Effects of occupational therapy task-oriented approach in upper extremity post-stroke rehabilitation.

Abstract

There is a need for effective Upper Extremity (UE) post-stroke rehabilitation approaches. The Occupational Therapy Task-Oriented (TO) approach was described early in the nineties of the past century. Many of the TO principles were supported in the literature. However, the TO as a whole was only evaluated in case studies. This study aimed to evaluate the functional and the impairment effects of this approach and to refine its treatment protocol. Twenty participants with stroke of three months or more fulfilled the minimal affected UE active movements of at least 10° of shoulder flexion and abduction and elbow flexion-extension and volunteered for this study. Participants were randomized into two order groups. The immediate group got 3 hours of TO treatment per week for six weeks and then got six weeks of no treatment control while the delayed intervention group underwent the reversed order. Participants were evaluated before the first phase, at the cross over, and after the second phase by trained, blinded evaluators. The treatment change scores from both groups were compared with those of the control. The results supported the TO functional superiority as indicated by significant and clinically meaningful changes in the Canadian Occupational Performance Measure (COPM), the Motor Activity Log (MAL), and the time scale of the Wolf Motor Function Test (WMFT). The result failed to support hypothesis of the impairment effects superiority of the TO. We conclude that the TO approach is an effective UE post-stroke rehabilitation approach in improving the UE functional abilities. More studies are needed to provide more evidence for this approach and to illuminate more of its therapeutic abilities with different stroke severity and chronicity levels.