Effects of Task-oriented Bilateral Arm Training on Motor Function for Stroke Patients
Date Issued
2009
Date
2009
Author(s)
Chiu, Yi-Chun
Abstract
Background and purpose: Upper extremity hemiparesis is a leading cause of functional disability after stroke. Task-oriented approach focuses on affected arm has been a main stream for upper limb rehabilitation in physical therapy for stroke patients. Studies in the past decade have shown that bilateral arm training might promote recovery in impairement, functional activities and movement strategy. Yet most studies reporting positive training effect use new protocols of mechanically repetitive movements, not a goal-directed task. The aim of this study was to investigate the immediate and long term effect of a task-oriented bilateral arm training program on body function and structure, activities, participation and movement strategy for stroke patients. Method: In this single-blind randomized controlled trial, 38 patients with unilateral stroke were recruited and randomly allocated into two groups. Experimental group received task-oriented bilateral arm training (1 hour per session, 2 sessions a week for 3 weeks), and control group received dose-matched balance training. Outcome measures included Fugl-Meyer Assessment- upper extremity part (FMA-UE), Action Research Arm Test (ARAT), Motor Activity Log(MAL) and kinematic performances. Tests were conducted during baseline, immediately after training and at follow-up (one month after trining). Kinematic data were collected by FASTRAK 3D electromagnetic system and calculated by MATLAB sofeware. Statistical analysis were conducted by SPSS 15.0 with signicant level set at 0.05. Results: There were no significant differences between groups, but patients in experimental group showed signigicant intra-group difference including FMA-UE, ARAT and reaching distance of affected arm during bilateral reaching. Considering participants with more severe arm dysfunction, the experimental group improved significantly more during the follow-up period on the kinematic variables related to symmetry of bilateral reaching, especially for the smoothness of reaching. Those improvements moderately correlated with severity of FMA-UE. Among those participants with more severe dysfunction in the experimental group, acute patients only improved more on FMA-UE and the movement time during bilateral reaching, but chronicity did not effect change of other variables. Conclusion: Stroke patients received three weeks of task-oriented bilateral arm training improved more in body function and structure, activity, and also demonstrate task-specific improvement on kinematic variable of bilateral reaching. Patients with more severe upper limb dysfunction benefit more signifigcantly, especially on symmetry and smoothness of bilateral reching. Further studies are needed to optimize treatment dose, increase sample size, and to explore wheather task-oriented design could strengthen the effect of bilateral arm training.
Subjects
Stroke
Upper extremity
Bilateral training
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