Repetitive task training for improving functional ability after stroke

French, Beverley; Thomas, Lois H; Coupe, Jacqueline; McMahon, Naoimh E.; Connell, Louise; Harrison, Joanna; Sutton, Chris J; Tishkovskaya, Svetlana; Watkins, Caroline

doi:10.1002/14651858.cd006073.pub3

Cited by 326 publications

(164 citation statements)

References 93 publications

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“…During rehabilitation programs, there are several different therapeutic approaches that physiotherapists may attempt with their patients, while trying to understand if they meet the required needs. Some of them were analyzed and collected from the works French et al [26], Oujamaa et al [27], and Sucar et al [28], presented below.…”

Section: Common Therapeutic Practicesmentioning

confidence: 99%

Gamifying Motor Rehabilitation Therapies: Challenges and Opportunities of Immersive Technologies

Ferreira

Menezes

2020

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Recovering from a traumatic incident (e.g, a stroke) implies rigorous and demanding therapies to ensure recovery of the lost capabilities. Due to the lack of short-term visible results, stroke patients tend to lose interest in their recovery process and frequently do not follow their therapists’ suggestions to continue performing their training at home, between physiotherapy sessions. This article explores the extent to which common computer games or specifically crafted games can serve as a rehabilitation practice, but also how conventional therapeutic devices might be transformed to be incorporated into games. Furthermore, we propose a platform that follows the opportunity of creating serious games that are designed for stroke patients with reduced upper limb mobility while following the same principles of common therapeutic procedures. This platform was carefully built with the purpose of allowing patients to comply tele-rehabilitation and promoting the execution of the recommended training at home. Following these ideas, we integrated two carefully designed games that have been tested and validated in our previous works, and we added a top-layer characterized by an online back-end application for therapists that allows them to observe their patients’ progress over time and draw different conclusions.

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Section: Common Therapeutic Practicesmentioning

confidence: 99%

Gamifying Motor Rehabilitation Therapies: Challenges and Opportunities of Immersive Technologies

Ferreira

Menezes

2020

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“…That MPT + CPT was found to produce equivalent benefit to FST + CPT is interesting, as FST is based on the findings that task-specific training drives recovery after stroke 7 and that the largest impact on upper limb improvement is loss of muscle strength. 18,19 In contrast, MPT concentrates on enhancing the quality of movement during whole or part functional tasks and not on repetitive progressive training of those everyday tasks.…”

Section: Clinical Efficacy: Relationship To Previous Studiesmentioning

confidence: 99%

“…Improving the outcome of upper limb rehabilitation after stroke is a research priority for the NHS 5 and, more widely, across Europe. 6 It is known that (1) upper limb recovery is enhanced by the provision of physical therapy based on repetitive task-specific training, 7 and (2) the 3 months immediately after stroke is when recovery is most rapid 8 and there is most potential for central nervous system reorganisation (neuroplasticity). 9 However, not everybody responds in the same way to particular forms of task-specific training.…”

Section: Chapter 1 Introductionmentioning

confidence: 99%

Functional strength training versus movement performance therapy for upper limb motor recovery early after stroke: a RCT

et al. 2018

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Background Not all stroke survivors respond to the same form of physical therapy in the same way early after stroke. The response is variable and a detailed understanding of the interaction between specific physical therapies and neural structure and function is needed. Objectives To determine if upper limb recovery is enhanced more by functional strength training (FST) than by movement performance therapy (MPT), to identify the differences in the neural correlates of response to (1) FST and (2) MPT and to determine whether or not pretreatment neural characteristics can predict recovery in response to (1) FST and (2) MPT. Design Randomised, controlled, observer-blind, multicentre trial with embedded explanatory investigations. An independent facility used computer-generated randomisation for participants’ group allocation. Setting In-patient rehabilitation, participants’ homes, university movement analysis facilities and NHS or university neuroimaging departments in the UK. Participants People who were between 2 and 60 days after stroke in the territory of the anterior cerebral circulation, with some voluntary muscle contraction in the more affected upper limb but not full function. Interventions Routine rehabilitation [conventional physical therapy (CPT)] plus either MPT or FST in equal doses during a 6-week intervention phase. FST was progressive resistive exercise provided during training of functional tasks. MPT was therapist ‘hands-on’ sensory input and guidance for production of smooth and accurate movement. Main outcomes Action Research Arm Test (ARAT) score for clinical efficacy. Neural measures were made of corticocortical [fractional anisotropy (FA) from corpus callosum midline], corticospinal connectivity (asymmetry of corticospinal tracts FA) and resting motor threshold of paretic biceps brachii (pBB) and extensor carpi radialis muscles (derived from transcranial magnetic stimulation). Analysis Change in ARAT scores were analysed using analysis of covariance models adjusted for baseline variables and randomisation strata. Correlation coefficients were calculated between change in neural measures and change in ARAT score per group and for the whole sample. An interaction term was calculated for each baseline neural measure and ARAT score change from baseline to outcome. Results A total of 288 participants were randomised [mean age 72.2 (standard deviation 12.5) years; mean ARAT score of 25.5 (18.2); n = 283]. For the 240 participants with ARAT measurements at baseline and outcome, the mean change scores were FST + CPT = 9.70 (11.72) and MPT + CPT = 7.90 (9.18). The group difference did not reach statistical significance (least squares mean difference 1.35, 95% confidence interval –1.20 to 3.90; p = 0.298). Correlations between ARAT change scores and baseline neural values ranged from –0.147 (p = 0.385) for whole-sample corticospinal connectivity (n = 37) to 0.199 (p = 0.320) for MPT + CPT resting motor threshold pBB (n = 27). No statistically significant interaction effects were found between baseline neural variables and change in ARAT score. There were no differences between groups in adverse events. Limitations The number of participants in the embedded explanatory investigation was lower than expected. Conclusions The small difference in upper limb improvement in response to FST and MPT did not reach statistical significance. Baseline neural measures neither correlated with upper limb recovery nor predicted therapy response. Future work Needs to continue investigation of the variability of response to specific physical therapies in people early after stroke. Trial registration Current Controlled Trials ISRCTN19090862 and National Research Ethics Service reference number 11/EE/0524. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership.

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“…Secondary objectives are (1) to determine the effect of RTT on secondary outcome measures, including activities of daily living, global motor function, quality of life/health status, and adverse events, (2) to determine the factors that could influence primary and secondary outcome measures, including the effect of dose of task practice, type of task (whole therapy, mixed, or single task), and timing of the intervention and type of intervention. We included only randomized or quasi-randomized trials in adults after stroke, where the intervention was an active motor sequence performed repetitively within a single training session, aimed toward a clear functional goal.…”

Section: Objectivesmentioning

confidence: 99%