Task-Focused Training: Increasing motivation with individual-specific training in stroke patients

Task-Focused Training: İntroduction

In today's article, I will talk about task-oriented training, which is another type of effective approach used in stroke patients, such as CIMT therapy . Stroke is a condition in which brain cells are damaged as a result of a sudden interruption or decrease in blood flow to the brain tissue. The post-stroke rehabilitation process is very important to improve patients' quality of life and help them regain their daily activities. Task-oriented training may be an effective approach in the rehabilitation process of stroke patients.

Terminology

Task-focused training is a training method in which patients are motivated by specific tasks and actively participate. For stroke patients, this method can be very useful for regaining motor skills, restoring daily activities and increasing independence.
Post-stroke task-oriented training encourages active participation of patients by assigning them specific tasks. For example, patients may be given specific tasks to relearn activities of daily living. These tasks may include daily living skills, such as preparing one's own meals, performing personal care activities, or navigating the home. Patients develop their own strategies for completing these tasks, thereby increasing their self-confidence.
Task-focused training may also help stroke patients regain motor skills. It can be aimed to improve muscle control and coordination by giving patients tasks such as repeating certain movements and performing certain activities. In this way, patients' physical independence increases and they can perform daily living activities more easily.

Hubbard and colleagues (2009) outlined some strategies to include in a task-specific training program.

1. Training must be meaningful and relevant to the client, including real-life activities.
2. Training activities should be random so that task sequence, context and environment vary
3. Training needs to be repetitive
4. Training may initially include components of a task but should always aim to reconstruct the entire task.
5. Training should include positive feedback (Hubbard et al., 2009).

History

The evidence informing task-specific training is based on animal (basic science) research ( Knapp et al., 1963 ; Nudo and Milliken , 1996 ; Nudo et al., 1996 ). The training was developed within the motor control and learning psychology literature . ( Schmidt and Lee, 2005 ) and has since been applied in human studies with ‘healthy’ participants ( Schmidt and Lee, 2005 ) and post-injury ( Nelson et al., 1996 ; Winstein et al., 2004 ; Michaelsen et al. ). The first evidence for training-associated neuroplastic changes was provided by Richards et al. was conducted in a meta-analysis in 2008 ( Hubbard et al ., 2009) .

Dosage

Stroke rehabilitation are based on the duration of active practice rather than the number of repetitions in a treatment session. Canadian Best Practice guidelines for rehabilitation recommend that patients receive at least three hours of task-specific therapy , five days per week ( Hebert et al ., 2016 ) . However, Lee et al. He noted that adherence to repeated practices for long periods of time often poses challenges for both stroke survivors and healthcare professionals. Similarly, it is possible to complete several repetitions of GOE within three hours , with long breaks in between, and it is necessary to perform fewer repetitions than may be necessary to achieve the desired goal (Lee et al ., 2015) . On the other hand, it has been shown that performing GOE for one hour (50 minutes of training, 10 minutes of rest) can promote motor learning in the upper extremity in order to prevent unwanted effects such as fatigue and pain, which may subsequently affect recovery. Additionally, the GOE program may have positive effects for patients with subacute stroke after only 2 weeks (10 hours) of training. Thus, physical therapists and other healthcare personnel can use this program as an effective, routine therapeutic intervention in the clinical setting. ( Ibrahim & Joseph, 2021) .

Mechanism

This method, also called task-oriented training, is a motor learning-based rehabilitation approach that facilitates the reshaping of the central nervous system and neural reorganization and is based on abundant repetition of motor performance (DİNÇER & BEK, 2021) . The proposed mechanism of action of GOE is based on the assumption that environmental enrichment that improves motor, cognitive, sensory and social stimulation with a high number of repetitions performed in a single session can stimulate relevant areas of the brain for a specific task and improve the learning phenomenon. GOE can also trigger changes in neuroplasticity , an important aspect of learning new tasks, and most rehabilitation strategies involve repeated task activities for better results.
In conclusion, task-oriented training may be an effective approach in the rehabilitation process of stroke patients . This method encourages patients' active participation, increases their self-confidence, improves their motor skills and helps them regain their daily living activities. Therefore, the use of task-oriented training methods in stroke rehabilitation may play an important role in improving patients' quality of life.



In the two pictures above; It is shown that robot-assisted task-oriented UL motor training can significantly increase the neural activation response of the SFC in mild to moderate patients.
Link of Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523102/

Canadian Stroke Best Practice Recommendations ; Early Level A; Late Level A


Participate in meaningful, engaging, repetitive, progressively adapted, task-specific and goal-directed training to improve motor control and restore sensorimotor function for the Upper Extremity
Must participate in meaningful, engaging, progressively adaptable, intensive, task-specific and goal-oriented training to improve transfer skills and mobility for the Lower Extremity ( Teasell et al ., 2020 ) .
Link of article: https://journals.sagepub.com/doi/full/10.1177/1747493019897843

SUMMARY

1. -  GOE content; Intensive, task-specific, challenging and variable training with rest
2. -  Positive Dosage àonly 2 weeks - 10 hour training for patients with subacute stroke
3. -  Tasks are meaningful to the patientà rehabilitation results are more successful
4. -  Repeated and consistent practiceà cortical reorganization.
5. -  GOE + Treatment of visual neglect and perceptual disorders + Robot + Virtual reality + Mirror àsignificant improvement in functional results

Stay tuned for new treatment approaches. Thank you...

You can access my previous articles from the links below.

CIMT: https://www.bulbapp.io/p/93956bdd-016b-4209-81a1-374725b3e457/kstlayc-zorunlu-hareket-tedavisi-cimt-ile-engellerimizi-amaya
Motor Imagery (Great): https://www.bulbapp.io/p/4e1658e6-0e35-477d-89e1-c597cf775954/current-treatment-approach-with-our-mind-not-our-body-motor-imagery
Robotic Rehabilitiion: https://www.bulbapp.io/p/687c36aa-7c23-42b3-8efc-8581483982b8/robotic-rehabilitation-the-treatment-method-of-the-future