Effects of Task-Oriented Circuit Training on Lower Extremity Motor Function and Brain Plasticity in Patients with Sub-acute Stroke: Meta-analysis and Preliminary Study
Date Issued
2012
Date
2012
Author(s)
Wong, Connie
Abstract
Recent studies have shown that task-oriented circuit training is effective in improving walking speed and walking endurance in patients with chronic stroke. However, the training effects of task-oriented approach in patients with sub-acute stroke remain unclear. It also remains to be explored regarding whether task-oriented training has effects on structural integrity of the corticospinal tract (CST) and activation patterns of the sensorimotor cortex (SMC) during ankle movements in patients with sub-acute stroke. Therefore, the purposes of this study were: (1) to investigate the effects of task-oriented training on lower extremity motor functions in patients with sub-acute stroke using meta-analysis; (2) to preliminarily investigate the effects of a 4-week task-oriented circuit training program on lower extremity motor functions (primary outcomes), the structural integrity of the CST of lower extremity motor fibers and brain activation patterns of the SMC (secondary outcomes) in patients with sub-acute stroke.
We conducted a meta-analysis to examine the effects of task-oriented approach in patients with sub-acute stroke and a preliminary study of an assessor-blind randomized controlled trial with a total of 3 patients with sub-acute stroke (experimental group: E1; control group: C1 and C2). The participants were randomly assigned to the experimental group or the control group. All participants received 4 weeks of exercise training, which were 4 sessions per week and 60 minutes for each session. The experimental group received task-oriented circuit training to improve lower extremity motor functions. The control group received stretch exercises and upper extremity activities in sitting posture. Both groups received clinical asessments on lower extremity motor functions (primary outcomes), the structural integrity of the CST using diffusion spectrum imaging, and the cortical activation patterns of the SMC using functional magnetic resonance imaging(secondary outcomes) at baseline, post-training (week 4), and 1 month follow-up (week 8). Because of the small number of subjects, we also included one subject (E2) who received the same training programs as experimental group in our pilot study as one subject of the training group result. Training effects were descriptively analyzed for individual subjects.
The meta-analysis results showed that task-oriented training led to significantly greater improvement than other training on 6-minute walking distance (mean difference = 82.49 meter; 95% confidence interval: 27.59-137.38) and comfortable gait speed (standardized mean difference = 0.27; 95% confidence interval: 0.03-0.52) in patients with subacute stroke. Our preliminary results showed that the experimental group achieved meaningful improvements in most of the primary outcomes but not for the control group. In addition, different brain reorganization patterns were observed in the two groups.
The results of meta-analysis provide relevant clinical evidence for the effects of task-oriented training on lower extremity motor functions, and this preliminary study provides the pilot result for the effects of task-oriented circuit training on lower extremity motor functions, brain structural and functional plasticity in patients with sub-acute stroke.
Subjects
stroke
task-oriented circuit training
walking function
corticospinal tract
brain plasticity
Type
thesis
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