Effects of strength training combined with task-oriented training on upper extremity recovery and enjoyment of individuals with chronic stroke
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Abstract
Only little evidence has assessed the impact of strength training combined with task-oriented training (TOT) on the upper extremity function of patients with chronic stroke. This study investigated the effects of adding strength training to TOT on the upper extremity recovery and enjoyment of individuals with chronic stroke. Nineteen chronic stroke patients were randomly allocated to either a strength training combined with TOT program (experimental group, n = 10) or a TOT-only program (control group, n = 9). Both groups received a 70-minute training program, 5 times a week for 4 weeks-with a total of 3,600 repetitions for all tasks in the training. The outcomes were assessed in terms of upper extremity functions, grip strength, upper extremity motor impairment, shoulder flexion active range of motion (AROM), muscle tone, and physical activity enjoyment as assessed using the Physical Activity Enjoyment Scale (PACES) at baseline and post-intervention. The upper extremity function, upper extremity motor impairment and shoulder flexion AROM of the participants in both groups improved significantly (p-value < 0.05) post-intervention without increasing spasticity. There were no statistically significant differences between the two groups. Grip muscle strength was improved in the experimental group only (p-value < 0.05). The PACES score of the experimental group and the control group were 105.0 (89.0, 118.2) and 91.0 (83.5, 106.0), respectively. The findings suggest benefit of 4-week strength training combined with TOT program on the improvement of upper extremity functions, upper extremity motor impairment and shoulder flexion AROM of the participants similar to the improvement witnessed in the participants of the TOT-only program. However, only the strength training combined with TOT program improved muscle strength. The post-chronic stroke patients seemed to enjoy the strength training combined with TOT program more than the TOT-only program.
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References
Kong KH, Chua KS, Lee J. Recovery of upper limb dexterity in patients more than 1 year after stroke: frequency, clinical correlates and predictors. NeuroRehabilitation 2011; 28(2): 105-11.
Carr JH, Shepherd RB. Neurological rehabilitation: optimizing motor performance: Elsevier Health Sciences; 2010.
Roby-Brami A, Jarrassé N, Parry R. Impairment and compensation in dexterous upper-limb function after stroke. from the direct consequences of pyramidal tract lesions to behavioral involvement of both upper-limbs in daily activities. Front Hum Neurosci 2021; 15: 1-20.
Kilbreath SL, Heard RC. Frequency of hand use in healthy older persons. Aust J Physiother 2005; 51(2): 119-22.
Raghavan P. Upper limb motor impairment after stroke. Phys Med Rehabil Clin N Am 2015; 26(4): 599-610.
Bourbonnais D, Vanden Noven S. Weakness in patients with hemiparesis. Am J Occup Ther 1989; 43(5): 313-9.
Ng SSM, Shepherd RB. Weakness in patients with stroke: implications for strength training in neurorehabilitation. Phys Ther Rev 2000; 5(4): 227-38.
Katrak P, Bowring G, Conroy P, Chilvers M, Poulos R, McNeil D. Predicting upper limb recovery after stroke: the place of early shoulder and hand movement. Arch Phys Med Rehabil 1998; 79(7): 758-61.
Nijland RH, van Wegen EE, Harmeling-van der Wel BC, Kwakkel G. Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: early prediction of functional outcome after stroke: the EPOS cohort study. Stroke 2010; 41(4): 745-50.
Graef P, Michaelsen SM, Dadalt ML, Rodrigues DA, Pereira F, Pagnussat AS. Effects of functional and analytical strength training on upperextremity activity after stroke: a randomized controlled trial. Braz J Phys Ther 2016; 20: 543-52.
Veldema J, Jansen P. Resistance training in stroke rehabilitation: systematic review and meta-analysis. Clin Rehabil 2020; 34(9): 1173-97.
Rensink M, Schuurmans M, Lindeman E, Hafsteinsdottir T. Task‐oriented training in rehabilitation after stroke: systematic review. J Adv Nurs 2009; 65(4): 737-54.
Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, et al. Effect of a task-oriented rehabilitation program on upper extremity recovery following motor stroke: the ICARE randomized clinical trial. J Am Med Assoc 2016; 315(6): 571-81.
da Silva PB, Antunes FN, Graef P, Cechetti F, de Souza Pagnussat A. Strength training associated with task-oriented training to enhance upper-limb motor function in elderly patients with mild impairment after stroke: a randomized controlled trial. Am J Phys Med Rehabil 2015; 94(1): 11-9.
Rice DB, McIntyre A, Mirkowski M, Janzen S, Viana R, Britt E, et al. Patient‐centered goal setting in a hospital‐based outpatient stroke rehabilitation center. PM R 2017; 9(9): 856-65.
Isariyapan O, Kerdsawatmongkon J, Chondaen N, Nualnetr N, Roongpiboonsopit D, Srisoparb W. Effects of a 2-week home-based strength training associated with task-oriented training to upper limb function activities in patients with chronic stroke. Srinagarind Med J 2020; 35(4): 463-9.
Wilkins KB, Owen M, Ingo C, Carmona C, Dewald J, Yao J. Neural plasticity in moderate to severe chronic stroke following a deviceassisted task-specific arm/hand intervention. Front Neurol 2017; 8: 284.
Arya KN, Verma R, Garg RK, Sharma VP, Agarwal M, Aggarwal GG. Meaningful taskspecific training (MTST) for stroke rehabilitation: a randomized controlled trial. Top Stroke Rehabil 2012; 19(3): 193-211.
Nair B. Clinical trial designs. Indian Dermatol Online J 2019; 10(2): 193.
Timmermans AA, Spooren AI, Kingma H, Seelen HA. Influence of task-oriented training content on skilled arm-hand performance in stroke: a systematic review. Neurorehabil Neural Repair 2010; 24(9): 858-70.
Morris DM, Uswatte G, Crago JE, Cook EW 3rd, Taub E. The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Arch Phys Med Rehabil 2001; 82(6): 750-5.
Bogard K, Wolf S, Zhang Q, Thompson P, Morris D, Nichols-Larsen D. Can the Wolf Motor Function Test be streamlined? Neurorehabil Neural Repair 2009; 23(5): 422-8.
Wu CY, Fu T, Lin KC, Feng CT, Hsieh KP, Yu HW, et al. Assessing the streamlined Wolf motor function test as an outcome measure for stroke rehabilitation. Neurorehabil Neural Repair 2011; 25(2): 194-9.
Chen HF, Wu CY, Lin KC, Chen HC, Chen CP, Chen CK. Rasch validation of the streamlined wolf motor function test in people with chronic stroke and subacute stroke. Phys Ther 2012; 92(8): 1017-26.
Murrock CJ, Bekhet A, Zauszniewski JA. Psychometric evaluation of the physical activity enjoyment scale in adults with functional limitations. Issues Ment Health Nurs 2016; 37(3): 164-71.
Mercier C, Bourbonnais D. Relative shoulder flexor and handgrip strength is related to upper limb function after stroke. Clin Rehabil 2004; 18(2): 215-21.
Hamilton GF, McDonald C, Chenier TC. Measurement of grip strength: validity and reliability of the sphygmomanometer and jamar grip dynamometer. J Orthop Sports Phys Ther 1992; 16(5): 215-9.
Allen D, Barnett F. Reliability and validity of an electronic dynamometer for measuring grip strength. Int J Ther Rehabil 2011; 18(5): 258-64.
Alt Murphy M, Resteghini C, Feys P, Lamers I. An overview of systematic reviews on upper extremity outcome measures after stroke. BMC Neurol 2015; 15: 1-15.
Kim H, Her J, Ko J, Park Ds, Woo JH, You Y, et al. Reliability, concurrent validity, and responsiveness of the Fugl-Meyer assessment (FMA) for hemiplegic patients. J Phys Ther Sci 2012; 24(9): 893-9.
Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair 2002; 16(3): 232-40.
Beebe JA, Lang CE. Active range of motion predicts upper extremity function 3 months after stroke. Stroke 2009; 40(5): 1772-9.
Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry: FA Davis; 2009.
Ansari NN, Naghdi S, Arab TK, Jalaie S. The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: limb and muscle group effect. NeuroRehabilitation 2008; 23(3): 231-7.
Bohannon RW, Cassidy D, Walsh S. Trunk muscle strength is impaired multidirectionally after stroke. Clin Rehabil 1995; 9(1): 47-51.
Kendzierski D, DeCarlo KJ. Physical activity enjoyment scale: two validation studies. J Sport Exerc Psychol 1991; 13(1): 50-64.
Lin CHJ, Knowlton BJ, Chiang MC, Iacoboni M, Udompholkul P, Wu AD. Brain-behavior correlates of optimizing learning through interleaved practice. Neuroimage 2011; 56(3): 1758-72.
Hosp JA, Luft AR. Cortical plasticity during motor learning and recovery after ischemic stroke. Neural plasticity 2011; 2011: 1-9.
Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, et al. Interdisciplinary comprehensive arm rehabilitation evaluation (ICARE): a randomized controlled trial protocol. BMC Neurol 2013; 13(1): 1-19.
Krakauer JW. Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol 2006; 19(1): 84-90.
Harris JE, Eng JJ. Strength training improves upper-limb function in individuals with stroke: a meta-analysis. Stroke 2010; 41(1): 136-40.