Task-related training of arm use in chronic stroke: A pilot study

Investigators : Ms Ro Packer, Dr Bev Phillips, Prof Mary Galea

With current rehabilitation practices only a small proportion of patients regain function of their affected upper limb. Recent research into the potential for motor recovery suggests that the brain has dynamic and plastic properties and that a higher level of recovery should be possible given the appropriate intervention. Recently completed research using early task-related training in acute stroke patients indicates an improved recovery in the affected upper limb. As yet there are no systematic studies to determine whether task-specific training can improve function in subjects with long term impairment from chronic stroke. The aim of this study is to assess the effect of a task-related training program on arm use in subjects with chronic impairment from stroke.

The design of the study is an interrupted time series design. Assessments of function will be made on entry to the study, after 8 weeks of no intervention to establish a baseline, immediately following the intervention and 3 months following the training program. These assessments include tests of strength, dexterity, sensation, use of the arm in functional type tasks and an assessment of quality of life.   The subjects act as their own controls. The assessor will be blind to the aim of the study and to the training program. After the 8 week baseline measurement period subjects will attend group training sessions with 3-4 subjects per group, twice a week, for fifteen 45 -60 minute sessions. During these sessions a physiotherapist will be assisting the subjects undertake task-related training tasks for their affected upper limb (Fig. 1). They will also be given tasks to practice at home. Repeated measure, within subject comparisons will be made prior to and following the task-related training intervention.

Figure1. Examples of tasks undertaken during training. A. Functional electrical stimulation of the wrist extensors in preparation for grasping. B. Pouring liquid using affected arm.

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