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Background The sequence of establishing a proximal stability or function before facilitation of the distal body part has long been recognized in stroke rehabilitation practice but lacks scientific evidence. This study plans to examine the effects of proximal priority robotic priming and impairment-oriented training (PRI) and distal priority robotic priming and impairment-oriented training (DRI). Methods This single-blind, randomized, comparative efficacy study will involve 40 participants with chronic stroke. Participants will be randomized into the PRI or DRI groups and receive 18 intervention sessions (90 min/day, 3 days/weeks for 6 weeks). The Fugl-Meyer Assessment Upper Extremity subscale, Medical Research Council Scale, Revised Nottingham Sensory Assessment, and Wolf Motor Function Test will be administered at baseline, after treatment, and at the 3-month follow-up. Two-way repeated-measures analysis of variance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after PRI and DRI. Discussion Through manipulating the sequence of applying wrist and forearm robots in therapy, this study will attempt to examine empirically the priming effect of proximal or distal priority robotic therapy in upper extremity impairment-oriented training for people with stroke. The findings will provide directions for further studies and empirical implications for clinical practice in upper extremity rehabilitation after stroke. Trial Registration ClinicalTrials.gov NCT04446273. Registered on June 23, 2020.

Background: Professional competence of young occupational therapists is enhanced through on-site resources, hands-on training and outcome-based education. The Direct Observation of Procedural Skills (DOPS) is a work-based assessment to evaluate professional knowledge, skills and attitude in occupational therapy (OT) clinical training. The perspectives of OT fieldwork teachers and trainees regarding the DOPS are important, but rarely investigated. This study aimed to investigate the perspectives of OT educators and trainees in using DOPS and their discrepancy for OT post-graduate year (PGY) training.Methods: An online survey was distributed to OT educators and trainees who participated in OT PGY training. The survey comprised five sections: demographic information, the practicality in using the DOPS in clinical settings, the ease of rating the DOPS, and advantages and disadvantages of the DOPS. The responses were based on a 5-point Likert scale. A score of 4 or 5 indicated that the responder agreed/simple or strongly agreed/very simple with the statement. A total of 86 and 41 surveys from OT teachers and trainees were returned respectively, and 64 and 30 from OT teachers and trainees who used DOPS were analyzed.Results: Over 70 percent of OT educators and trainees agreed that clinical resources (i.e., time, personnel support and cooperation, feedback and training) were sufficient when using the DOPS. Most OT educators and trainees agreed that DOPS matched with OT training goals, benefited the OT competence training and had a fair, objective and consistent scoring system. A significant higher percentage of OT trainees felt stressful in DOPS assessment than that of trainers. Significant higher percentages of OT trainees strongly agreed that DOPS was a practical and appropriate assessment for OT competence training, and had a fair, objective and consistent scoring system than those of OT teachers. There were no significant differences between teachers and trainees regarding easiness of rating DOPS items.Conclusion: Most OT educators and trainees agreed that DOPS was a practical and appropriate assessment for the OT PGY training.

BackgroundThe sequence of establishing proximal stability or function before facilitation of the distal body part has long been recognized in stroke rehabilitation practice but lacks scientific evidence. This study plans to examine the effects of proximal priority robotic priming and impairment-oriented training (PRI) and distal priority robotic priming and impairment-oriented training (DRI). MethodsThis single-blind, randomized, comparative efficacy study will involve 40 participants with chronic stroke. Participants will be randomized into PRI or DRI groups and receive 18 intervention sessions (90 min/d, 3 d/wk for 6 weeks). The Fugl-Meyer Assessment Upper Extremity subscale, Medical Research Council Scale, Revised Nottingham Sensory Assessment, and Wolf Motor Function Test will be administered at baseline, after treatment, and at the 3-month follow-up. Two-way repeated-measures analysis of variance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after PRI and DRI. DiscussionThrough manipulating the sequence of applying wrist and forearm robots in therapy, this study will attempt to examine empirically the priming effect of proximal or distal priority robotic therapy in upper extremity impairment-oriented training for people with stroke. The findings will provide directions for further studies and empirical implications for clinical practice in upper extremity rehabilitation after stroke.Trial RegistrationThis trial was registered on June 23, 2020, at www.clinicaltrials.gov (NCT04446273).