WHAT CLINICAL STUDIES ARE PROVING ABOUT TASK
SPECIFIC ENHANCEMENT THERAPY
Task-specific training: evidence for and transition to clinical practice.
Hubbard IJ, Parsons MW, Neilson C, Carey LM. - Acute Stroke Unit, John Hunter Hospital, Hunter New England Area Health Service, Newcastle, and the University of Newcastle, Newcastle, Australia.
There is mounting evidence of the value of task-specific training as a neuromotor intervention in neurological rehabilitation. The evidence is founded in the psychology of motor skill learning and in the neuroscience of experience-dependent and learning-dependent neural plastic changes in the brain in animals and humans. Further, there is growing empirical evidence for the effectiveness of task-specific training in rehabilitation and for neural plastic changes following task-specific training in the context of rehabilitation.
We recommend that task-specific training be routinely applied by an occupational therapist as a component of their neuromotor interventions, particularly in management related to post-stroke upper limb recovery. Specifically, we propose five implementation strategies based on review of the evidence. These are: task specific training should be relevant to the patient/client and to the context; be randomly assigned; be repetitive and involve massed practice; aim towards reconstruction of the whole task; and be reinforced with positive and timely feedback.
Occup Ther Int. 2009;16(3-4):175-89. doi: 10.1002/oti.275
Effects of Task-Specific Locomotor and Strength Training in Adults Who were Ambulatory Stroke: Results of the STEPS Randomized Clinical Trial.
Katherine J Sullivan, David A Brown, Tara Klassen, Sara Mulroy, Tingting Ge, Stanley P Azen, Carolee J Winstein and for the Physical Therapy Clinical Research Network (PTClinResNet).
Task specificity effects are particularly strong for highly practiced skill where motor abilities acquired with practice are specific to the task that is performed.
Phys Ther. 2007 Dec;87(12):1580-602. Epub 2007 Sep 25
Participants’ Perspectives on the Feasibility of a Novel, Intensive, Task-Specific Intervention for Individuals with Chronic Stroke: A Qualitative Analysis.
Angela R. Merlo, Ashley Goodman, Bruce A. McClenaghan and Stacy L. Fritz.
Conclusions: These findings suggest that participants perceive this novel and intensive, task-specific intervention as a feasible therapeutic option for individuals with chronic stroke. Despite the fatigue and muscle soreness associated with intensive rehabilitation, participants frequently reported enjoying the therapy and stated disappointment with the short duration (10 days).
Phys Ther. 2013 Feb;93(2):147-57. doi: 10.2522/ptj.20110147. Epub 2012 Nov 2
Comparison of Task Specific Exercises and Mirror Therapy to Improve Upper Limb Function in Subacute Stroke Patients.
Sneha S. Khandare, R. M. Singaravelan, Subhash M. Khatri
Improving use of the affected upper limb (UL) is important because difficulty in using this UL in daily tasks has been associated with reduced quality of life. Primary objective of this study was to find out the effectiveness of combined TSE and MT interventions in sub-acute stroke patients to improve UL function and secondary objective was to compare the effectiveness of combined TSE and MT interventions with TSE alone and MT alone. Group A received TSE, Group B received MT and Group C received TSE as well as MT. Outcome measures were Action Research Arm Test, Fugl-Meyer Assessment and Voluntary Control Grading. All 3 groups showed statistically significant improvement on outcome measures but Group C improved more than the other 2 groups. Conclusion: TSE and MT interventions should be combined altogether in the treatment of sub-acute stroke patients to improve UL function.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 7, Issue 1 (May.-Jun. 2013), PP 05-14.
Impact of a circuit-style task specific activity program on falls and injurious falls in a PACE program.
Dale L Avers, DPT, PhD - College of Health Professions. Syracuse, NY.
These findings suggest a novel task-specific program can reduce injurious falls and may reduce frequency of falls in a group of PACE participants.
Task-oriented training in rehabilitation after stroke: systematic review
Marijke Rensink, Marieke Schuurmans, Eline Lindeman & Tho´ ra Hafsteinsdo´ ttir
Studies of task-related training showed benefits for functional outcome compared with traditional therapies. Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health related quality of life.
Journal of Advanced Nursing doi: 10.1111/j.1365-2648.2008.04925.x
What’s New in Stroke Rehabilitation
In addition to quantity, the quality of interventions is equally important. Evidence suggests that the nature of interventions is important. Little benefits were seen with treatments such as repetitive training or resistance strengthening exercises. On the other hand, task-specific therapy in which treatment is specifically designed to deal with lost abilities or tasks showed best results. An excellent example of this is left-sided neglect, where task-specific training (enhanced visual scanning techniques) improves visual neglect with associated improvements in function. Similarly, short periods of prism adaptation improve not only visual neglect for several days but also perception of contralateral tactile stimuli. On reviewing the evidence in favor of less-intense, task-specific rehabilitation treatments, argued that intensity did not need to be altered to result in significant clinical improvements. This is supported by a recent study showing that increased used of the paretic hand recruited previously silent ipsilateral corticospinal pathways even in poorly recovered stroke patients. Hence, task-specific approaches, especially with stroke motor therapy, can be more efficacious than traditional approaches, which focus on impairment.
This is an exciting time in stroke rehabilitation. There is a real sense in the research community that stroke rehabilitation is beginning to realize its potential and the concepts of intensity of therapy, task-specific training, and increased sensory stimulation are now being supported by strong scientific evidence. The potential for using technology to assist in the rehabilitation process is now beginning to be realized. There is also a trend toward moving interdisciplinary stroke rehabilitation increasingly out into the community. Although this decade began with the promise of thrombolytics, increasingly it appears that the future of stroke care will be with the refinement and improvement of rehabilitation therapies.
Stroke. 2004;35:383-385; doi: 10.1161/01.STR.0000115937.94104.76
Transfer of Training Between Distinct Motor Tasks After Stroke
Implications for Task-Specific Approaches to Upper-Extremity Neurorehabilitation
Although task-specific training is emerging as a viable approach for recovering motor function after stroke, there is little evidence for whether the effects of such training transfer to other functional motor tasks not directly practiced in therapy.
Objective. The purpose of the current study was to test whether training on one motor task in individuals with chronic hemiparesis post-stroke would transfer to untrained tasks that were either spatiotemporally similar or different.
Methods. In all, 11 participants with chronic mild to moderate hemiparesis following stroke completed 5 days of supervised massed practice of a feeding task with their affected side. Performance on the feeding task, along with 2 other untrained functional upper-extremity motor tasks (sorting, dressing) was assessed before and after training.
Results. Performance of all 3 tasks improved significantly after training exclusively on 1 motor task. The amount of improvement in the untrained tasks was comparable and was not dependent on the degree of similarity to the trained task.
Conclusions. Because the number and type of tasks that can be practiced are often limited within standard stroke rehabilitation, results from this study will be useful for designing task-specific training plans to maximize therapy benefits.
Meaningful task-specific training (MTST) for stroke rehabilitation: a randomized controlled trial.
The upper extremity motor deficit is one of the functional challenges in post stroke patients. The objective of the present study was to evaluate the effectiveness of the meaningful task-specific training (MTST) on the upper extremity motor recovery during the subacute phase after a stroke.
The MTST group showed a positive improvement in the mean scores on the outcome measures at post and follow-up assessments in comparison to the control group. Further, statistically significant differences were observed in changes between the groups at post and follow-up assessment for FMA, ARAT, GWMFT, and MAL.
The MTST produced statistically significant and clinically relevant improvements in the upper extremity motor recovery of the patients who had a subacute stroke.
Top Stroke Rehabil. 2012 May-Jun;19(3):193-211. doi: 10.1310/tsr1903-193.
Neuroplasticity after spinal cord injury and training: an emerging paradigm shift in rehabilitation and walking recovery.
Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, PO Box 100154, UFHSC, Gainesville, FL 32610-0154, USA. firstname.lastname@example.org
Physical rehabilitation after spinal cord injury has been based on the premise that the nervous system is hard-wired and irreparable. Upon this assumption, clinicians have compensated for irremediable sensorimotor deficits using braces, assistive devices, and wheelchairs to achieve upright and seated mobility. Evidence from basic science, however, demonstrates that the central nervous system after injury is malleable and can learn, and this evidence has challenged our current assumptions. The evidence is especially compelling concerning locomotion. The purpose of this perspective article is to summarize the evidence supporting an impending paradigm shift from compensation for deficits to rehabilitation as an agent for walking recovery. A physiologically based approach for the rehabilitation of walking has developed, translating evidence for activity-dependent neuroplasticity after spinal cord injury and the neurobiological control of walking. Advanced by partnerships among neuroscientists, clinicians, and researchers, critical rehabilitation concepts are emerging for activity-based therapy to improve walking recovery, with promising clinical findings.
Phys Ther. 2006 Oct;86(10):1406-25.
The role of task-specific training in rehabilitation therapies.
Task-oriented therapy is important. It makes intuitive sense that the best way to relearn a given task is to train specifically for that task. In animals, functional reorganization is greater for tasks that are meaningful to the animal. Repetition alone, without usefulness or meaning in terms of function, is not enough to produce increased motor cortical representations. In humans, less intense but task-specific training regimens with the more affected limb can produce cortical reorganization and associated, meaningful functional improvements.
Department of Physical Medicine and Rehabilitation, St. Joseph's Health Care and the University of Western Ontario, London, Ontario, Canada.
Top Stroke Rehabil. 2005 Summer;12(3):58-65.
A Gait Rehabilitation and Training System based on Task Specific Repetitive Approach
Practice, effort and specificity have been proved as the major principles for gait rehabilitation. The best way to improve performance of a motor task is to execute that specific motor task again and again.