To study the effectiveness of repetitive task
oriented training as Occupational Therapy
oriented training as Occupational Therapy
intervention in upper limb weakness in adult
stroke: Systematic Review .
Hamad Medical Corporation,
Occupational Therapy Department,
Doha Qatar.
Priya Vitthal Gawhale
Repetitive Task Training is a treatment in which
client repeat a series of specific movements
client repeat a series of specific movements
over and over again.
A stroke often leaves a person with problems
using their arms and legs.
The goal is to improve functional use of your
1.Introduction 2 Methods 2.Methods 3.Results 4.Discussion 5.Limitations
6.Conclusion and Implications
6.Conclusion and Implications
stroke leads to interference in Performance
areas such as ADL, Work and in context
Primary specific objectives: To determine the
effectiveness of repetitive task oriented
training in upper limb weakness in stroke.
Secondary Objective: ‐To study the effect of
repetitivep task oriented trainingg as occupationalp
Therapy intervention in stroke in upper limb
function and activities of daily living.
Search strategy: Search strategy used for
database MEDLINE EMBASE CINAHL Cochrane
database MEDLINE, EMBASE, CINAHL, Cochrane
controlled trials searched for articles in
1. computer‐aided search in bibliographic
databases was done of follows
databases was done of follows
2. longitudinal cohort studies,
3 original prognostic studies, and
4. randomized controlled trials ,
5. papers addressing task oriented training in
stroke published in the period from 1996 to
October 2011, were included.
Inclusion criteria
1) Studies randomized controlled clinical trials 1) Studies – randomized controlled clinical trials ,
cohort studies, case studies , overviewed.
2) Participants – Adults with age group of 30 ‐70
diagnosis of stroke Ischemic and hemorrhagic
stroke.
3) Articles studies with Interventions as
repetitive, task and function based upper limb repetitive, task and function based upper limb
strengthening activities used to improve upper
limb function
4) Types of outcome measures‐Interventions
focused On functional performance using focused On functional performance using
Client with perceptual deficits & severe
cognitive impairment excluded
cognitive impairment excluded.
Motor recovery stage 1 to 3 were excluded.
Level1 A‐ Systematic review of RCT
Level 1B = RCT with narrow Confidence interval
Level 1B = RCT with narrow Confidence interval
Level 1c= All or None case Series
Level 2A = Systematic review cohort studies
Level 2B= cohort study/ low quality RCT
Level2c=Outcomes research
Level 3A=Systematic review of case controlled
Level 3B=Case controlled study
1) We found total 30 RCT on repetitive task
training in stroke in upper limb. Study selected
the comparison done control group with usual
care and experimental group with repetitive
task training .
2) Primary Outcome measures tool for upper
limb function measured by Arm function test,
hand function test and sitting balance/ reach.
Specific outcome measures UE/reach were
motor assessment Scale ,Action research arm
test, the functional test of Hemi paretic UE.
4) Studies with Hand function measured used
nine hole test,, box and block test.
5) Sitting balance and reach using sitting
equilibrium index and motor assessment scale.
6) SECONDARY OUTCOME MEASURES:
Using Activity of daily living impairment level
measured by the Functional Independence
measured by the Functional Independence
Study design
Sacketts level of evidence
Outcome measures used
Intervention used
Results R f
References
Potentially relevant citations retrieved from electronic literature search (n = 478)
Abstracts put forward to review (n = 554) Citations excluded based on inclusion and
exclusion criteria (n = 248)
p ( )
Full-text articles put forward to review (n = 378) Abstracts excluded based on inclusion and
exclusion criteria (n = 633) Additional abstracts were excluded because publication dates prior to the year 1996. FOR CURRENT Updates
Studies excluded after full-text review (n = 199)
Additional studies were excluded as the participants were not DCD diagnosed using the sacketts level criteria (n = 52)
articles retrieved Randomized controlled trial Systematic Review
Level 1 Arm function , Hand function , sitting balance, ADL, upper limb impairment Repetitive task oriented training in upper limb such as reaching, holding drinking glass,etc. Studies shows modest improv ementin ADL But slight improvement in French et.al.2007 p upper limb impairment. Randomized controlled trial
Level 1 Block & Box test & Nine hole peg test. Repetitive task oriented training in upper limb. Review of study shows significant improvement in arm functions. Higgins ,Wood-Dauphinees. Randomized controlled trial
Level 1 Arm function test,hand function test.
Repetitive task oriented training.
Study shows task oriented training effective In improving participation ADL. Resink M.Schurmans M.,Hafsteinsdottir. T. Study Design/ methodology of articles retrieve Sacketts level of evidence Outcome measure used
Intervention used Results Author Randomized
controlled trial
Level 1 Arm function test,berge balance test Task oriented training, functional task training in upper limb. Results shows significant improvement in activities of daily living ,no difference in hand strength improvement. Salbach et,al Randomized controlled trial
Level 1 Jebson hand function test, Repetitive task oriented retraining in upper limb Results shows task oriented training is Blennerhassett and dite pp g effective in upper limb function. Randomized controlled trial Level 1
Arm function test, box and block test
Task oriented strength training in upper limb.
All the results shows significant improvement in participation of daily living. Yange et,al (2006) Randomized controlled trial
Level 1 Arm function test, hand function tests Repetitive functional task oriented training with practice Results shows the significant improvement in self care. Winstein et.al Randomized controlled trial
Level 1 Wolf motor function test, fugl Meyer arm test
Task oriented training. Results shows some improvement in activities of daily living. Pang et.al Study design Sacketts evidence level ( /6) Outcome measure used
Intervention/ Author EXPRIM(n) Control Sample Size (N) Result Repetitive task training Ramdomised control Trial 1 Arm function test, sitting balance, ADL, g such as reaching, holding, drinking glass of water French et.al (2007) 60 60 Studies shows m improvement in A But not in upper impairment
RCT 1 Block and b t t i Repetitive Haggins 80 80
Review of study shows signif
i t i
RCT 1 box test, nine
hole. ADL
epe e agg s
RCT 1 Thielman IMPROVEADL
MENT SIGNIFICANT 80 80 MAS, FIM
RCT 1 shepharddean & Improvement in ADL 40 40 MAS. Sitting index
RCT 1 Yang et.al improvement in ADLsignificant 60 60 Improvement in functional task.
RCT 1 Beverly french shows modest improvem ent in self care activities
90 90 Arm function test, hand function tests
This systematic review explored the efficacy of
repetitive task oriented as OT intervention for
t k U i th i t
stroke .Using the primary outcome measures
arm function test, hand function test and
secondary outcome measure FIM in ADL.
This review shows significant effect in ADL
participation .
we applied a qualitative best‐evidence
synthesis. We found limited evidence for
improving sitting balance & hand functions
BLUE LINE- Shows significant improvement in Arm functions YELLOW LINE- Shows slight improvement in ADL functions
RED LINE – Shows no statically improvement in hand functions.
• Data analyzed in systematic review shows task
oriented retraining more effective in acute and
oriented retraining more effective in acute and
sub acute stroke clients than chronic clients.
Repetitive task training shows early recovery in
activities of daily living But shows not significant
improvement in hand strength
Limitation of study only English articles
reviewed
Review focused on intervention in ADL but
could not able to focused on Quality of life
The above analysis data regarding systematic
review of repetitive task oriented training
review of repetitive task oriented training
shows significant improvement in ADL activities.
Task should be more goal oriented.
Further research in repetitive task training
should be using more specific and meaning task
which can be used as functional outcome for
which can be used as functional outcome for
International scientific organizing committee of
Honk kong and chairman Dr. simon and
secretary mam Ceilina cum for helping me each
secretary mam Ceilina cum for helping me each
step. very special heartly thank to my
Occupational Therapy Department Head Mr.
sultan sir and shobha mam . Thank you to
MEDICAL RESEARCH for approval & assistance.
S i l Th k t d t d Si Al
Special Thank to my dear respected Sir Alaa
sheikh acting supervisor of HGH for supporting
to me.
Thank my colleagues , Library of HAMAD
Medical Corporation for availing books journals.
1) Upper limb recovery after stroke: the stroke
survivors' perspective Disability Rehab.
2005;27: 1213–1223 CrossRefMedline
2005;27: 1213–1223.CrossRefMedline
2). Probability of regaining dexterity in the
flaccid upper limb: impact of severity of paresis
and time since onset in acute stroke. Stroke.
2003;34:2181–2186.
3) P di ti t f th li b
3) Predicting motor recovery of the upper limb
after stroke rehabilitation: value of a clinical
examination. 2000.CrossRefMedline
REFERENCE
4)) Review: Task‐ oriented trainingg in
rehabilitation after stroke‐ systematic
review.(Journal of adv Nurs 2009)
5)Repetitive task training for improving
functional ability after stroke(The Cochrane
Databaseatabase of systematic review 007) of systematic review 2007)
6) Giban, J.W. &schkade,J. K.(1997)
Occupational adaptation intervention with
patients cerebro vascular accident. American
Journal Of Occupational Therapy)
7) The Effect of task –oriented intervention on
arm function in people with in stroke : a
Randomised controlled trial.( School of physical
& occupational Therapy, faculty of medicine)
8) Upper limb recovery after stroke: the stroke
survivors' perspective Disability
Rehah.2005;27:1213–1223.; CrossRefMedline
