Coaching by Task (Practice)

The motor function impairment deriving from stroke injury has a negative impact on autonomy and on the activities of daily living. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. To facilitate the activation of brain areas and consequently neuroplasticity, it may be advantageous to combine traditional motor rehabilitation with innovative technology, in order to promote motor re-learning and skill re-acquisition by means of an enhanced training. Following these principles, exercises should involve multiple sensory modalities exploiting the adaptive nature of the nervous system, in order to promote active patient participation. Movement re-learning could be improved by means of training in an enriched environment focused on optimizing the affordances between the motor system and the physical environment: virtual reality technologies allow for the possibility to create specific settings where the affordances are optimized. Several autors report that patients treated in virtual representation could, in both acute and chronic stroke, improve their arm motor function. Reinforced Feedback in a Virtual Environment (RFVE), can incorporate the elements necessary to maximize motor learning, such as repetitive and differentiated task practice, feedback of performance and results, and reinforcement of the motivation. The RFVE approach may lead to better rehabilitation outcomes in the treatment of the upper limb in stroke patients.

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Improvements in Hand Function in Adults With Chronic Tetraplegia Following a Multiday 10-Hz Repetitive Transcranial Magnetic Stimulation Intervention Combined With Repetitive Task Practice

Journal of Neurologic Physical Therapy ◽

10.1097/npt.0000000000000062 ◽

2015 ◽

Vol 39 (1) ◽

pp. 23-30 ◽

Cited By ~ 25

Author(s):

Joyce Gomes-Osman ◽

Edelle C. Field-Fote

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Hand Function ◽

Task Practice

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Abstract 144: Forced Aerobic Exercise Enhances Upper Extremity Task Practice in Patients with Stroke

Stroke ◽

10.1161/str.46.suppl_1.144 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Susan Linder ◽

Anson Rosenfeldt ◽

Jay Alberts

Keyword(s):

Aerobic Exercise ◽

Upper Extremity ◽

Motor Function ◽

Cardiovascular Health ◽

Statistical Significance ◽

Voluntary Exercise ◽

Depressive Symptomology ◽

Task Practice ◽

The Central Nervous System ◽

Minute Session

Introduction: Aerobic exercise (AE) has been shown to improve cardiovascular health in individuals with stroke; however, the potential role of AE in enhancing neuroplasticity after stroke has not been systematically studied. We have implemented a forced exercise (FE) cycling intervention, initially developed for individuals with Parkinson’s disease, with a cohort of individuals with chronic stroke. We hypothesize that intensive AE training, when paired with repetitive task practice (RTP), will “prime” the central nervous system, to exploit the motor learning effects of task practice. Hypothesis: Individuals who perform FE followed by RTP will demonstrate greater improvements in motor and non-motor function compared to the voluntary rate aerobic exercise (VE) + RTP and RTP only groups. Individuals in both AE groups (FE and VE) will demonstrate greater improvements in VO2peak compared to the RTP only group. Methods: Fifteen individuals 6-12 months post-stroke were enrolled into one of the following groups: 1) Forced Exercise + RTP (FE + RTP); 2) Voluntary Exercise + RTP (VE + RTP); and 3) Time-matched RTP. Participants in the AE groups completed one 45-minute session of stationary cycling followed immediately by one 45-minute session of upper extremity RTP; however, the rate of cycling for the FE group was augmented to approximately 35% faster than their voluntary rate. All participants completed a total of 24 exercise sessions over an 8-week period. Results: While all three groups made significant improvements in motor function as measured by the Fugl-Meyer Assessment (p=.03), the FE+RTP group exceeded the VE+RTP and RTP only groups, approaching statistical significance (p=0.06), despite the two AE groups completing 44% less RTP practice time than the RTP group. Improvements in self-reported quality of life and depressive symptomology also improved across all three groups, with trends favoring the FE group. VO2peak improved by 1.1 and 2.68 mL/kg/min for the FE+RTP and VE+RTP groups, respectively; while VO2peak decreased by 0.85mL/kg/min in the RTP group. Conclusion: FE + RTP is a promising intervention to enhance motor and non-motor function, in addition to aerobic capacity in individuals 6-12 months after stroke.

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Multimodal Mental Practice Versus Repetitive Task Practice Only to Treat Chronic Stroke: A Randomized Controlled Pilot Study

American Journal of Occupational Therapy ◽

10.5014/ajot.2021.044925 ◽

2021 ◽

Vol 75 (6) ◽

Author(s):

Stephen J. Page ◽

Peter Levine

Keyword(s):

Pilot Study ◽

Outcome Measures ◽

Large Scale ◽

Action Observation ◽

Functional Limitation ◽

Secondary Analysis ◽

Chronic Stroke ◽

Mental Practice ◽

Randomized Controlled ◽

Task Practice

Importance: Occupational therapists are the primary clinicians tasked with management of the more affected upper extremity (UE) after stroke. However, there is a paucity of efficacious, easy-to-use, inexpensive interventions to increase poststroke UE function. Objective: To compare the effect of a multimodal mental practice (MMMP) regimen with a repetitive task practice (RTP)–only regimen on paretic UE functional limitation. Design: Secondary analysis of randomized controlled pilot study data. Setting: Outpatient clinical rehabilitation laboratory. Participants: Eighteen chronic stroke survivors exhibiting moderate, stable UE impairment. Intervention: Participants administered RTP only participated in 45-min, one-on-one occupational therapy sessions 3 times per week for 10 wk; participants administered MMMP completed time-matched UE training sessions consisting of action observation, RTP, and mental practice, delivered in 15-min increments. Outcomes and Measures: The Action Research Arm Test, the UE section of the Fugl-Meyer Scale, and the Hand subscale of the Stroke Impact Scale (Version 3.0) were administered 1 wk before and 1 wk after intervention. Results: The MMMP group exhibited significantly larger (p < .01) increases on all three outcome measures compared with the RTP group and surpassed minimal clinically important difference standards for all three UE outcome measures. Conclusions and Relevance: Because of the time-matched duration of MMMP and RTP, findings suggest that MMMP may be just as feasible as RTP to implement in clinical settings. Efforts to replicate results of this study in a large-scale trial are warranted. What This Article Adds: This study shows the efficacy of an easy-to-use protocol that significantly increased affected arm function even years after stroke.

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