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

Abstract

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.

A Comparative Efficacy Study of Robotic Priming of Bilateral Approach in Stroke Rehabilitation

“…In addition, numerous priming techniques can be combined with task-oriented approaches. Similar findings have been reported for stimulation-based and manipulation input sensory priming techniques assessed with the FMA ( 34 , 43 , 44 ). This may indicate the efficiency of combining contemporary therapies with priming techniques and the need to clarify the best combination regimen in future studies.…”

“…Prior studies have noted the additional effect of priming combined with a task-oriented approach. For chronic stroke patients, combining movement-based priming and task-oriented approaches can be a promising intervention strategy for recovery in the arms ( 34 ). The objective of the study was to identify the efficacy of RMT and RBULT, two different hybrid approaches that are based on the tenet of bilateral movement practice.…”

“…The primary outcome measure, the FMA, quantitatively measures the recovery of motor impairment and has high reliability, validity, and responsiveness in stroke patients (20,21). Motor impairment levels were classified as severe (score 0-15), severe to moderate (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), moderate to mild (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53), or mild (54-66) (19). The proximal (0-42), distal (0-24), and total (0-66) FMA-upper extremity (UE) scores were used to compare different UE elements in the current study.…”

Effectiveness of Constraint-Induced Movement Therapy (CIMT) on Balance and Functional Mobility in the Stroke Population: A Systematic Review and Meta-Analysis

“…Many advanced rehabilitation methods to treat patients after a stroke, including robotic-assisted technology [ 3 , 4 , 5 ], transcranial brain stimulation [ 2 , 5 , 6 ], virtual reality techniques [ 7 ], and game-based rehabilitation [ 8 ], have emerged in recent decades. Along with these advanced rehabilitation methods, the traditional approaches of neurodevelopmental treatment [ 9 ], proprioceptive neuromuscular facilitation [ 9 , 10 , 11 ], constraint-induced movement therapy (CIMT) [ 12 ], and task-oriented training [ 13 ] continue to be popular and used for the rehabilitation of patients after stroke to improve strength, balance, gait, function, and quality of life.…”

The Effect of Applying Robot-Assisted Task-Oriented Training Using Human-Robot Collaborative Interaction Force Control Technology on Upper Limb Function in Stroke Patients: Preliminary Findings

“…Rehabilitation to improve and maintain patients' functions plays a critical role in the recovery process [ 8 ]. Many rehabilitative therapies have been applied to improve UL function, such as robot-assisted therapy [ 9 ], virtual reality [ 10 ], mirror therapy [ 11 ], music playing [ 12 ], transcranial direct current stimulation [ 13 ], motor imagery [ 14 ], bilateral motor training [ 15 ], task-oriented training (TOT) [ 16 ], and constraint-induced movement therapy [ 17 ]. Among these approaches, TOT [ 18 ] and robot-assisted training are reported to be effective for improving patients' poststroke abilities to execute activities of daily living (ADL) and their UL function [ 19 ].…”