ activities accounting for 35% of active time. After removing outliers, an average of 150.2 ± 85.2 UE repetitions occurred per session. Functional electrical stimulation (FES) was commonly used as an adjuvant to task-oriented activities and knowledge of performance was provided often during treatment.
Taken together, these results suggest that task-oriented training is commonly used by OT practitioners to address UE hemiparesis and musculoskeletal interventions are often used to mitigate spasticity in preparation for task-oriented activities. Future research will include video observation and analysis of OT practice sessions across multiple practice settings, as well as analyzing our remaining survey data across multiple practice settings (e.g., inpatient rehabilitation, skilled nursing facilities) to describe similarities and differences with the current findings.
Full Text: Wengerd_Dissertation_11.26.19.pdf (3.16 MB) View|Download

via OhioLINK ETD: Wengerd, Lauren Rachel

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[Abstract + References] Comparison of Dual Task and Task Oriented Training Programme on Gait in Chronic Stroke – Full Text PDF


Stroke is the major cause of disability and handicap in adults and it usually results in some degree of muscle weakness. Daily living requires balance and walking ability while performing tasks. Several factors affect the functional independence in post stroke period in which gait plays a significant role. 30 subjects of age group 45-60 years were selected by purposive sampling and informed consent was taken. The subjects were divided into 2 groups A and B of 15 each. Both the groups received conventional physiotherapy as muscle strengthening of affected lower limb and balance training. Group A received dual task training and Group B received task oriented training for 8 weeks. Pre test and post test data for gait parameters (gait speed, cadence, step length, stride length) were obtained by using 10meter walk test respectively. Unpaired‘t’ test was applied at the p<0.05 for the comparison within and between the groups for the variable Gait Parameters(i.e gait speed, cadence, step length, stride length). The values of gait parameters between the groups were significant which showed that task oriented training is more effective than dual task training to improve gait in chronic stroke.


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via Comparison of Dual Task and Task Oriented Training Programme on Gait in Chronic Stroke :: Science Publishing Group

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[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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