Effects of a nurse-led acupressure programme for stroke patients in China. Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: The protocol of the FIT-Stroke trial A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural china (the RECOVER trial): design and rationale Virtual Immersion for Post-Stroke Hand Rehabilitation Therapy Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical Trial. A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers. Training of Reaching in Stroke Survivors With Severe and Chronic Upper Limb Paresis Using a Novel Nonrobotic Device: A Randomized Clinical Trial Effects of peripheral sensory nerve stimulation plus task-oriented training on upper extremity function in patients with subacute stroke: a pilot randomized crossover trial Effects of task-oriented robot training on arm function, activity, and quality of life in chronic stroke patients: a randomized controlled trial Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Team functioning and patient outcomes in stroke rehabilitation. Combining rTMS and Task-Oriented Training in the Rehabilitation of the Arm after Stroke: A Pilot Randomized Controlled Trial Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial Task-oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomized controlled trial Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial. Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial A Low-Cost Adaptive Balance Training Platform for Stroke Patients: A Usability Study Effectiveness of a structured circuit class therapy model in stroke rehabilitation: a protocol for a randomised controlled trial Effect of mental practice on the improvement of function and daily activity performance of the upper extremity in patients with subacute stroke: a randomized clinical trial. The implementation of snoezelen in psychogeriatric care: an evaluation through the eyes of caregivers. The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation Clinical application of circuit training for subacute stroke patients: a preliminary study
AIM AND OBJECTIVE To examine the effects of a nurse-led acupressure programme on the recovery of motor function and daily activities of stroke patients . BACKGROUND Stroke is one of the main causes of death and permanent physical disability in the world . The traditional Chinese medicine ( TCM ) is widely used for the treatment and rehabilitation of people with stroke in China . Physiotherapy or occupational therapy can not be performed several times a day . Therefore , research ers and healthcare providers have been seeking effective and efficient alternative strategies for the rehabilitation of stroke patients . Acupressure , non-invasive and widely accessible to any healthcare professionals , is one of the promising alternatives . METHODS Seventy-eight stroke patients were recruited and r and omly assigned into an intervention or control group , with 39 patients in each . The intervention group received acupressure plus routine care , while the control group received only routine care only . The acupressure treatment was carried out by nurses . Patient 's activities of daily living ( ADL ) and motor function from both groups were evaluated at the point of recruitment , and at the end of the first and third month after stroke . RESULTS The ADL and the Fugl-Meyer motor scores in the intervention group were significantly higher than those in the control group at the end of the third month ( p<0.05 ) . CONCLUSION Nurse-led acupressure programme had positive effects on the recovery of motor function and daily activities of stroke patients . Our study suggests that nurse-led acupressure programmes play an important role in the recovery of stroke patients . RELEVANCE TO CLINICAL PRACTICE Healthcare providers need to think about alternative care methods including acupressure for the rehabilitation of stroke patients . Acupressure is one of the promising alternatives nursing intervention for stroke patients in practice Background Most patients who suffer a stroke experience reduced walking competency and health-related quality of life ( HRQoL ) . A key factor in effective stroke rehabilitation is intensive , task-specific training . Recent studies suggest that intensive , patient-tailored training can be organized as a circuit with a series of task-oriented workstations . Primary aim of the FIT-Stroke trial is to evaluate the effects and cost-effectiveness of a structured , progressive task-oriented circuit class training ( CCT ) programme , compared to usual physiotherapeutic care during outpatient rehabilitation in a rehabilitation centre . The task-oriented CCT will be applied in groups of 4 to 6 patients . Outcome will be defined in terms of gait and gait-related ADLs after stroke . The trial will also investigate the generalizability of treatment effects of task-oriented CCT in terms of perceived fatigue , anxiety , depression and perceived HRQoL. Methods / design The multicentre single-blinded r and omized trial will include 220 stroke patients discharged to the community from inpatient rehabilitation , who are able to communicate and walk at least 10 m without physical , h and s-on assistance . After discharge from inpatient rehabilitation , patients in the experimental group will receive task-oriented CCT two times a week for 12 weeks at the physiotherapy department of the rehabilitation centre . Control group patients will receive usual individual , face-to-face , physiotherapy . Costs will be evaluated by having each patient keep a cost diary for the first 24 weeks after r and omisation . Primary outcomes are the mobility part of the Stroke Impact Scale ( SIS-3.0 ) and the EuroQol . Secondary outcomes are the other domains of SIS-3.0 , lower limb muscle strength , walking endurance , gait speed , balance , confidence not to fall , instrumental ADL , fatigue , anxiety , depression and HRQoL. Discussion Based on assumptions about the effect of intensity of practice and specificity of treatment effects , FIT-Stroke will address two key aims . The first aim is to investigate the effects of task-oriented CCT on walking competency and HRQoL compared to usual face-to-face physiotherapy . The second aim is to reveal the cost-effectiveness of task-oriented CCT in the first 6 months post stroke . Both aims were recently recommended as priorities by the American Hearth Association and Stroke Council . Trial registration This study is registered in the Dutch Trial Register as NTR1534 Rationale Stroke is the leading cause of death and disability in rural China . For stroke patients residing in re source -limited rural areas , secondary prevention and rehabilitation are largely unavailable , and where present , are far below evidence -based st and ards . Aim This study aims to develop and implement a simplified stroke rehabilitation program that utilizes nurses and family caregivers for service delivery , and evaluate its feasibility and effectiveness in rural China . Methods and design This 2-year r and omized controlled trial is being conducted in 2–3 county hospitals located in northwest , northeast , and southwest China . Eligible and consenting stroke in patients ( 200 in total ) have been recruited and r and omized into either a control or intervention group . Nurses in the county hospital are trained by rehabilitation specialists and in turn train the family caregivers in the intervention group . They also provide telephone follow-up care three times post discharge . The recruitment , baseline , intervention , follow-up care , and evaluation are guided by the RECOVER mobile phone app specifically design ed for this study . Study outcome The primary outcome is patients ’ Barthel Index ( activities of daily living : mobility , self-care , and toileting ) at 6 months . Process and economic evaluation will also be conducted . Discussion The results of our study will generate initial high- quality evidence to improve stroke care in re source -scarce setting s. If proven effective , this innovative care delivery model has the potential to improve the health and function of stroke patients  , relieve caregiver burden , guide policy-making , and advance translational research in the field of stroke care Stroke is the leading cause of serious , long-term disability in the United States . Impairment of upper extremity function is a common outcome following stroke , often to the detriment of lifestyle and employment opportunities . While the upper extremity is a natural target for therapy , treatment may be hampered by limitations in baseline capability as lack of success may discourage arm and h and use . We developeda virtual reality ( VR ) system in order to encourage repetitive task practice . This system combined an assistive glove with a novel VR environment . A set of exercises for this system was developed to encourage specific movements . Six stroke survivors with chronic upper extremity hemiparesis volunteered to participate in a pilot study in which they completed 18 one-hour training sessions with the VR system .  Performance with the system was recorded across the 18 training sessions . Clinical evaluations of motor control were conducted at three time points : prior to initiation of training , following the end of training , and 1 month later . Subjects displayed significant improvement on performance of the virtual tasks over the course of the training , although for the clinical outcome measures only lateral pinch showed significant improvement . Future expansion to multi-user virtual environments may extend the benefits of this system for stroke survivors with hemiparesis by furthering engagement in the rehabilitation exercises INTRODUCTION The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living ( ADLs ) . Motor imagery ( MI ) is an active process during which a specific action is reproduced within working memory without any actual movements . MI training enhances motor learning , neural reorganization and cortical activation in stroke . The efficacy of MI training involving lower extremity mobility tasks need to be assessed . AIM To evaluate the effects of combining motor imagery with physical practice in paretic Lower Extremity Muscles Strength and Gait Performance in Ambulant Stroke subjects . MATERIAL S AND METHODS A R and omized Clinical Trial was conducted in Department of Physical Therapy , Tertiary Care Hospitals , Mangalore , India which includes 40 hemi paretic subjects ( > 3 months post-stroke ) who were ambulant with good imagery ability in both KVIQ-20 ≥ 60 and Time dependent MI screening test were recruited and r and omly allocated into task-oriented training group ( n=20 ) and task-oriented training group plus MI group ( n=20 ) . Subjects in both groups underwent task orientated training for lower extremity 45 - 60 minutes , 4 days per week for 3 weeks . In addition , the experimental group received 30 minutes of audio-based lower extremity mobility tasks for MI practice  . Isometric muscle strength of Hip , Knee and Ankle using a h and -held dynamometer and self-selected 10 m gait speed were assessed before and after 3 weeks of intervention . RESULTS Both the groups had found a significant change for all the outcome measures following 3 weeks of interventions with p < .05 . The experimental group had shown a significant improvement in paretic hip muscles ( both flexors and extensors ) , knee extensors and ankle dorsiflexors and gait speed compare to control group with p < .05 between group analyses . CONCLUSION Additional task specific MI training improves paretic muscle strength and gait performance in ambulant stroke patients AIMS To test the effectiveness of a discharge planning program for dyads of older stroke survivors and their family caregivers in Taiwan . BACKGROUND Family caregivers of stroke survivors often feel inadequately prepared to deal with the physical , cognitive and emotional needs of the stroke survivors . However , little information could be found on discharge planning programs for caregivers of stroke survivors in Asian families . DESIGN A r and omised experimental design was used to explore the effects of a discharge planning program for 158 dyads of older stroke patients and their family caregivers . METHODS The control group ( n = 86 dyads ) received only routine hospital discharge planning services  and the experimental group ( n = 72 dyads ) received routine hospital discharge planning services plus the caregiver-oriented discharge planning program . Outcome variables were measured at baseline , before discharge and one month after hospital discharge . Variables were measured by the Nurse Evaluation of Caregiver Preparation Scale , Preparedness for Caregiving Scale , Caregiver Discharge Needs Satisfaction Scale and Perception of Balance between Competing Needs Scale . RESULTS Caregivers in the experimental group had significantly better nurse evaluation and self-evaluation of preparation after the program than before , and greater satisfaction of discharge needs one month after discharge than before discharge . Caregivers in the experimental group had significantly better nurse evaluations and self-evaluations of preparation and better satisfaction of discharge needs after the program compared with the control group . However , no significant difference was found between caregiver groups in perceived balance of competing needs . CONCLUSIONS This discharge planning program benefited family caregivers of older stroke patients during the transition from hospitalisation to one month after discharge . RELEVANCE TO CLINICAL PRACTICE This caregiver-oriented discharge planning program , with its emphasis on individualised health education and home visits following discharge may improve caregivers ' preparation and the satisfaction of their needs during the discharge transition Background and Purpose — Severe upper limb paresis is a major contributor to disability after stroke . This study investigated the efficacy of a new nonrobotic training device , the Sensorimotor Active Rehabilitation Training ( SMART ) Arm , that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension , permitting stroke survivors with severe paresis to practice a constrained reaching task . Methods — A single-blind , r and omized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis . Thirty-three participants completed the study , of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation , 13 received training using the SMART Arm alone , and 10 received no intervention ( control ) . Training consisted of 12 1-hour sessions over 4 weeks . The primary outcome measure was “ upper arm function , ” item 6 of the Motor Assessment Scale . Secondary outcome measures included impairment measures ; triceps muscle strength , reaching force , modified Ashworth scale ; and activity measures : reaching distance and Motor Assessment Scale . Assessment s were administered before ( 0 weeks ) and after training ( 4 weeks ) and at 2 months follow-up ( 12 weeks ) . Results — Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up . There was no significant difference between these 2 groups . There was no change in the control group . Conclusions — Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis , highlighting the benefits of intensive task-oriented practice , even in the context of severe paresis Objective : To investigate the feasibility of peripheral sensory nerve stimulation combined with task-oriented training in patients with stroke during inpatient rehabilitation . Design : A pilot r and omized crossover trial . Setting : Two rehabilitation hospitals . Subjects : Twenty-two patients with subacute stroke . Interventions : Participants were r and omly assigned to two groups and underwent two weeks of training in addition to conventional inpatient rehabilitation . The immediate group underwent peripheral sensory nerve stimulation combined with task-oriented training in the first week , followed by another week with task-oriented training alone . The delayed group underwent the same training in reverse order . Main measures : Outcome measures were the level of fatigue and Wolf Motor Function Test . Patients were assessed at baseline , one and two weeks . Results : All participants completed the study with no adverse events . There was no significant difference in level of fatigue between each treatment . From baseline to one week , the immediate group showed larger improvements than the delayed groups in the Wolf Motor Function Test ( decrease in mean time ( ± SD ) from 41.9 ± 16.2 seconds to 30.6 ± 11.4 seconds versus from 46.8 ± 19.4 seconds to 42.9 ± 14.7 seconds , respectively ) but the difference did not reach significance after Bonferroni correction ( P = 0.041 ) . Within-group comparison showed significant improvements in the Wolf Motor Function Test mean time after the peripheral sensory nerve stimulation combined with task-oriented training periods in each group ( P < 0.01 ) . Conclusion : Peripheral sensory nerve stimulation is feasible in clinical setting s and may enhance the effects of task-oriented training in patients with subacute stroke Background Over fifty percent of stroke patients experience chronic arm h and performance problems , compromising independence in daily life activities and quality of life . Task-oriented training may improve arm h and performance after stroke , whereby augmented therapy may lead to a better treatment outcome . Technology-supported training holds opportunities for increasing training intensity . However , the effects of robot-supported task-oriented training with real life objects in stroke patients are not known to date . The aim of the present study was to investigate the effectiveness and added value of the Haptic Master robot combined with task-oriented arm h and training in chronic stroke patients . Methods In a single-blind r and omized controlled trial , 22 chronic stroke patients were r and omly allocated to receive either task-oriented robot-assisted arm-h and training ( experimental group ) or task-oriented non-robotic arm-h and training ( control group ) . For training , the T-TOAT ( Technology-supported Task-Oriented Arm Training ) method was applied . Training was provided during 8 weeks , 4 times/week , 2 × 30 min/day . Results A significant improvement after training on the Action Research Arm Test ( ARAT ) was demonstrated in the experimental group ( p = 0.008 ) . Results were maintained until 6 months after cessation of the training . On the perceived performance measure ( Motor Activity Log ( MAL ) ) , both , the experimental and control group improved significantly after training ( control group p = 0.008 ; experimental group p = 0.013 ) . The improvements on MAL in both groups were maintained until 6 months after cessation of the training . With regard to quality of life , only in the control group a significant improvement after training was found ( EuroQol-5D p = 0.015 , SF-36 physical p = 0.01 ) . However , the improvement on SF-36 in the control group was not maintained ( p = 0.012 ) . No between-group differences could be demonstrated on any of the outcome measures . Conclusion Arm h and performance improved in chronic stroke patients , after eight weeks of task oriented training . The use of a Haptic Master robot in support of task-oriented arm training did not show additional value over the video-instructed task-oriented exercises in highly functional stroke patients . Clinical trial registration informationCurrent Controlled Trials IS RCT Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov OBJECTIVE To evaluate the relationship between rehabilitation team functioning and stroke patient outcomes .  DESIGN Prospect i ve observational study . SETTING Veterans Administration ( VA ) inpatient and subacute rehabilitation units . PARTICIPANTS Forty-six VA rehabilitation teams , including 530 rehabilitation team members from 6 disciplines ( medicine , nursing , social work , physical therapy , occupational therapy , speech language pathology ) and 1688 stroke patients treated by the teams . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Ten scales assessing team member perceptions of team functioning ( communication , perceived effectiveness , physician involvement , physician support , teamness , utility of quality information , innovation , interprofessional relationships , order and organization , task orientation ) and 3 primary patient outcome variables-functional improvement , discharge home , and length of rehabilitation stay ( LOS ) . RESULTS Three of the 10 measures of team functioning were significantly associated with patient functional improvement ( P < .05 ) : task orientation , order and organization , and utility of quality information . One measure of team functioning-effectiveness-was significantly associated with LOS ( P < .05 ) . None of the team variables predicted discharge destination . Aspects of team functioning that were important to outcomes differed depending on the outcome of interests . Efforts directed toward improving team activities and relationships , including collaborative planning and problem solving and the use of feedback information , may enhance rehabilitation treatment effectiveness . CONCLUSIONS Characteristics of team functioning predict selected rehabilitation outcomes Introduction . Repetitive transcranial magnetic stimulation ( rTMS ) is a promising technique for promoting rehabilitation of arm function  after stroke . The feasibility and impact of rTMS as an adjunct to traditional task-oriented training to improve arm function have not yet been demonstrated . Objective . Evaluate the feasibility of a r and omized controlled trial aim ed at determining the efficacy of rTMS as an adjunct to task-oriented therapy in facilitating restoration of arm function after stroke . Methods . Stratified block-r and omized controlled trial set in the general community . Eleven stroke persons with mild to severe arm deficits were recruited and r and omized to receive 8 sessions of real-rTMS or sham-rTMS followed by ninety minutes of arm tasks design ed to improve function . Results . Medium to large , statistically significant effect sizes ( 0.49 to 1.63 ) were observed in both groups on several measures of arm function at the postintervention evaluation . Three out of four subjects in the real-TMS condition showed increased levels of corticomotor excitability after the first stimulation session . Conclusions . Preliminary evidence suggests that an rTMS protocol potent enough to induce transient increases in cortical excitability of the lesioned hemisphere is feasible but did not show promising results as an adjunct to task-specific training . This trial is registration with Clinical Trials.gov NCT00850408 Background Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation . A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain . This trial investigates whether mental practice can contribute to a quicker and /or better recovery of stroke in two Dutch nursing homes . The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual . In addition , we will investigate prognostic variables and feasibility ( process evaluation ) . Methods A r and omised , controlled , observer masked prospect i ve trial will be conducted with adult stroke patients in the (sub)acute phase of stroke recovery . Over a six weeks intervention period the control group will receive multi professional therapy as usual . Patients in the experimental group will be instructed how to perform mental practice , and will receive care as usual in which mental practice is embedded in physical , occupation and speech therapy sessions . Outcome will be assessed at six weeks and six months . The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale . Secondary outcomes are : Motricity Index , Nine Hole Peg Test , Barthel Index , Timed up and Go , 10 metres walking test , Rivermead Mobility Index . A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility . All patients are asked to keep a log to determine unguided training intensity . Discussion Advantages and disadvantages of several aspects of the chosen design are discussed . Trial registration IS RCT Objective : To evaluate the efficacy of an in-hospital programme based on task-oriented exercises associated with early full weight-bearing in patients with multiple comorbidities undergoing total hip replacement . Design : R and omized controlled trial . Setting : Specialised rehabilitation centre . Subjects : A total of 100 patients ( mean age of 69 ( 8) years ; 40 males , 60 females ) . Interventions : The experimental group underwent task-oriented exercises and was encouraged to ab and on any walking aids by the end of their in-hospital stay . The control group underwent open chain kinetic exercises , and was recommended to use partial weight-bearing and walking aids until three months after surgery . Both groups individually followed programmes of 90-minute sessions five times a week for three weeks . Outcome measures : Western Ontario and McMaster Universities Osteoarthritis Index , Pain Numerical Rating Scale , Functional Independence Measure , and Short-Form Health Survey . The participants were evaluated before , after training , and after a further 12 months . Results : There were no significant between-group differences at baseline . After training , a between-group difference of 12 points was found for the Western Ontario and McMaster Universities Osteoarthritis Index – functional subscale , indicating a clinical ly tangible treatment effect on disability . The Functional Independence Measure increased by 31 and 15 points in the experimental and control group , respectively . A linear mixed model revealed significant effects of time , group , and time by group interaction on disability , pain , activities of daily living , and most of the physical quality of life domains . Conclusion : Task-oriented exercises associated with early full weight-bearing improve disability , pain , activities of daily living , and quality of life after total hip replacement BACKGROUND Family caregivers provide the foundation for long-term home care of stroke survivors . The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external re sources to cope with this situation , thereby placing their own health at risk . We conducted a r and omised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers . OBJECTIVES To evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence , problem-solving coping abilities , caregiver 's depressive symptoms , caregiving burden and re sources ( family functioning , social support ) and physical health ( such as caregiving-related injury ) , as well as potential placement of stroke survivors . DESIGN A prospect i ve multi-centre and single-blinded r and omised controlled trial stratified by survivors ' history of stroke . SETTING AND PARTICIPANTS Adult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong . METHODS The design of the trial was based on the relational/problem-solving model . Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of question naires before r and omisation , immediately , one- and three-months post-intervention . The control group received usual care , whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme ( two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions ) . Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests . RESULTS We recruited 128 caregiver-survivor dyads . The intervention group demonstrated significantly greater improvements throughout the study ( p < 0.01 ) in terms of caregiving competence , problem-solving coping abilities and social support satisfaction . This group also displayed significantly greater improvements in terms of family functioning ( p < 0.05 ) at one-month post-intervention , an increased number of social support ( p < 0.001 ) and a lower level of burden at three-month post-intervention . However , there was no significant effect on enabling stroke survivors to remain in their home . Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities , which suggested its mediating effect on caregiving competence of stroke caregivers . CONCLUSIONS Findings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home . Design R and omised controlled trial with follow-up to 24 weeks . Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherl and s Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic . Patients were r and omly allocated to circuit training or usual physiotherapy , after stratification by rehabilitation centre , with an online r and omisation procedure . Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks . The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency . The control group received usual outpatient physiotherapy . Main outcome measures The primary outcome was the mobility domain of the stroke impact scale ( SIS , version 3.0 ) . Secondary outcomes were st and ing balance , self reported abilities , gait speed , walking distance , stair climbing , instrumental activities of daily living , fatigue , anxiety , and depression . Differences between groups were analysed according to the intention to treat principle . All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks . Results 126 patients were included in the circuit training group and 124 in the usual care group ( control ) , with data from 125 and 117 , respectively , available for analysis . One patient from the circuit training  group and seven from the control group dropped out . Circuit training was a safe intervention , and no serious adverse events were reported . There were no significant differences between groups for the stroke impact scale mobility domain ( β=0.05 ( SE 0.68 ) , P=0.943 ) at 12 weeks . Circuit training was associated with significantly higher scores in terms of gait speed ( 0.09 m/s ( SE 0.02 ) , P<0.001 ) , walking distance ( 20.0 m ( SE 7.4 ) , P=0.007 ) , and modified stairs test ( −1.6 s ( SE 0.7 ) , P=0.015 ) . There were no significant differences between groups for the other secondary outcomes , except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale . With the exception of gait speed ( −0.04 m/s ( SE 0.02 ) , P=0.040 ) , there were no significant differences between groups at follow-up . Conclusion Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient . Trial registration Dutch Trial Register ( NTR1534 ) Stroke patients usually suffer from asymmetric posture due to hemi-paresis that can result in reduced postural controllability leading to a balance deficit . This deficit increases the risk of falls , which often makes them dependent on caregivers for community ambulation , thus deteriorating their quality of life . Conventional balance training involves rehabilitation exercises performed under physiotherapist ’s supervision , where the scarcity of trained professionals as well as the cost of clinic-based rehabilitation programs can deter stroke survivors from undergoing regular balance training . Thus , research ers have been exploring technology-assisted solutions , e.g. , home-based virtual reality ( VR ) setup . In this paper , we developed a VR-based balance training ( VBaT ) platform , where VR-augmented user-interface using Nintendo Wii balance boardwas tested in a laboratory setting for its feasibility . The VBaT offered tasks of varying difficulties to the participants that adapted to individual performance capability during balance training . We performed a preliminaryusability study with 7 stroke survivors ( post-stroke period > 6 months ) . Preliminary results indicate the potential of theVBaT system to cause improvement in overall average task performance over the course of training while using the VBaT. Thus the VBaT system is proposed to be a step toward an effective balance training platform for people with balance disorder Background Currently , the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity performed with multiple repetitions . Circuit Class Therapy ( CCT ) is well suited to accomplish multiple task-specific activities . However , while repetitive task practice is achievable with circuit class therapy , in stroke survivors repetitive activities may be affected by poor neurologic inputs to motor units , result ing in decreases in discharging rates which consequently may reduce the efficiency of muscular contraction . To accomplish multiple repetitions , stroke survivors may require augmented duration of practice . To date , no study has examined the effect of augmented duration of CCT in stroke rehabilitation , and specifically what duration of CCT is more effective in influencing functional capacity among stroke survivors . Methods / design Using a r and omised controlled trial with blinded outcome assessment , this study is aim ed at determining the effectiveness of structured augmented CCT in stroke rehabilitation . Sixty-eight stroke survivors ( to be recruited from a tertiary health institution in Kano , Northwest , Nigeria ) will be r and omised into one of four groups : three intervention groups of differing CCT duration s namely : 60 min , 90 min , and 120minuntes respectively , and a control group . Participants will take part in an 8-week structured intensive CCT intervention . Participants will be assessed at baseline , post-intervention , and six-month follow-up for the effectiveness of the varied duration s of therapy , using st and ardised tools . Based on the WHO-ICF model , the outcomes are body structure/function , activity limitation , and participation restriction measures . Discussion It is expected that the outcome of this study will clarify whether increasing CCT duration leads to better recovery of motor function in stroke survivors . Trial registration Pan African Clinical Trial Registry ( PACTR ) : OBJECTIVES More than 50 % of patients with upper limb paresis after stroke face long-term impaired arm function and ensuing disability in daily life . This study aims to evaluate the effectiveness of a task-oriented mental practice ( MP ) approach as an addition to regular arm-h and therapy in patients with subacute stroke . METHODS A multicenter , prospect i ve , single-blind , r and omized clinical trial was performed . Patients trained for 6 weeks , at least 3 times per day . In the experimental group , patients performed video-instructed MP . In the control group , patients performed neurodevelopmental therapy-based exercise therapy . The primary outcome measures are Fugl-Meyer test , Frenchay arm test , Wolf motor function test , and accelerometry . RESULTS The patients did improve over time on Fugl-Meyer test and Wolf motor function test in both the control and the experimental group . A significant improvement on the Frenchay arm test was found after training ( which was maintained at 12-month follow-up ) only in the experimental group . However , no difference in training effects between groups was demonstrated . CONCLUSIONS Training effects were demonstrated after MP training in patients with subacute stroke . However , the results of this study do not corroborate the hypothesis that the use of MP in addition to therapy as usual in patients with subacute stroke has an additional effect over neurodevelopmental therapy in addition to therapy as usual Many intervention studies lack an investigation of the extent to which the intervention was implemented as intended , which makes outcome measures difficult to interpret . The aim of the present study was to gain insight into the implementation process of snoezelen in 24-h dementia care . The intervention in each of six experimental wards comprised  training sessions in ' snoezelen for caregivers '  , evaluated using a question naire . To study experience with implementation , the follow-up and general meetings ( 20 in total ) were attended and semi-structured interviews ( six in total ) were conducted . The results indicated that the implementation of snoezelen effected a change from task-oriented care to resident-oriented care . The nursing assistants also experienced changes at the resident level and organisational changes . However , the lack of intervention in the organisational structure and obstructive factors such as under-staffing seemed to get in the way of the integration of multi-sensory stimulation in the daily care in two of the six wards Objective : To evaluate the efficacy of a task-oriented intervention in enhancing arm function in people with stroke . Design : Two-centre , observer-blinded , stratified , block-r and omized controlled trial . Setting : General community . Patients : Ninety-one individuals within one year of a first or recurrent stroke consented to participate between May 2000 and February 2003 . Interventions : The experimental intervention involved practice of functional , unilateral and bilateral tasks that were design ed to improve gross and fine manual dexterity whereas the control intervention was composed of walking tasks . Members in both groups participated in three sessions a week for six weeks . Main outcome measure(s ) : The primary test of arm function was the Box and Block Test . Secondary tests included the Nine-Hole Peg Test , maximal grip strength , the Test d'Evaluation des Membres supé rieurs des Personnes Agées ( TEMPA ) and the Stroke Rehabilitation Assessment of Movement . Results : Results are for the more affected arm . Baseline performance on the Box and Block Test was an average of 26 blocks ( st and ard deviation ( SD=16 ) in the experimental group ( n=47 ) and 26 blocks ( Sd=18 ) in the control group ( n=44 ) . These values represent approximately 40 % of age-predicted values . Values for the postintervention evaluation were an average of 28 ( SD=17 ) and 28 ( SD=19 ) blocks for the experimental and control group respectively . No meaningful change on other measures of arm function was observed . Conclusions : A task-oriented intervention did not improve voluntary movement or manual dexterity of the affected arm in people with chronic stroke Background Early rehabilitation after stroke is essential to help reduce disability . Purpose To summarize evidence on the benefits and harms of nonpharmacologic and pharmacologic treatments for motor deficits and mood disorders in adults who have had stroke . Data Sources English- language search es of multiple electronic data bases from April 2009 through July 2018 ; targeted search es to December 2018 for studies of selective serotonin reuptake inhibitors ( SSRIs ) or serotonin-norepinephrine reuptake inhibitors . Study Selection 19 systematic review s and 37 r and omized controlled trials addressing therapies for motor deficits or mood disorders in adults with stroke . Data Extraction One investigator abstract ed the data , and quality and GRADE assessment were checked by a second investigator . Data Synthesis Most interventions ( for example , SSRIs , mental practice , mirror therapy ) did not improve motor function . High- quality evidence did not support use of fluoxetine to improve motor function . Moderate- quality evidence supported use of cardiorespiratory training to improve maximum walking speed and repetitive task training or transcranial direct current stimulation to improve activities of daily living ( ADLs ) . Low- quality evidence supported use of robotic arm training to improve ADLs . Low- quality evidence indicated that antidepressants may reduce depression , whereas the frequency and severity of antidepressant-related adverse effects was unclear . Low- quality evidence suggested that cognitive behavioral therapy and exercise , including mind-body exercise , may reduce symptoms of depression and anxiety . Limitation Studies were of poor quality , interventions and comparators were heterogeneous , and evidence on harms was scarce . Conclusion Cardiorespiratory training , repetitive task training , and transcranial direct current stimulation may improve ADLs in adults with stroke .  Cognitive behavioral therapy , exercise , and SSRIs may reduce symptoms of poststroke depression , but use of SSRIs to prevent depression or improve motor function was not supported . Primary Funding Source U.S. Department of Veterans Affairs , Veterans Health Administration [ Purpose ] To investigate how task-oriented circuit training for the recovery motor control of the lower-extremity , balance and walking endurance could be clinical ly applied to subacute stroke inpatient group therapy . [ Subjects and Methods ] Twenty subacute stroke patients were r and omly assigned to the intervention group ( n=10 ) or the control group ( n=10 ) . The intervention consisted of a structured , progressive , inpatient circuit training program focused on mobility and gait training as well as physical fitness training that was performed for 90 minutes , 5 days a week for 4 weeks . The control group received individual physiotherapy of neurodevelopmental treatment for 60 minutes , 5 days a week for 4 weeks . Outcome measures were lower-extremity motor control , balance , gait endurance and activities of daily living before and after 4 weeks . [ Results ] There were no significant differences at baseline between the two groups . After 4 weeks , both groups showed significant improvements in all outcome measures , but there were no significant differences between the two groups during the invention period . [ Conclusion ] In spite of the small sample size , these findings suggest that task-oriented circuit training might be used as a cost-effective and alternative method of individual physiotherapy for the motor recovery of lower-extremity , balance and walking endurance of subacute stroke patients
RESULTS Studies of task-related training showed benefits for functional outcome compared with traditional therapies .
Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life .
CONCLUSION Generally , task-oriented rehabilitation proved to be more effective .
Many interventions are feasible for nurses and can be performed in a ward or at home .
AIM This paper is a report of a review conducted to provide an overview of the evidence in the literature on task-oriented training of stroke survivors and its relevance in daily nursing practice .
BACKGROUND Stroke is the second leading cause of death and one of the leading causes of adult disability in the Western world .
The use of neurodevelopmental treatment in the daily nursing care of stroke survivors does not improve clinical outcomes .
Nurses are therefore exploring other forms of rehabilitation intervention , including task-oriented rehabilitation .
Despite the growing number of studies showing evidence on task-oriented interventions , recommendations for daily nursing practice are lacking .