Task oriented training and evaluation at home (TOTE Home)

Abstract

Hemiparesis following a stroke frequently leads to “learned non-use” of the weaker arm and hand. Task oriented training has been suggested as a contemporary neurorehabilitation technique. A single-subject AB series design with a follow-up was conducted to assess the effectiveness of a task oriented training program administered in participants’ homes. This intervention, Task Oriented Training at Home (TOTE Home), incorporated current experience-dependent plasticity aspects (Kleim & Jones, 2008) modeled after the ASAP protocol parameters as described in Winstein et al. (2013) and principles of task oriented training as suggested by Lang and Birkenmeier (2014). Repeated measures of accelerometry and level of confidence on a priority task were analyzed with visual analysis of changes in level, trend, and slope (Portney & Watkins, 2009). Change scores from standardized assessments for the upper extremity (Fugl-Meyer, 1980), Motor Activity Log (van der lee, Beckerman, Knol, de Vet, & Bouter, 2004), Stroke Impact Scale question of recovery (Duncan et al., 1999), Functional Test for the Hemiparetic Upper Extremity (Wilson, Baker, & Craddock, 1984), and Canadian Occupational Performance Measure (Law et al., 2005) were evaluated on data collected at baseline, post-intervention, and follow-up time periods (Portney & Watkins, 2009). Four participants completed TOTE Home and each demonstrated improvement in movement and function of their affected upper extremity as measured by accelerometry, self-efficacy, and other standardized measures. The degree of improvement varied between each participant. A detectable change was evident in all outcome measures following intervention. Each participant’s progress throughout the TOTE Home study was supported by aspects of both Motor Learning Theory (Bass-Haugen, Mathiowetz, & Flinn, 2008; Carr & Shepherd, 1989) and the Theory of Occupational Adaptation (Schkade & Schultz, 1992; Schultz & Schkade, 1992).