Task-Oriented Training – Upper Extremity

Two high quality RCTs (Langhammer et al., 2000; Van Vliet et al., 2005) examined the effect of upper extremity task-oriented training on ADLs in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Langhammer et al., 2000) found no significant difference in ADLs (measured by the Barthel Index) at either 2 weeks or 3 months, between a group of patients who received a 3-month full-body motor relearning program based on a task-oriented training approach (based on the approach described by Carr & Sheppard, 1987), compared to a group that received Bobath-based treatment for 3 months.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Van Vliet et al., 2005) found no significant difference at 1, 3 and 6 months in ADLs (measured by the Barthel Index and the Extended ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of Daily Living Scale) between a group who received a whole body motor relearning program based on a task-specific repetitive approach (based on the approach described by Carr & Sheppard, 1987), compared to a group who received Bobath treatment.
Note: Treatment did not have a specific ‘end-point’ and continued as long as needed.

Conclusion: There is strong evidence (Level 1a) from two high quality RCTs that task-oriented training for the upper extremity is not more effective in improving ADLs compared to Bobath treatment in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Winstein et al., 2004) examined the effect of upper extremity task-oriented training on arm strength in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. firstly stratified patients according to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity based on the Orpington Prognostic Scale as more severe or less severe. Patients were then randomized within these strata to receive one of three interventions: task-oriented training + standard care, strength training + standard care, or standard care alone. There was no significant between-group difference in arm strength (measured by isometric torque) at 4-6 weeks (post-treatment). There was a significant between-group difference in arm strength only at 9-month follow-up among patients with less severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. only, in favour of task-oriented training compared to strength training.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that task-oriented training is not more effective than comparison interventions (strength training, standard care) for improving arm strength among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: However, task-oriented training was seen to be more effective than strength training at 9-month follow-up among patients with less severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One non-randomized study (Christie et al., 2011) examined the effect of upper extremity task-oriented training on dressing in patients with acute stroke. This non-randomized study provided patients to a group-based task-specific dressing retraining program during admission in a stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.). There was a significant improvement in upper limb dressing skills (Functional Independence Measure) at discharge (average 4 sessions).

Conclusion: There is limited evidence (level 2b) from one non-randomized study that a task-specific dressing program is effective for improving dressing skills in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Winstein et al., 2004) examined the effect of upper extremity task-oriented training on grip strength in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. ) firstly stratified patients according to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity based on the Orpington Prognostic Scale as more severe or less severe. Patients were then randomized within these strata to receive one of three interventions: task-oriented training + standard care, strength training + standard care, or standard care alone. There was no significant between-group difference in grip strength (measured by handheld dynamometer) at 4-6 weeks (post-treatment) or follow-up (9 months).

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that task-oriented training for the upper extremity is not more effective than comparison interventions (strength training, standard care) for improving grip strength among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCTs (Van Vliet et al., 2005) examined the effect of upper extremity task-oriented training on hand dexterity in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive a full-body task-specific repetitive approach (based on the approach described by Carr & Sheppard, 1987) or a control group that received Bobath treatment. There was no significant between-group difference in hand dexterity (measured by the Ten Hole Peg Test) at 1, 3 or 6 months.
Note: Treatment did not have a specific ‘end-point’ and continued as long as needed.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that upper extremity task-oriented training is not more effective than a comparison intervention (Bobath treatment) for improving hand dexterity among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Winstein et al., 2004) examined the effect of upper extremity task-oriented training on pain in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. firstly stratified patients according to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity based on the Orpington Prognostic Scale as more severe or less severe. Patients were then randomized within these strata to receive one of three interventions: task-oriented training + standard care, strength training + standard care, or standard care alone. There was no significant between-group difference in pain (measured by the Fugl-Meyer Assessment pain subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
) at 4-6 weeks (post-treatment) or follow-up (9 months).

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that upper extremity task-oriented training is not more effective than comparison interventions (strength training, standard care) for reducing pain among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Liu et al., 2004) examined the effect of upper extremity task-oriented training on perceived task performance in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive functional task training or mental imagery for 3 weeks. There were significant between-group differences in patients’ perceived performance of trained tasks (measured by 7 point Likert scaleLikert scaling is one type of response to items in a questionnaire or tool. For example, Likert scaling would have you rate an item such as “I am satisfied with the care I received” on a scale using a 1-to-5 response scale where:
• 1 = strongly disagree
• 2 = disagree
• 3 = undecided
• 4 = agree
• 5 = strongly agree
You will find various options and scaling methods for the number of response choices (1-to-7, 1-to-9, 0-to-4). Odd-numbered scales usually have a middle value that is labelled Neutral or Undecided. Some tools used forced-choice Likert scaling with an even number of responses and no middle neutral or undecided choice.) at 2 weeks (mid-treatment), 3 weeks (post-treatment) and 1-month follow-up, and untrained tasks at post-treatment (3 weeks), in favour of mental imagery compared to functional task training.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that functional task training is not more effective than a comparison intervention (mental imagery) for improving perceived task performance among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. In fact, mental imagery was found to be more effective than functional task training.

One high quality RCT (Winstein et al., 2004) examined the effect of upper extremity task-oriented training on pinch force in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. firstly stratified patients according to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity based on the Orpington Prognostic Scale as more severe or less severe. Patients were then randomized within these strata to receive one of three interventions: task-oriented training + standard care, strength training + standard care, or standard care alone. There was no significant between-group difference in palmar pinch force at 4-6 weeks (post-treatment). There was a significant between-group difference in palmar pinch force at 9-month follow-up among patients with less severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., in favour of task-oriented training compared to standard care, but not between task-oriented training and strength training.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that upper extremity task-oriented training is not more effective than comparison interventions (strength training, standard care) for improving palmar pinch force among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: However, task-oriented training was more effective than standard care for improving palmar pinch force among patients with less severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. in the long term.

One high quality RCT (Winstein et al., 2004) examined the effect of upper extremity task-oriented training on range of motion in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. firstly stratified patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. according to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity based on the Orpington Prognostic Scale as more severe or less severe. Patients were then randomized within these strata to receive one of three interventions: task-oriented training + standard care, strength training + standard care, or standard care alone. There was no significant between-group difference in range of motion (measured by the Fugl-Meyer Assessment) at 4-6 weeks (post-treatment) or follow-up (9 months).

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that upper extremity task-oriented training is not more effective than comparison interventions (strength training, standard care) for improving range of motion among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Two high quality RCTs (Liu et al., 2004; Winstein et al., 2004) investigated the effect of upper extremity task-oriented training on sensation among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Liu et al., 2004) randomized patients to receive functional task training or mental imagery for 3 weeks. There was no significant between-group difference in sensation (measured by the Fugl-Meyer Assessment sensation subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
) at 1 week (mid-treatment), 2 weeks (mid-treatment), 3 weeks (post-treatment) or 1-month follow-up.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Winstein et al., 2004) firstly stratified patients according to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity based on the Orpington Prognostic Scale as more severe or less severe. Patients were then randomized within these strata to receive one of three interventions: task-oriented training + standard care, strength training + standard care, or standard care alone. There was no significant between-group difference in sensation (measured by the Fugl-Meyer Assessment sensation subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
) at 4-6 weeks (post-treatment) or follow-up (9 months).

Conclusion: There is strong evidence (level 1a) from two high quality RCTs that task-oriented training is not more effective than comparison interventions (mental imagery, strength training, standard care) for improving sensation among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Four high quality RCTs (Langhammer et al., 2000; Liu et al., 2004; Winstein et al., 2004; Van Vliet et al., 2005) investigated the effect of upper extremity task-oriented training on upper extremity motor function in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Langhammer et al., 2000) randomized patients to receive a full-body relearning program based on a task-oriented training approach by Carr & Sheppard (1987) or Bobath treatment. Between-group differences in upper extremity motor function (Sødring Motor Evaluation Scale –upper extremity subtest) and overall motor function (Motor Assessment Scale) approached significance after 2 weeks of intervention (10 sessions), in favour of task-oriented training compared to Bobath treatment. There were no significant between-group differences in either outcome at 3 months.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Liu et al., 2004) randomized patients to receive functional task training or mental imagery for 3 weeks. There was no significant between-group difference in upper extremity motor function (Fugl-Meyer Assessment (FMA) upper extremity motor function subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
) at 1 week (mid-treatment), 2 weeks (mid-treatment), 3 weeks (post-treatment) or 1-month follow-up.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Winstein et al., 2004) firstly stratified patients according to strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity based on the Orpington Prognostic Scale as more severe or less severe. Patients were then randomized within these strata to receive one of three interventions: task-oriented training + standard care, strength training + standard care, or standard care alone. There was a significant between-group difference in upper extremity motor function (measured by the FMA) at 4-6 weeks (post-treatment) among patients with less severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. only, in favour of task-oriented training compared to standard care. A significant between-group difference was also seen at this time point in favour of strength training compared to standard care. Results did not remain significant at follow-up (9 months). There was no significant difference in upper extremity motor function between task-oriented training and strength training at either time point.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Van Vliet et al., 2005) randomised patients to receive a full-body task-specific repetitive approach based on Carr & Sheppard (1987), or Bobath treatment. There was no significant between-group difference in upper extremity motor function (Rivermead Motor Assessment, Motor Assessment Scale) at 1, 3 and 6 months.
Note: Treatment did not have a specific ‘end-point’ and continued as long as needed.

Conclusion: There is strong evidence (level 1a) from four high quality RCTs that task-oriented training is not more effective than comparison interventions (Bobath treatment, mental imagery, strength training or standard care alone) for improving upper extremity motor function among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: However, one of the high quality RCTs found that task-oriented training was more effective than standard care alone only among patients with less severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Results were significant at post-treatment but did not remain significant at long-term follow-up.

One high quality RCTs (Van Vliet et al., 2005) examined the effect of upper extremity task-oriented training on upper extremity spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCT found no significant difference at 1,3 and 6 months for upper extremity spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
(measured by the Modified Ashworth Scale) between a group who received a whole body motor relearning program based on a task-specific repetitive approach (Carr & Sheppard, 1987), compared to a group who received Bobath treatment. It should be noted that treatment did not have a specific ‘end-point’ and continued as long as was needed.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that task-oriented training for the upper extremity is not more effective than a comparison intervention (Bobath treatment) in reducing upper extremity spasticityamong patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Two high quality RCTs (Baskett et al., 1999; Widén Holmqvist et al., 1998) investigated the effect of upper extremity task-oriented training on ADLs among patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Baskett et al., 1999) randomized patients to receive functional self-directed home-based therapy or conventional outpatient physical and occupational therapy. There were no significant between group differences in activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living (measured by the modified Barthel Index) at 6 weeks or 3 months.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients to receive task-oriented home rehabilitation or conventional outpatient rehabilitation. There were no significant between-group differences in ADLs (measured by the Katz Index of Independence in ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of Daily Living personal and instrumental scores, Barthel Index and Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index) at 3 months (approaching end of treatment).
Note: The study had a small sample size and may not have been adequately powered to detect between-group differences.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs that task-oriented training is not more effective than conventional rehabilitation for improving activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living among patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCTs (Baskett et al., 1999) investigated the effect of upper extremity task-oriented training on emotional wellbeing among patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCT randomized patients to receive functional self-directed home-based therapy or conventional outpatient physical and occupational therapy. There were no significant between-group differences in emotional wellbeing (measured using the Hospital Anxiety and DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale and the General Health Questionnaire – GHQ-28) at 6 weeks or 3 months.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that task-oriented training is not more effective than conventional rehabilitation for improving emotional wellbeing among patients with subacute stroke.

One high quality RCTs (Baskett et al., 1999) investigated the effect of upper extremity task-oriented training on grip strength among patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCT randomized patients to receive functional self-directed home-based therapy or conventional outpatient physical and occupational therapy. There were no significant between group differences in grip strength (measured using the Jamar Dynamometer) at 6 weeks or 3 months.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that task-oriented training is not more effective than conventional rehabilitation for improving grip strength among patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Three high quality RCTs (Blennerhassett & Dite, 2004; Baskett et al., 1999; Widén Holmqvist et al., 1998) investigated the effect of upper extremity task-oriented training on hand function and dexterity among patients with subacute stroke.

The first high quality RCT (Blennerhassett & Dite, 2004) randomized patients to receive upper extremity task-oriented training and conventional rehabilitation or lower-limb task-oriented mobility training and conventional rehabilitation. There were no significant between-group differences in hand function and dexterity (measured by the Jebsen Taylor Hand Function Test) at 4 weeks (post-treatment) or 6 months (follow-up).

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Baskett et al., 1999) randomized patients to receive functional self-directed home-based therapy or conventional outpatient physical and occupational therapy. There were no significant between group differences in manual dexterity (measured by the Nine Hole Peg Test) at 6 weeks or 3 months.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients to receive task-oriented home rehabilitation or conventional outpatient rehabilitation. There were no significant between-group differences in manual dexterity (Nine Hole Peg Test) at 3 months (approaching end of treatment).
Note: The study had a small sample size and may not have been adequately powered to detect between-group differences.

Conclusion: There is strong evidence (Level 1a) from three high quality RCTs that task-oriented training is not more effective than comparison interventions (lower-limb task-oriented mobility training or conventional rehabilitation) for improving hand function and dexterity in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCTs (Arya et al., 2012) investigated the effect of upper extremity task-oriented training on upper extremity motor activity among patients with subacute stroke. This high quality RCT randomized patients to receive meaningful task-specific training (MTST) or standard training based on Brunnstrom movement therapy and Bobath neurodevelopmental therapy. There was a significant between-group difference in change scores on measures of upper extremity motor activity (Motor Activity Log amount of use and quality of movement scores) at 8-week follow-up, in favour of MTST compared to standard training.
Note: Results depict change scores at 8-week follow-up. Statistical data for between-group differences in scores at 4 weeks (post-treatment) and 8 weeks (follow-up) was not provided. This study cannot therefore be used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.

Conclusion: There is insufficient evidence (level 5) regarding the effectiveness of task-oriented training compared to other interventions on upper extremity motor activity among patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported a significant difference in follow-up change scores, in favour of task-specific training compared to standard training.

Four high quality RCTs (Arya et al., 2012; Blennerhassett & Dite, 2004; Baskett et al., 1999; Widén Holmqvist et al., 1998) investigated the effect of upper extremity task-oriented training on upper extremity motor function among patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Arya et al., 2012) randomized patients to receive meaningful task-specific training (MTST) or standard training based on Brunnstrom movement therapy and Bobath neurodevelopmental therapy. There was a significant between-group difference in change scores on measures of upper extremity motor function (Fugl-Meyer Assessment FMA upper extremity, upper arm and wrist and hand scores, Action Research Arm Test overall, grasp, grip, pinch and gross arm movement scores, Graded Wolf Motor Function Test time and quality of movement scores) at 8-week follow-up, in favour of MTST compared to standard training.
Note: Results depict change scores at 8-week follow-up. Statistical data for between-group differences in scores at 4 weeks (post-treatment) and 8 weeks (follow-up) was not provided. This study cannot therefore be used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Blennerhassett & Dite, 2004) randomized patients to receive upper limb task-oriented training combined with standard rehabilitation or lower limb task-oriented mobility training combined with standard rehabilitation (control). There were no significant between-group differences in upper extremity motor function (measured using the Motor Assessment Scale) at 4 weeks (post-treatment) or 6 months (follow-up).
Note: The study may not have been adequately powered (n=30) to find significant between-group differences. A significant within-group difference on the MAS was found for the upper limb group but not the mobility group. Significance was set to p=0.008 to account for multiple comparisons.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Baskett et al., 1999) randomized patients to receive functional self-directed home-based therapy or conventional outpatient physical and occupational therapy. There were no significant between group differences in upper extremity motor function (measured by the Motor Assessment Scale and Frenchay Arm Test) at 6 weeks or 3 months.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients to receive task-oriented home rehabilitation or conventional outpatient rehabilitation. There were no significant between-group differences in upper extremity motor function (Fugl-Meyer assessment arm score) at 3 months (approaching end of treatment).
Note: The study had a small sample size and may not have been adequately powered to detect between-group differences.

Conclusion: There is strong evidence (level 1a) from three high quality RCTs that upper extremity task-oriented training is not more effective than comparison interventions (lower limb task-oriented mobility training, conventional rehabilitation) for improving upper extremity motor function among patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: However, two of the high quality RCTs may not have been sufficiently powered to detect significant change. Further, one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported follow-up change scores only.

Two high quality RCTs (Corti et al., 2012; Higgins et al., 2006) examined the effect of upper extremity task-oriented training on ADLs in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality crossover RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Corti et al., 2012) randomized patients to receive functional task practice or dynamic high-intensity resistance (power) training. There were no significant between-group differences in functional activity (measured by the Chedoke McMaster Hand and Arm Inventory) at post-treatment (10 weeks, 20 weeks).

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Higgins et al., 2006) randomized patients to receive upper extremity task-oriented training or task-oriented mobility training. There were no significant between-group differences in ADLs (measured by the Barthel Index and the Older Americans Resources and Services Scale – Instrumental ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of Daily Living) at post-treatment (6 weeks).

Conclusion: There is strong evidence (Level 1a) from two high quality RCTs that upper extremity task-oriented training is not more effective than comparison interventions (power training, task-oriented mobility training) for improving ADLs in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Higgins et al. 2006) investigated the effect of task-oriented training on grip strength in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCT found no difference in grip strength as measured by a hand-held dynamometer immediately post-intervention (at 6 weeks), between a group that received upper-extremity task-oriented training compared to a group that received a task-oriented mobility training.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that upper extremity task-oriented training is not more effective than a comparison intervention (task-oriented mobility training) for improving grip strength among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Higgins et al., 2006) investigated the effect of upper extremity task-oriented training on hand function and dexterity in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The study found no significant differences immediately post-treatment (at 6 weeks) in hand function and dexterity as measured by the Box & Block Test and the Nine-Hole Peg Test, between a group that received upper extremity task-oriented training compared to a group that received task-oriented mobility training.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that upper extremity task-oriented training is not more effective than a comparison intervention (task-oriented mobility training) for improving hand function and dexterity among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Corti et al., 2012) investigated the effect of upper extremity task-oriented training on participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in patients with chronic stroke. This high quality crossover RCT randomized patients to receive functional task practice or dynamic high-intensity resistance (power) training. There were no significant between-group differences in participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (measured by the Reintegration to Normal Living Index) at post-treatment (10 weeks, 20 weeks).

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that task-oriented training is not more effective than power training for improving participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Higgins et al., 2006) investigated the effect of upper extremity task-oriented training on quality of life in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. At 6 weeks (immediately post-intervention) the study found no significant differences in quality of life as measured by 2 upper-extremity questions from the Medical Outcomes Short Form-36, and the Geriatric DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale, between a group that received upper extremity task-oriented training compared to a group that received task-oriented mobility training.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that upper extremity task-oriented training is not more effective than a comparison intervention (task-oriented mobility training) for improving quality of life among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Thielman et al., 2008) investigated the effect of upper-extremity task-oriented training on elbow and shoulder range of motion in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. At 4 weeks, there was no significant difference between a group that received upper-extremity task-oriented training with trunk restraint compared to a group that received progressive resistance exercises with trunk restraint.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that upper extremity task-oriented training is not more effective than a comparison intervention (progressive resistance exercises) for improving range of motion among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: This study may not have been adequately powered (n=11) to find significant between-group differences.

One high quality RCT (Corti et al., 2012) investigated the effect of upper extremity task-oriented training on spasticity in patients with chronic stroke. This high quality crossover RCT randomized patients to receive functional task practice or dynamic high-intensity resistance (power) training. There was no significant between-group difference in upper extremity spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
(measured by the Modified Ashworth Scale) at post-treatment (10 weeks, 20 weeks).

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that task-oriented training is not more effective than a comparison intervention (power training) for reducing spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
among patients with chronic stroke.

One high quality RCT (Corti et al., 2012) investigated the effect of upper extremity task-oriented training on stroke impairment in patients with chronic stroke. This high quality crossover RCT randomized patients to receive task-oriented training or dynamic high-intensity resistance (power) training. There were no significant between-group differences in stroke impairment (measured by the European Stroke Scale) at post-treatment (10 weeks, 20 weeks).

Conclusion: There is moderate evidence (level 1b) from one high quality RCT that task oriented training is not more effective than a comparison intervention (power training) for improving strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. impairment among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Two high quality RCTs (Corti et al., 2012; Thielman et al., 2008) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Thielman et al. 2004) investigated the effect of upper extremity task-oriented training on trunk compensation in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality crossover RCT (Corti et al., 2012) randomized patients to receive functional task practice or dynamic high-intensity resistance (power) training. There was a significant between-group difference in kinematic measures of trunk displacement at 10 weeks and 20 weeks, in favour of power training compared to functional task practice.

The second high quality RCT (Thielman et al., 2008) found no significant differences at 4 weeks (immediately post-treatment) in trunk compensation, measured by kinematics, between a group that received upper-extremity task-oriented training with trunk restraint compared to a group that received progressive resistance exercises with trunk restraint.
Note: This study may not have been adequately powered (n=11) to find significant between-group differences,

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Thielman et al. 2004) found no significant differences at 4 weeks (immediately post-treatment) in trunk compensation, measured by kinematics, between a group that received task-oriented training compared to a group that received progressive resistive training.
Note: This study may not have been adequately powered (n=12) to find significant between-group differences.

Conclusion: There is strong evidence (Level 1a) from two high quality RCTs and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that upper extremity task-oriented training is not more effective than comparison intervention (resistance training) for improving trunk compensation among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. In fact, one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that power training was more effective than task-oriented training for improving trunk displacement.
Note: Some studies may not have been adequately powered to find significant between-group differences.

Two high quality RCTs (Corti et al., 2012; Thielman et al., 2008) and one fair quality RCT (Thielman et al. 2004) investigated the effect of upper extremity task-oriented training on upper extremity kinematics in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality crossover RCT (Corti et al., 2012) randomized patients to receive functional task practice or dynamic high-intensity resistance (power) training. There were significant between-group differences in kinematic measures of elbow extension ROM at 10 weeks, in favour of power training compared to functional task practice. There was a significant between-group difference in movement speed (measured as mean velocity) at 20 weeks, in favour of functional task practice compared to power training. There were no significant between-group differences at either time point for other kinematic measures of movement accuracy (measured as reach-path ratio and submovements), motor coordination (time to peak hand velocity, time to maximum shoulder flexion, time to maximum elbow extension), and shoulder flexion ROM.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Thielman et al., 2008) randomized patients to receive upper-extremity task-oriented training with trunk restraint or a control group that received progressive resistance exercises with trunk restraint. There were found no significant difference in kinematic measures of arm trajectory at 4 weeks (post-treatment).
Note: This study may not have been adequately powered to find significant between-group differences (n=11); further, the intervention group, but not the control group, showed a significant pre-post improvement in arm trajectory (reaching hand path, deceleration time and upper arm flexion).

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Thielman et al., 2004) randomized patients to receive upper-extremity task-oriented training or a control group that received progressive resistance exercises. There were no significant differences in kinematic measures of arm trajectory at 4 weeks (post-treatment).
Note: This study may not have been adequately powered to find significant between-group differences (n=12). Further analysis revealed that within the intervention group, patients with initial low-level function (based on a reaching pre-test) had improved significantly more at 4 weeks than patients with initial high-level function across all kinematic variables for arm movement. Furthermore, within the low-level subgroup of the intervention group there was a significant pre-post improvement in hand path (suggesting better coordination of elbow and shoulder motion) while there were no significant improvements for any kinematic measures in the control group.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs and one fair quality RCTthat task-oriented training is not more effective than comparison interventions (power training, progressive resistance exercises with trunk restraint) for improving upper extremity kinematics among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that task-oriented training was more effective than power training for improving movement speed; the same high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that power training was more effective than task-oriented training for improving elbow extension ROM and trunk displacement.

Three high quality RCTs (Corti et al., 2012; Higgins et al., 2006 ; Thielman et al., 2008) and one fair quality RCT (Thielman et al. 2004) investigated the effect of upper extremity task-oriented training on upper extremity motor function in patients with chronic stroke.

The first high quality crossover RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Corti et al., 2012) randomized patients with chronic stroke to receive functional task practice or dynamic high-intensity resistance (power) training. There was no significant between-group difference in upper extremity function (measured by the Fugl-Meyer Assessment of Upper Extremity Motor Score and shoulder/elbow score) at post-treatment (10 weeks, 20 weeks).

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Higgins et al., 2006) found no significant difference at post-treatment (6 weeks) in upper extremity motor function as measured by the upper extremity subscale of the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Rehabilitation Assessment of Movement (STREAM) and the Upper Extremity Performance Test for the Elderly, between a group that received upper extremity task-oriented training compared to a group that received lower extremity task-oriented training.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Thielman et al. 2008) found no significant difference in motor function (measured by the Fugl-Meyer Assessment –upper limb score and the Wolf Motor Arm Test) at 4 weeks (immediately post-treatment), between a group that received task-oriented training with trunk restraint compared to the group that received progressive resistance training with trunk restraint.
Note: This study may not have been adequately powered (n=11) to find significant between-group differences.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Thielman et al., 2004) reported no significant differences in upper extremity motor function immediately post-intervention (at 4 weeks), measured by 2 upper extremity subscales from the Motor Assessment Scale and the arm section of the Rivermead Motor Assessment, between a group that received upper-extremity task-oriented training compared to a group that received progressive resistance exercises.
Note: The study may not have been adequately powered (n=12) to find significant between-group differences.

Conclusion: There is strong evidence (Level 1a) from three high quality RCTs and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that upper extremity task-oriented training is not more effective than comparison interventions (power training, resistance training, lower extremity task-oriented training) for improving upper extremity motor function among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..