Posts Tagged Task-oriented

[Abstract] Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial

Background. Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many.

Objective. To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes.

Methods. On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases.

Results. Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log–28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences.

Conclusions. Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier ( Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at Identifier: NCT00871715).

via Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial – Rebecca Lewthwaite, Carolee J. Winstein, Christianne J. Lane, Sarah Blanton, Burl R. Wagenheim, Monica A. Nelsen, Alexander W. Dromerick, Steven L. Wolf, 2018

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[Abstract] Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review

Acquired brain injury (ABI) is associated with a range of cognitive and motor deficits, and poses a significant personal, societal, and economic burden. Rehabilitation programs are available that target motor skills or cognitive functioning. In this review, we summarize the existing evidence that training may enhance structural neuroplasticity in patients with ABI, as assessed using structural magnetic resonance imaging (MRI)–based techniques that probe microstructure or morphology. Twenty-five research articles met key inclusion criteria. Most trials measured relevant outcomes and had treatment benefits that would justify the risk of potential harm. The rehabilitation program included a variety of task-oriented movement exercises (such as facilitation therapy, postural control training), neurorehabilitation techniques (such as constraint-induced movement therapy) or computer-assisted training programs (eg, Cogmed program). The reviewed studies describe regional alterations in white matter architecture and/or gray matter volume with training. Only weak-to-moderate correlations were observed between improved behavioral function and structural changes. While structural MRI is a powerful tool for detection of longitudinal structural changes, specific measures about the underlying biological mechanisms are lacking. Continued work in this field may potentially see structural MRI metrics used as biomarkers to help guide treatment at the individual patient level.

via Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review – Karen Caeyenberghs, Adam Clemente, Phoebe Imms, Gary Egan, Darren R. Hocking, Alexander Leemans, Claudia Metzler-Baddeley, Derek K. Jones, Peter H. Wilson, 2018

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[Abstract + References] Virtual Reality for Neurorehabilitation: Insights From 3 European Clinics


Virtual reality for the treatment of motor impairment is a burgeoning application of digital technology in neurorehabilitation. Virtual reality systems pose an opportunity for health care providers to augment the dose of task-oriented exercises delivered both in the clinic, and via telerehabilitation models in the home. The technology is almost exclusively applied as an adjunct to traditional approaches and is typically characterized by the use of gamified exergames which feature task-oriented physiotherapy exercises. At present, evidence for the efficacy of this technology is sparse, with some reviews suggesting it is the same or no better than conventional approaches. The purpose of this article is to provide real-world insights on the adoption of a virtual reality by 3 European clinics in 3 different service delivery models. These include an inpatient setting for Parkinson disease, a kiosk model for pediatric neurorehabilitation, and a home-based telerehabilitation model for neurologic patients. Motivations, settings, requirements for the pathology, outcomes, and challenges encountered during this process are reported with the objective of priming clinicians on what to expect when implementing virtual reality in neurorehabilitation.


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via Virtual Reality for Neurorehabilitation: Insights From 3 European Clinics – PM&R

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[Abstract] Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke


Spasticity, a common impairment after stroke, has profound negative impact on outcomes in patients with stroke. Botulinum toxin type A (BoNT-A) injection combined with rehabilitation training is suggested for spasticity treatment. However, there is no recommendation about what kind of rehabilitation training is more appropriate than others following BoNT-A injection. The purpose of this study was to compare the effects of combining BoNT-A injection with bilateral robot-assisted (RT) or mirror (MT) or task-oriented (TT) therapy for upper extremity (UE) spasticity in patients with chronic stroke.

Material and method

Participants were randomly assigned to RT, or MT, or TT group after BoNT-A injection. The participants received 45 minutes of intervention per day, 3 days/week, for 8 weeks according the allocated results. In addition, all participants received 30 minutes of functional practice training. At pre-intervention, post-intervention and 3-month follow-up a blinded research assistant did outcome measures, including body function and structures by Fugl-Meyer Assessment (FMA), and Modified Ashworth Scale (MAS); activity and participation measures by Motor Activity Log (MAL), and Nottingham Extended Activities of Daily Living Scale (EADLS).


Thirty-seven subjects met the inclusion criteria and underwent randomization, 13 were assigned to the RT; 12 to MT; and 12 to TT group. The 3 groups were well matched with regard to baseline characteristics and functional status. All groups had significant improvement in FMA, MAS and MAL post-intervention. There were no group differences in FMA, MAS, EADLs either post-intervention or at follow-up. There was a trend that TT group had higher quality of movement (QOM) in MAL post intervention than the other 2 groups (P = 0.07), at follow-up TT group had significantly higher QOM in MAL than the other 2 groups (P = 0.03).


Combining BoNT-A injection with TT resulted in better quality of UE movement in patients with spastic stroke than with RT or MT.


via Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke – ScienceDirect 

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[ARTICLE] Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach – Full Text



Motor recovery of persons after stroke may be enhanced by a novel approach where residual muscle activity is facilitated by patient-controlled electrical muscle activation. Myoelectric activity from hemiparetic muscles is then used for continuous control of functional electrical stimulation (MeCFES) of same or synergic muscles to promote restoration of movements during task-oriented therapy (TOT). Use of MeCFES during TOT may help to obtain a larger functional and neurological recovery than otherwise possible.

Study design

Multicenter randomized controlled trial.


Eighty two acute and chronic stroke victims were recruited through the collaborating facilities and after signing an informed consent were randomized to receive either the experimental (MeCFES assisted TOT (M-TOT) or conventional rehabilitation care including TOT (C-TOT). Both groups received 45 minutes of rehabilitation over 25 sessions. Outcomes were Action Research Arm Test (ARAT), Upper Extremity Fugl-Meyer Assessment (FMA-UE) scores and Disability of the Arm Shoulder and Hand questionnaire.


Sixty eight subjects completed the protocol (Mean age 66.2, range 36.5–88.7, onset months 12.7, range 0.8–19.1) of which 45 were seen at follow up 5 weeks later. There were significant improvements in both groups on ARAT (median improvement: MeCFES TOT group 3.0; C-TOT group 2.0) and FMA-UE (median improvement: M-TOT 4.5; C-TOT 3.5). Considering subacute subjects (time since stroke < 6 months), there was a trend for a larger proportion of improved patients in the M-TOT group following rehabilitation (57.9%) than in the C-TOT group (33.2%) (difference in proportion improved 24.7%; 95% CI -4.0; 48.6), though the study did not meet the planned sample size.


This is the first large multicentre RCT to compare MeCFES assisted TOT with conventional care TOT for the upper extremity. No adverse events or negative outcomes were encountered, thus we conclude that MeCFES can be a safe adjunct to rehabilitation that could promote recovery of upper limb function in persons after stroke, particularly when applied in the subacute phase.



Stroke is the leading cause of disability in adults in the world and can result in highly complex clinical situations. The insult often involves the sensory-motor system leading to hemiparesis and impairment of the upper limb in over 50% of survivors [1,2]. Although some structural recovery is possible, especially in the first months after stroke, only a small percentage of persons recover pre-morbid movement patterns and functionality [3].

Limitations in reaching and grasping have an important role in determining the level of independence of the person in their daily activities and the subsequent impact on their quality of life. Tailored goal oriented rehabilitation is therefore an essential factor in reducing impairment and augmenting functionality of a hemiplegic arm. A plurality of interventions may help the subject to restore participation and adapt to the new clinical status including task oriented therapy (TOT) that has been shown to be effective for motor recovery [4,5], as well as constraint induced movement therapy (CIMT) [6], biofeedback and robot assisted therapy [79]. Moreover, electrostimulation has been applied to improve muscle recruitment and aid motor recovery. Since resources and time in rehabilitation are limited it is important to identify and employ effective interventions [10].

The inability to use the arm in an efficient way may lead to non use of the arm and hand that can lead to changes also at the neural level [11]. It is therefore essential that arm use is facilitated in meaningful activities. Approaches that assist the person during purposeful voluntarily activated movement could be important for inducing neuroplasticity and increasing function. Neuromuscular electrical stimulation (NMES) has been employed in rehabilitation of stroke patients either to generate muscle contraction or be a support during movements; however, with inconsistent results [1120]. A prerequisite for neuroplasticity through training is the volitional intent and attention of the person and it therefore follows that the user should participate consciously in the rehabilitative intervention [21,22].

Through the use of EMG it is technically possible to register the myoelectric activity from voluntary contraction of a muscle while its motor nerve is being stimulated by electrical impulses [23]. MeCFES is a method where the FES is directly controlled by volitional EMG activity. In contrast to EMG triggered FES, the controlling muscle is continuously controlling the stimulation intensity. Thus the resulting movement and intrinsic multisensory activation is synchronized with the active attention and intention of the subject and the muscle contraction can be gradually modulated by the subject himself facilitating motor learning and recovery of function. This has been demonstrated to be possible in spinal cord injured subjects [24,25] and a pilot study has shown that when the controlling and stimulated muscles are homologous or they are synergistic it may lead to a marked increase in motor function of the hemiparetic forearm of selected stroke patients [26]. Motor learning principles required for CNS-activity-dependent plasticity, in fact, include task-oriented movements, muscle activation driving practice of movement, focused attention, repetition of desired movements, and training specificity [21,22,27]. The use of MeCFES during active challenging goal oriented movements should help the patient and the therapist overcome the effect of learned non use by turning attempts to move the arm into successful movements.

We hypothesize that applying MeCFES in a task oriented paradigm to assist normal arm movements during rehabilitation of the upper limb in persons with stroke will improve the movement quality and success and thus induce recovery at the body functions level (impairment) and the activity level (disability) of the International Classification of Function, Disability and Health (ICF) [28] superior to that induced by usual care task-oriented rehabilitation.[…]

Continue —>  Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach

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[Abstract] Improving real-world walking habits after stroke requires behavioural change techniques, not just exercise and gait training [synopsis]


Summary of: Stretton CM, Mudge S, Kayes NM, McPherson KM. Interventions to improve real-world walking after stroke: a systematic review and meta-analysis. Clin Rehabil. 2017;31:310-318.

Objective: To examine whether interventions that target walking in the real world are more effective than usual care or no intervention for improving actual walking behaviour in real-world settings in people with stroke.

Data sources: EBSCO Megafile, AMED, Scopus, Cochrane Database of Systemic Reviews, PEDro, OTseeker, and PsycBITE were searched from inception to November 2015. The database search was supplemented by hand searching.

Study selection: Randomised or quasi-randomised, controlled trials examining progressive task-oriented exercise interventions with or without behavioural change techniques. Studies had to have a usual care comparison group or a no-intervention/attention control group and measure the effects of the interventions on real-world walking (activity monitoring and/or self-report questionnaires).

Data extraction: Two reviewers extracted data. Methodological quality was assessed using the Cochrane Risk of Bias tool.

Data synthesis: Of the 4478 studies initially identified by the search, nine studies (10 treatment arms) with a total of 693 participants in the experimental group and 565 in the control group met the selection criteria and were included in the meta-analysis. Overall, the included studies were evaluated to have a low risk of bias. Based on the quantitative pooling of the available data from these trials, at post-intervention assessment there was a statistically significant difference in real-world walking in favour of the intervention group, by a standardised mean difference (SMD) of 0.29 (95% CI 0.17 to 0.41). Quantitative pooling of five studies with 3 to 6 month follow-up data found a SMD of 0.32 (95% CI 0.16 to 0.48) in favour of the intervention group. Pre-planned subgroup analysis found that interventions that incorporated at least one behaviour change technique were effective (SMD 0.27, 95% CI 0.12 to 0.43) whereas those without any behaviour change strategies were not effective (SMD –0.19, 95% CI –0.11 to 0.49).

Conclusion: Task-oriented exercise interventions alone appeared to be insufficient for improving real-world walking habits in people with stroke. Exercise and gait-oriented interventions that employed behaviour change techniques were more likely to be effective in changing real-world walking behaviour, but the estimated treatment effect was small.

Provenance: Invited. Not peer reviewed.

Source: Improving real-world walking habits after stroke requires behavioural change techniques, not just exercise and gait training [synopsis] – Journal of Physiotherapy

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[VIDEO] gloreha Sinfonia – YouTube

Fits like a Glove

Doctors, phisiotherapists and caregivers have a mutual key goal: enhancing Patient Quality of Life. Professional experience and robotic technology are the ideal means to a successful rehabilitation.
Gloreha is a robotic glove which permits customizable, task-oriented, and adjustable therapies. An involving and motivating therapy is given by the sum of upper limb motor recovery, proprioceptive stimulation and interaction with real objects.
Gloreha Sinfonia is a device for upper limb rehabilitation that supports patients during all the phases of recovery.

A comfortable and lightweight glove
The key feature of Gloreha Sinfonia is a rehabilitation glove which supports fingers joint motion, while detecting voluntary active motion.
Patients are totally involved during motor exercises, thanks to multisensory stimulation and 3D animation on the screen.
According to necessity, motion can be triggered by the robotic glove (passive mobilization), or by the patients themselves (active games). The device will support patients’ effort, intervening only when necessary (active-assisted mobilization).

Task-oriented functional exercises for rehabilitation
The aim of every rehabilitation program is the recovery of the Activities of Daily Living (ADL). Gloreha Sinfonia helps patients perform grasping, reaching, picking exercises, and interacting with real objects.
Gloreha Sinfonia is an ideal workstation designed to recover functional movements. It also provides a wide variety of motivational and challenging exercises with different difficulty levels.

Weight compensation
Gloreha Sinfonia includes two dynamic supports. Their function is to relieve upper limb weight, fostering the completion of functional exercises:
Patients’ arms can completely move and float freely.

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[WEB SITE] Task-oriented rehab program does not result in greater recovery from stroke – Medical News Today

The use of a structured, task-oriented rehabilitation program, compared with usual rehabilitation, did not result in better motor function or recovery after 12 months for patients with moderate upper extremity impairment following a stroke, according to a study in JAMA.

Clinicians providing care for patients with stroke lack evidence for determining the best type and amount of motor therapy during outpatient rehabilitation. Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits.

Carolee J. Winstein, Ph.D., of the University of Southern California, Los Angeles, and colleagues randomly assigned 361 participants with moderate motor impairment following a stroke to structured, task-oriented upper extremity training (n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. Participants were recruited from 7 U.S. hospitals, treated in the outpatient setting, and tested at 12 months on various measures of motor function and recovery.

Among the 361 patients (average age, 61 years), 304 (84 percent) completed the 12-month primary outcome assessment. The researchers found there were no group differences in upper extremity motor performance; specifically, the structured, task-oriented motor therapy was not superior to usual outpatient occupational therapy for the same number of hours, showing no additional benefit for an evidence-based, intensive, restorative therapy program. In addition, there was no advantage to providing more than twice the average dose (average, 27 hours) of therapy compared with the average 11 hours received by the observation-only group, showing that substantially more therapy time was not associated with additional motor restoration.

“These findings do not support superiority of this task-oriented rehabilitation program for patients with motor stroke and moderate upper extremity impairment,” the authors write.

“With payer pressures on reducing inpatient rehabilitation, outpatient rehabilitation may be of greater importance for patients with stroke. The findings from this study provide important new guidance to clinicians who must choose the best treatment for patients with stroke,” the researchers write. “The results suggest that usual and customary community-based therapy, provided during the typical outpatient rehabilitation time window by licensed therapists, improves upper extremity motor function and that more than doubling the dose of therapy does not lead to meaningful differences in motor outcomes.”

“The data pertaining to dose of rehabilitation therapy may be important to policy makers and may be useful to estimate the cost and expected effect of aftercare in the outpatient setting.”

Source: Task-oriented rehab program does not result in greater recovery from stroke – Medical News Today

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[ARTICLE] Effects of task-oriented treadmill-walking training on walking ability of stoke patients


Background: Generally, treadmill-walking training focuses on weight bearing and the speed of walking. However, changes in direction, speed, and slope while walking require adaptation.

Objective: The effects of task-oriented treadmill-walking training (TOTWT) on the walking ability of stroke patients were evaluated.

Methods: Subjects were randomly divided into two groups: the task-oriented treadmill-walking training (TOTWT) group and the conventional treadmill-walking training (CTWT) group. Evaluation was performed before the commencement of the training and again 4 and 8 wk after training was initiated. The OptoGait system measured gait parameters. The Timed Up and Go test and 6-min walk test were also performed.

Results: Within each group, both the TOTWT and the CTWT groups significantly differed before and after the intervention in all tests (P <  0.05); the CTWT group showed greater improvement in all tests following TOTWT (P <  0.05).

Conclusion: TOTWT improves gait and rehabilitation in the stroke-affected limb, and also improves general gait characteristics.

via Effects of task-oriented treadmill-walking training on walking ability of stoke patients: Topics in Stroke Rehabilitation: Vol 0, No 0.

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