The Effect of Task-oriented Training on Upper Extremity Motor Functions in Chronic Stroke Patients

Stroke refers to a neurological disorder caused by cerebrovascular damage. It is defined as a sudden brain attack that causes partial or complete brain dysfunction due to blockage or rupture of blood vessels of the brain.The primary symptom of stroke is hemiparesis. In addition, stroke negatively affects senses, motor function, perception, cognition and language, depending on location, etiology and infarct volume. One study reported that %85 of stroke patients had hemiparesis and more than %69 had upper limp disfunction. In general, upper limb dysfunction not only causes problem in performing tasks that require fine motor skills (Daily tasks such as personal hygiene activities, eating and handwriting), but also makes ıt very difficult the perform tasks that require gross motor skills (such as balancing).(walking and self protection reflexes). Upper limb dysfunction reduces the quality of life (QoL) of patients with paralysis. It limits their ability to live independently in society as it impairs many of the basic IADLs (such as crawling, balancing, walking, writing, eating, washing and manipulating objects) necessary for individuals to live independently. Hands and arms are used in a wide range of tasks performed in the workplace and used to communicate.They also play an important role in various cognitive activities and motor functions. In stroke patients, the recovery of upper limb function, which is necessary to independently perform IADLs, can be considered as critical as the recovery of walking. The aim of therapeutic training in rehabilitation is to help patients try to use the affected side and voluntarily perform motor functions, and there are various physical intervention approaches.According to several recent studies conducted in stroke patients, among them, task-oriented training is reported to be effective in developing functional motor skills necessary to perform activities of daily living. Task-oriented training can help patients to increase their ability to perform IADLs. Training consists of a variety of functional activities that offer a more effective treatment approach. Task-oriented training is a therapeutic model based on the theory of motor control system, which regulates the movements of organisms by the nervous system, including reflexes. It uses a functional approach in the rehabilitation of neurological patients and teaches patients task-specific strategies to help them adapt to changing environments. The approach involves patients practicing a skill necessary to achieve the goal of a task to facilitate problem solving by improving their ability to adapt to various situations and developing an effective reward strategy. In addition, the approach for maximal learning involves motivating patients behaviorally using tasks related to their personal daily lives and emphasizes the interaction between patients and their environment. Task-focused training uses a patient-centered approach rather than a therapist-centered approach, and meaningful tasks are selected as a core component. The therapeutic goal of task-focused training is maximal recovery of motor function through proactive performance of activities using the upper limb on the affected side rather than the intact side . It was stated that repetitive and focused task-oriented training improves recovery of upper limb function and can improve motor order, dexterity and agility in the upper limb.

Lee also reported that task-oriented circuit training improved upper limb functions, performance in activities of daily living, and self-efficacy in expressing confidence.

The aim of our study was to investigate the effects of task-oriented training added to conventional rehabilitation on upper extremity muscle thickness and upper extremity motor functions.

Inclusion criteria

• History of cerebrovascular accident at least 6 months ago;
• Score at least 20 points on the mini mental test;
• Not having pain with tension or severe weakness in the shoulder muscles;
• Active shoulder flexion movement of at least 30 degrees
• Having a stroke for the first time
• The level of motor function is Stage 3 or Stage 4 in Brunnstrom Staging according to the proximal function of the upper extremity
• Not receiving botulinum toxin treatment for the last 3 months

Exclusion criteria

• Presence of concomitant neurological, orthopedic, cardiovascular diseases and severe comorbidities
• Severe spasticity of the elbow flexors more than 2 on the Modified Ashworth Scale