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Issue Date: July 01, 2015
Published Online: February 09, 2016
Updated: January 01, 2020
A Task-Specific Training Protocol for Individuals With Moderate Upper-Limb Hemiparesis Improves Motor Function
Author Affiliations
  • Rush University
  • University of Illinois at Chicago
Article Information
Hand and Upper Extremity / Mental Health / Neurologic Conditions / Stroke / Prevention and Intervention
Research Platform   |   July 01, 2015
A Task-Specific Training Protocol for Individuals With Moderate Upper-Limb Hemiparesis Improves Motor Function
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911515151. https://doi.org/10.5014/ajot.2015.69S1-RP303B
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911515151. https://doi.org/10.5014/ajot.2015.69S1-RP303B
Abstract

Date Presented 4/17/2015

We present a task-specific protocol that is occupation-based and has been used in registered clinical trials. Analysis of data from a control group that received only the task-specific protocol indicated significant pre-/postintervention improvements found in the Wolf Motor Function Test.

SIGNIFICANCE: Stroke is one of the most common life-altering experiences, affecting nearly 800,000 people each year in the United States alone. Hand and arm functions are frequently impaired, with 60% to 70% of individuals reporting inability to use the hand during daily activities. Most studies investigating arm paralysis use individuals with mild impairment. One of the most popular techniques for improving arm paralysis is constraint-induced movement therapy. However, this treatment is only appropriate for individuals who have mild arm paralysis (limited to the upper quartile). Our intervention protocol is highly significant because it targets a large subset of the stroke population (subjects with moderate-to-severe arm impairment) that is currently not well served.
INNOVATION: On the basis of current evidence in motor control, the protocol used in this study addresses components of upper-extremity motor control, including (1) proximal control; (2) grasp, grip, and release; (3) reaching; and (4) fine motor manipulation. The protocol also includes practicing whole tasks using preferred activities of daily living selected via the Canadian Occupational Performance Measure. This protocol, created by the first author, has been used as a control treatment in several pilot studies as well as clinical trials (clinical trial numbers: NCT01049802 and NCT00170716). In this presentation, we examine the pre-/postintervention as well as follow-up results of the control group. We attempted to answer the following research question: Will use of a systematic task-oriented therapy protocol improve performance in upper-extremity measures of function and impairment in individuals with moderate upper-extremity hemiparesis?
METHOD: We completed a secondary analysis on a study that compared two groups. The experimental group used a mechanized glove that promoted finger extension (J-Glove) while practicing a version of the protocol that was modified (due to the wrist being blocked by the glove). The data presented here are from the control group that received training in the protocol without the benefit of the J-Glove. Eleven subjects with poststroke hand impairment (Chedoke–McMaster Stroke Assessment—Hand [CMSA–H]) were enrolled >6 mo poststroke. Participants were randomized to receive 18 sessions, 1-hr in length (3 times per week), of a novel upper-extremity occupational therapy paradigm focused on the hand. One group of this parallel study used an actuated glove (experimental: n = 11), whereas the other group did not (control: n = 11). Primary outcome measures included the Wolf Motor Function Test (WMFT), Action Research Arm Test, Fugl–Meyer Upper Extremity Motor Assessment, as well as grip and pinch strength. Because of the small sample size and our interest in the effects of the protocol alone, we used one-way, repeated-measures analysis of variance (ANOVA) with time as the repeated factor. Post hoc analysis was completed with least significant difference (LSD).
RESULTS: A total of 22 participants completed the study. Analysis of the control group indicated that statistically significant results (p < .008) were found in the WMFT (time). Post hoc analysis indicated that differences between pre-/postintervention as well as preintervention and follow-up time points were significant.
CONCLUSION: Individuals with moderate upper-limb hemiparesis who had 18 hr of a task-specific training protocol made significant improvements in the WMFT.