Posts Tagged Task-specific

[ARTICLE] Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury

Abstract

Background:

Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses.

Methods:

A systematic review of the literature published between 1995 and 2016 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit.

Results:

Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality–based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality–based balance training may improve walking speed and distance in these patient groups. Finally, strong evidence suggests that body weight–supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance.

Discussion:

The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient’s engagement. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy.

Limitations:

As walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance.

Summary:

The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. Future studies should clarify the potential utility of specific training parameters that lead to improved walking speed and distance in these populations in both chronic and subacute stages following injury.

Disclaimer:

These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for persons with chronic stroke, incomplete spinal cord injury, and traumatic brain injury to improve walking speed and distance.

TABLE OF CONTENTS

INTRODUCTION AND METHODS

Summary of Action Statements………………………………………………..53

Levels of Evidence and Grade of Recommendations…………………54

Methods………………………………………………………………………………….57

ACTION STATEMENTS AND RESEARCH RECOMMENDATIONS

Action Statements…………………………………………………………………..63

Discussion…………………………………………………………………………….79

Conclusions…………………………………………………………………………..82

Summary of Research Recommendations……………………………….83

ACKNOWLEDGMENTS AND REFERENCES

Acknowledgments…………………………………………………………………84

References……………………………………………………………………………84

TABLES AND FIGURE

Table 1: Levels of Evidence for Studies……………………………………54

Table 2: Standard and Revised Definitions for Recommendations………………..54

Table 3: Example of PICO Search Terms for Strength Training………………….58

Table 4: Survey Results………………………………………………….59

Figure 1: Flow chart for article searches and appraisals…………………….60

Table 5: Final Recommendations for Clinical Practice Guideline on Locomotor Function…..79

APPENDIX: EVIDENCE TABLES

Appendix Table 1: Walking Training at Moderate to High Aerobic Intensities…….91

Appendix Table 2: Walking Training With Augmented Feedback/Virtual Reality…….92

Appendix Table 3: Strength Training……………………………………….93

Appendix Table 4: Cycling and Recumbent Stepping Training……………………94

Appendix Table 5: Circuit and Combined Exercise Training…………………….95

Appendix Table 6A: Balance Training: Sitting/Standing With Altered Feedback/Weight Shift……..96

Appendix Table 6B: Balance Training: Augmented Feedback With Vibration………..97

Appendix Table 6C: Balance Training: Augmented Visual Feedback……………….98

Appendix Table 7: Body Weight–Supported Treadmill Walking………………99

Appendix Table 8: Robotic-Assisted Walking Training………………………..100

[…]

 

Continue —-> Clinical Practice Guideline to Improve Locomotor Function Fo… : Journal of Neurologic Physical Therapy

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[Abstract] A Preliminary Study: Mobile Device for Hand and Wrist Rehabilitation – IEEE Conference Publication

Abstract:

Task-specific rehabilitation has emerged as an influential approach to address the specific neurological problems. In particular, the recovery of hand and wrist functions of people suffering from hemiparesis and hemiplegia has appeared as a means of voluntary practices. In this study, a passive rehabilitation device has been designed to offer repetitive, low-cost, portable, easy-to-use human-machine interface for people who have limited hand-wrist mobility, also substantially decrease the therapist’s workload, and provide motivation and objective feedback to users. Therapy-based task-oriented virtual reality games are also accompanied with the proposed rehabilitation device to raise patient’s attention and motivation throught the therapy.

via A Preliminary Study: Mobile Device for Hand and Wrist Rehabilitation – IEEE Conference Publication

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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

Chapter 9

Mobility and the Lower Extremity

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995).In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

For evidence tables, please click here.

Source: Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation

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[ARTICLE] Improving arm function in chronic stroke: a pilot study of sensory amplitude electrical stimulation via glove electrode during task-specific training

Abstract

Objective: To investigate the effects of sensory amplitude electrical stimulation (SES) delivered by glove electrode during task-specific exercise on arm movement, function, and sensation in chronic stroke.

Design: Intervention pilot study, pre-test, post-test, follow-up design.

Setting: University research laboratory and home-based intervention.

Participants: 11 individuals with chronic stroke (7.2 ± 4.1 years post onset) and moderate arm paresis [10.82/20 ± 2.27 on the Stroke Rehabilitation Assessment of Movement (STREAM) — Arm Subscale]. Participants were seven males and four females (mean age: 59 years). Participants were recruited from university-based database.

Intervention: Participants engaged in task-specific training at home for 30 min, twice daily, for 5 weeks, while receiving SES via glove electrode. Participants received supervised task practice at least twice during intervention period for 1 hour.

Main outcome measures: Jebsen–Taylor Hand Function Test (JTHFT), STREAM — Arm Subscale, Motor Activity Log-14 (MAL-14) — Amount and Quality Subscales, and Nottingham Stereognosis Assessment (NSA).

Results: Significant changes were found in group mean pre- and post-test comparisons on the NSA (P = 0.042), MAL amount subscale (P = 0.047), and JTHFT (with writing item 29 excluded) (P = 0.003) and in pre-test to follow-up comparisons on NSA (P = 0.027) and JTHFT (writing item excluded) (P = 0.009). There was no significant change on the STREAM (P = 1.0). Individuals with a greater baseline motor capacity determined by STREAM scores (P = 0.048) and more recent stroke (P = 0.014) had significantly greater improvements.

Conclusion: Combining task-specific training with glove-based SES in chronic stroke resulted in changes in arm sensation and function that were maintained at 3-month follow-up.

via Improving arm function in chronic stroke: a pilot study of sensory amplitude electrical stimulation via glove electrode during task-specific training: Topics in Stroke Rehabilitation: Vol 0, No 0.

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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

Abstract

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995). In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

Get Full Text PDF

via Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation.

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[ARTICLE] Effectiveness of Interventions to Improve Occupational Performance of People With Motor Impairments After Stroke: An Evidence-Based Review

Abstract

We conducted a review to determine the effectiveness of interventions to improve occupational performance in people with motor impairments after stroke as part of the American Occupational Therapy Association’s Evidence-Based Practice Project. One hundred forty-nine studies met inclusion criteria. Findings related to key outcomes from select interventions are presented.

Results suggest that a variety of effective interventions are available to improve occupational performance after stroke. Evidence suggests that repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation can improve upper-extremity function, balance and mobility, and/or activity and participation.

Commonalities among several of the effective interventions include the use of goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements.

via Effectiveness of Interventions to Improve Occupational Performance of People With Motor Impairments After Stroke: An Evidence-Based Review.

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[ARTICLE] Upper Extremity Functional Outcomes With and Without Trunk Restraint in Stroke Patients – Full Text PDF

Abstract

Background and Purpose: Task-specific training improves functional outcomes after stroke. However, gains may be accompanied by increases in movements compensating for motor impairments. This study hypothesized that restriction of compensatory trunk movements may encourage recovery of premorbid movement patterns leading to better functional outcomes. The goal of this study was to determine whether task-specific training with trunk restraint produces greater improvements in upper extremity function than training without trunk restraint in post-stroke patients.

Patients and Methods: Thirty male chronic stroke patients with age ranged between 40-55 years were included in this study. Patients were divided into two equal groups (Group I and Group II). The first group (Group I) received reach to grasp and transfer blocks and pins using Box and Block Test (BBT) and Purdue Pegboard training during which compensatory movement of the trunk was prevented by trunk restraint. The second group (Group II) practiced the same task without trunk restraint. Motor function of the upper limb and gross manual dexterity were recorded using Upper Extremity Performance Test (TEMPA) and BBT respectively.

Results: There was a statistically very highly significant increase and highly significant increase of the mean value of the TEMPA score of the affected upper limb post treatment in both groups (p=0.0001 in GI and p=0.001 in GII). Also, there was a statistically very highly significant increase in BBT score post treatment in both groups (p=0.0001). Trunkrestraint group had statistically non significant greater improvement in motor function as compared to group without trunk restraint (p=0.057) but trunk-restraint group had a statistically very highly significant improvement of gross manual dexterity as compared to group without trunk restraint (p=0.0001).

Conclusion: Task-specific training with trunk restraint can be suggested as an effective method in improving upper extremity function in patients with impaired arm and hand function post stroke.

Full Text PDF

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