Date Presented 4/8/2016
The effectiveness and feasibility of translating a stroke-specific, task-oriented training program to the context of participants’ homes is explored. Participants improved upper-extremity functional movement with this intervention, which is based on behavioral neuroscience and motor learning theory.
Primary Author and Speaker: Veronica Rowe
RESEARCH QUESTIONS: Is a stroke-specific task-oriented training program at home, administered to people with subacute stroke utilizing the current principles of experience dependent plasticity and motor learning feasible and effective? What effects persist 1 mo after this training?
RATIONALE: Stroke-specific task-oriented training is a rehabilitation method that has been shown to reduce hemiparesis through focused use of the affected, weaker upper extremity (Lang & Birkenmeier, 2014). Task-oriented training is based on behavioral neuroscience (Kleim & Jones, 2008) and models of motor learning (Bass-Haugen & Mathiowetz, 2008). It consists of repeated, challenging practice of functional, goal-oriented activities that are challenges to a participant’s ability to function (Lang & Birkenmeier, 2014). The research to date on task-oriented training has been conducted in controlled research environments. This research study explored the effectiveness and feasibility of translating current task-oriented training programs to the “real” context of participants’ homes.
DESIGN: A single-subject, AB series design with a follow-up was implemented.
PARTICIPANTS: Four stroke survivors with moderate hemiparesis who were 3- to 12-mo post first cerebrovascular accident participated in this study.
METHOD: The intervention (Task Oriented Training and Evaluation at Home; TOTE Home) consisted of 30 sessions (1 hr each) of one-on-one training, 3×/wk. The intervention was modeled after the protocol outlined in the ICARE randomized clinical trial (Winstein et al., 2004) and Lang and Birkenmeier’s (2014) manual on task-oriented training. Target behaviors recorded during all phases of this study included accelerometry, a brief self-efficacy rating scale, participant ratings of effectiveness, and the occupational therapist’s ratings of participant engagement. Pre-, post-, and 1-mo follow-up outcome measures included the Fugl-Meyer Assessment, the Motor Activity Log, the Stroke Impact Scale, and the Functional Test for the Hemiparetic Upper Extremity.
ANALYSIS: Visual analysis was utilized to assess repeated target behaviors. Change scores on other outcome measures were assessed to help better describe each participant and the changes that occurred.
RESULTS: Preliminary results indicate that TOTE Home is both an effective and a feasible intervention.
DISCUSSION: It is feasible to implement a stroke-specific task-oriented training program in clients’ homes. With this intervention, participants improved upper-extremity movement function over time. These changes persisted following completion of the intervention. Specific important aspects of the intervention include salience in the tasks (meaningfulness) and specificity (skilled movements) that affected the participant’s compliance with repetition and intensity of the training.
IMPACT STATEMENT: Stroke-specific task-oriented training is based on scientific findings and now has shown to be an evidence-based intervention. This makes it a powerful treatment methodology that occupational therapists can implement within feasible practice time frames to help meet client’s occupational needs within the environment of their own home.
References
Bass-Haugen, J., & Mathiowetz, V. (2008). Optimizing motor behavior using the occupational therapy task-oriented approach. In M. V. Radomski & C. T. Latham (Ed.), Occupational therapy for physical dysfunction (pp. 598–617). Philadelphia: Lippincott Williams & Wilkins.
Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, 51, S225–S239. http://dx.doi.org/10.1044/1092-4388(2008/018)
Lang, C. E., & Birkenmeier, R. L. (2014). Upper-extremity task-specific training after stroke or disability: A manual for occupational therapy and physical therapy. Bethesda, MD: AOTA Press.
Winstein, C. J., Rose, D. K., Tan, S. M., Lewthwaite, R., Chui, H. C., & Azen, S. P. (2004). A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke. Archives of Physical Medicine and Rehabilitation, 85, 620–628.
