Effectiveness of Interventions to Improve Occupational Performance of People With Motor Impairments After Stroke: An Evidence-Based Review

Abstract

We conducted a review to determine the effectiveness of interventions to improve occupational performance in people with motor impairments after stroke as part of the American Occupational Therapy Association’s Evidence-Based Practice Project. One hundred forty-nine studies met inclusion criteria. Findings related to key outcomes from select interventions are presented. Results suggest that a variety of effective interventions are available to improve occupational performance after stroke. Evidence suggests that repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation can improve upper-extremity function, balance and mobility, and/or activity and participation. Commonalities among several of the effective interventions include the use of goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements.

Keywords

activities of daily living evaluation studies as topic evidence based practice motor skills disorders occupational therapy stroke

Motor impairments are a common consequence of stroke. These deficits often compromise a person’s ability to engage in meaningful occupations. Currently, occupational therapists use multiple interventions to remediate motor impairments. However, no consensus has been reached regarding which interventions are most effective for improving occupational performance. The purpose of this review was to answer the following focused question: What is the evidence for the effectiveness of interventions to improve occupational performance for those with motor impairments after stroke?

Background Literature and Statement of Problem

Motor deficits are one of the most common and challenging consequences of a stroke (Nakayama, Jørgensen, Raaschou, & Olsen, 1994). A longitudinal community-based study that evaluated 108 participants who experienced an ischemic stroke found that 50% had hemiparesis, 30% were unable to walk without assistance, and 25% were dependent for activities of daily living (ADLs; Kelly-Hayes et al., 2003). Thus, a clear need exists for evidence-based rehabilitative strategies that address motor impairments to improve a stroke survivor’s occupational performance. In addition, the stroke population is one of the largest groups treated by occupational therapists in the physical disability setting (National Board for Certification in Occupational Therapy, 2012), and it is important that the strategies used in the clinic be supported by evidence-based research (American Occupational Therapy Association [AOTA], 2007). The last evidence-based review of stroke interventions for occupational therapists, published by AOTA in 2008, included an appraisal of studies conducted through 2003 (Sabari, 2008). Since then, several systematic reviews and meta-analyses have investigated the effectiveness of specific interventions, for example, constraint-induced movement therapy (Peurala et al., 2012), mental practice (Nilsen, Gillen, & Gordon, 2010), and strengthening (Ada, Dorsch, & Canning, 2006). Additionally, guidelines synthesizing data related to multiple interventions (Duncan et al., 2005) have been published. However, these reviews did not emphasize a specific focus on improving occupational performance. Therefore, to ensure best practice in stroke rehabilitation, it is vital that an updated appraisal of existing interventions be done.

Method for Conducting the Evidence-Based Review

Detailed information regarding the methodology for the entire review can be found in “Method for the Evidence-Based Reviews on Occupational Therapy and Stroke” in this issue (Arbesman, Lieberman, & Berlanstein, 2015). Because the main focus of this review was to document the interventions that improve occupational performance for people with motor deficits after stroke, we paid particular attention to choice of outcome measures. If a study did not include at least one outcome measure that addressed occupational performance, that is, improvement in the ability to participate in areas of occupation (ADLs, instrumental activities of daily living, rest and sleep, education, work, play, leisure, and social participation; AOTA, 2014), the study was excluded. We also included measures that focused on upper-extremity (UE) function or balance and mobility using simulated ADLs.

Data were evaluated with reference to three primary outcomes: UE function, balance and mobility, and activity and participation. Although not a complete list, examples of included outcome measures are, for UE function, the Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Frenchay Arm Test, Jebsen–Taylor Test of Hand Function, Motor Activity Log, and Wolf Motor Function Test; for balance and mobility, the Berg Balance Scale, 6-Minute Walk Test, and Timed Up and Go test; and for activity and participation, the Barthel Index, Canadian Occupational Performance Measure, FIM™, and Stroke Impact Scale.

Results

We reviewed 4,930 titles and abstracts and selected 485 studies for full review. Of these, 149 studies met the established criteria for inclusion in the review; 129 articles were rated as providing Level I evidence, 18 studies were rated as providing Level II evidence, and 2 studies were rated as providing Level III evidence. Data from each article were categorized according to intervention type, extracted and put into evidence table format, and later summarized and appraised in a Critically Appraised Topic (see Nilsen et al., 2014). Given space limitations, we briefly describe and highlight the key findings of the following select interventions: repetitive task practice (RTP), constraint-induced and modified constraint-induced movement therapy (CIMT and mCIMT, respectively), mental practice (MP), virtual reality (VR), mirror therapy (MT), action observation (AO), and strengthening and exercise. Supplemental Table 1 (available online at http://otjournal.net; navigate to this article, and click on “Supplemental”) summarizes select studies that highlight the major findings related to these interventions (see Wolf & Nilsen, 2015, for the full evidence table).

Repetitive Task Practice

RTP is an overarching term used to describe training approaches that include performance of goal-directed, individualized tasks with frequent repetitions of task-related or task-specific movements (French et al., 2008). Eighteen Level I studies (Allison & Dennett, 2007; Arya et al., 2012; Chan, Chan, & Au, 2006; Cirstea & Levin, 2007; Cirstea, Ptito, & Levin, 2006; English & Hillier, 2011; Feys et al., 2004; French et al., 2008, 2010; Harris, Eng, Miller, & Dawson, 2009; McClellan & Ada, 2004; Michaelsen, Dannenbaum, & Levin, 2006; Platz et al., 2009; Thielman, 2010; Thielman, Dean, & Gentile, 2004; Thielman, Kaminski, & Gentile, 2008; Tung, Yang, Lee, & Wang, 2010; Yelnik et al., 2008) and six Level II studies (Buschfort et al., 2010; Byl, Pitsch, & Abrams, 2008; Harris, Eng, Miller, & Dawson, 2010; Kawahira et al., 2010; Schneider, Münte, Rodriguez-Fornells, Sailer, & Altenmüller, 2010; Schneider, Schönle, Altenmüller, & Münte, 2007) reported on the effectiveness of various types of RTP (e.g., task-specific training, task-related training, repetitive task training, repetitive motor practice, circuit training) in improving aspects of occupational performance after stroke. Seventeen studies included outcome measures related to UE function, with 13 studies reporting positive findings favoring RTP (Arya et al., 2012; Buschfort et al., 2010; Byl et al., 2008; Cirstea & Levin, 2007; Feys et al., 2004; French et al., 2008; Harris et al., 2009; Michaelsen et al., 2006; Platz et al., 2009; Schneider et al., 2007, 2010; Thielman, 2010; Thielman et al., 2004). Nine studies included outcome measures addressing balance and mobility. Seven of these studies (Allison & Dennett, 2007; Byl et al., 2008; Chan et al., 2006; English & Hillier, 2011; French et al., 2008, 2010; McClellan & Ada, 2004) reported positive effects of RTP for improving balance and mobility. Six studies included outcome measures related to activity and participation, with 4 studies (Chan et al., 2006; French et al., 2008, 2010; Yelnik et al., 2008) reporting RTP had a positive effect on activity and participation.

CIMT and mCIMT

CIMT is a method of training that involves restraint of the unaffected limb for ∼ 90% of waking hours, forcing use of the affected limb during daily activities. The other components of CIMT include shaping and intensive and repetitive task training using the affected limb for 6 hr/day for 2 wk (Taub et al., 2006). mCIMT is a shortened version of the original CIMT. During mCIMT, the amount of time for intensive training of the affected limb, the restraint time of the nonaffected limb, or both are decreased and/or distributed over a longer period of time. For example, the intensive training sessions in mCIMT range from 30 min to 3 hr/session, session frequency ranges from 2 days/wk to 5 days/wk, restraint of the unimpaired limb is generally ≤6 hr/day, and the length of the intervention ranges from 2 to 10 wk (Shi, Tian, Yang, & Zhao, 2011). mCIMT is believed to decrease issues related to compliance, as well as any dangers that may be associated with prolonged restraint time (Shi et al., 2011). Sixteen Level I studies (Bonaiuti, Rebasti, & Sioli, 2007; Brogårdh & Lexell, 2010; Brogårdh & Sjölund, 2006; Corbetta, Sirtori, Moja, & Gatti, 2010; Hakkennes & Keating, 2005; Hayner, Gibson, & Giles, 2010; Kim et al., 2008; Lin et al., 2010; Peurala et al., 2012; Shi et al., 2011; Sirtori, Corbetta, Moja, & Gatti, 2009; Wang, Zhao, Zhu, Li, & Meng, 2011; Wolf et al., 2010; Woodbury et al., 2009; Wu, Chuang, Lin, Chen, & Tsay, 2011; Yen, Wang, Chen, & Hong, 2005) and 4 Level II studies (Azab et al., 2009; Barzel et al., 2009; Taub et al., 2006; Uswatte, Taub, Morris, Barman, & Crago, 2006) examined the effectiveness of CIMT, mCIMT, or both in improving aspects of occupational performance.

Nineteen (Barzel et al., 2009; Bonaiuti et al., 2007; Brogårdh & Lexell, 2010; Brogårdh & Sjölund, 2006; Corbetta et al., 2010; Hakkennes & Keating, 2005; Hayner et al., 2010; Kim et al., 2008; Lin et al., 2010; Peurala et al., 2012; Shi et al., 2011; Sirtori et al., 2009; Taub et al., 2006; Uswatte et al., 2006; Wang et al., 2011; Wolf et al., 2010; Woodbury et al., 2009; Wu et al., 2011; Yen et al., 2005) of 20 studies included outcome measures related to UE function. All of these studies reported positive findings on at least one outcome measure, indicating that CIMT or mCIMT improved UE function. Seven studies included outcome measures addressing activity and participation, with 6 of them (Azab et al., 2009; Hayner et al., 2010; Peurala et al., 2012; Shi et al., 2011; Sirtori et al., 2009; Wolf et al., 2010) reporting positive effects of CIMT or mCIMT on at least one outcome measure related to activity and participation. Several studies reported that improvements in UE function (e.g., Taub et al., 2006; Wolf et al., 2010) and activity and participation (e.g., Azab et al., 2009) attributed to CIMT are maintained over time. Moreover, Barzel et al. (2009) compared a 4-wk home-based mCIMT program (intensive practice 2 hr/day, 5 days/wk, with restraint of the unimpaired limb for 60% of waking hours) with the original CIMT protocol in chronic stroke survivors. They found that both groups improved significantly on measures of UE function with no between-group differences; these improvements were maintained at 6-mo follow-up for both groups, suggesting the benefits gained from the protocols were comparable.

Mental Practice

Mental practice is a training method during which a person cognitively rehearses a physical skill in the absence of actual movements (Jackson, Lafleur, Malouin, Richards, & Doyon, 2001). Most often, this type of training is coupled with traditional task-oriented practice. Nine Level I studies (Barclay-Goddard, Stevenson, Poluha, & Thalman, 2011; Bovend’Eerdt, Dawes, Sackley, Izadi, & Wade, 2010; Braun et al., 2012; Ietswaart et al., 2011; Liu, Chan, Lee, & Hui-Chan, 2004; Liu et al., 2009; Nilsen et al., 2010; Nilsen, Gillen, DiRusso, & Gordon, 2012; Page, Dunning, Hermann, Leonard, & Levine, 2011) investigated the effectiveness of this type of training. Seven studies included outcome measures addressing UE function. Of these 7 studies, 3 (Barclay-Goddard et al., 2011; Nilsen et al., 2010, 2012) reported positive findings favoring MP on outcome measures related to UE function.

Seven studies included outcome measures related to activity and participation. Three (Barclay-Goddard et al., 2011; Liu et al., 2004, 2009) of the 7 studies reported positive findings in favor of MP on at least outcome measures related to activity and participation. Additionally, results of 1 study suggest improvements in activity and participation attributed to MP may be maintained over time (Liu et al., 2004).

Virtual Reality

During virtual reality, participants take part in various goal-directed activities in a computer-based, interactive, multisensory simulated environment designed to replicate real-world experiences. VR environments can be immersive (in which the individual has a strong sense of presence in entering the computer-generated world) or nonimmersive (e.g., video gaming systems such as the Wii).

Four Level I studies (da Silva Cameirão, Bermúdez I Badia, Duarte, & Verschure, 2011; Henderson, Korner-Bitensky, Levin, & Roth, 2007; Laver, George, Thomas, Deutsch, & Crotty, 2011; Saposnik & Levin, 2011) and 1 Level II study (Mouawad, Doust, Max, & McNulty, 2011) investigated the effectiveness of this type of training. All of the included studies reported positive findings favoring VR on at least one outcome measure related to UE function, and 1 of 2 studies that included outcome measures related to activity and participation reported positive findings in support of VR (Laver et al., 2011).

Mirror Therapy

During mirror therapy, a mirror or mirror box is placed in the midsagittal position between the extremities of interest. The individual is then encouraged to concentrate on the mirror reflection of the uninvolved extremity performing movements or receiving sensory stimulation while the involved extremity remains hidden out of sight behind the mirror. This procedure creates a visual illusion whereby the activities of the uninvolved extremity are attributed to the involved extremity (Ramachandran & Altschuler, 2009). Movements performed range from simple isolated joint movements to functional movements with objects, and active engagement of the unseen impaired limb is often, but not always, encouraged during the treatment.

Three Level I articles (Lee, Cho, & Song, 2012; Thieme et al., 2013; Thieme, Mehrholz, Pohl, Behrens, & Dohle, 2012) investigated the effectiveness of this type of training. All of the studies included outcome measures related to UE function, with 2 studies reporting positive findings in favor of MT (Lee et al., 2012; Thieme et al., 2012). Additionally, Thieme et al. (2012) reported that improvements in UE function attributed to MT were maintained at 6-mo follow-up. Two studies included outcome measures addressing activity and participation, with 1 study reporting positive findings in favor of MT (Thieme et al., 2012).

Action Observation

During action observation, participants watch another person performing common functional actions (most often by watching a prerecorded video) with the intention of imitating the observed actions (Ertelt et al., 2007). Accordingly, AO is followed by actual task performance.

Two Level I articles investigated the effectiveness of this type of training (Ertelt et al., 2007; Franceschini et al., 2012). Ertelt et al. (2007) reported a significant effect favoring AO on measures of UE function and activity and participation in chronic stroke survivors, and these improvements were maintained at a 2-mo follow-up. Franceschini et al. (2012) investigated the effects of AO on UE recovery in acute stroke survivors. A significant effect favoring AO on one outcome measure related to UE function was noted; this improvement was maintained at 4- to 5-mo follow-up.

Strengthening and Exercise

All forms of strengthening and exercise, including yoga and tai chi, were combined into the intervention category of strengthening and exercise. Fifteen Level I studies (Ada et al., 2006; Au-Yeung, Hui-Chan, & Tang, 2009; Brazzelli, Saunders, Greig, & Mead, 2011; Galvin, Murphy, Cusack, & Stokes, 2008; Harrington et al., 2010; Harris & Eng, 2010; Hart et al., 2004; Holmgren, Gosman-Hedström, Lindström, & Wester, 2010; Langhammer, Stanghelle, & Lindmark, 2008, 2009; Mead et al., 2007; Olney et al., 2006; Pak & Patten, 2008; Pang, Harris, & Eng, 2006; Schmid et al., 2012) and 1 Level II study (Stuart et al., 2009) provided evidence regarding the effectiveness of strengthening and exercise. Six studies included outcome measures related to UE function, with 5 studies (Ada et al., 2006; Harris & Eng, 2010; Langhammer et al., 2009; Pak & Patten, 2008; Pang et al., 2006) reporting positive findings in favor of strengthening and exercise for improving UE function. Eight of 11 studies reported positive effects of strengthening and exercise on outcome measures related to balance and mobility (Ada et al., 2006; Brazzelli et al., 2011; Langhammer et al., 2009; Mead et al., 2007; Olney et al., 2006; Pak & Patten, 2008; Schmid et al., 2012; Stuart et al., 2009). Thirteen studies included measures related to activity and participation, with 11 studies (Ada et al., 2006; Galvin et al., 2008; Harrington et al., 2010; Hart et al., 2004; Holmgren et al., 2010; Langhammer et al., 2008, 2009; Mead et al., 2007; Olney et al., 2006; Pak & Patten, 2008; Stuart et al., 2009) reporting positive effects of strengthening and exercise on improving activity and participation.

Discussion and Implications for Practice, Education, and Research

On the basis of our review, a variety of evidence-based interventions are effective at improving occupational performance of people with motor impairments after stroke. For example, the results of the review suggest evidence exists for the effectiveness of RTP, CIMT, and mCIMT for improving UE function and activity and participation. Consistent with previous practice guidelines that suggested providing “task-based practice opportunities” for stroke survivors with residual motor capacities (Sabari, 2008, p. 49), both of these interventions stress training of the impaired arm and hand using goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements. Clearly, the key components of these interventions are consistent with occupational therapy’s notion that engagement in occupation is a key to health and well-being (AOTA, 2014).

With regard to CIMT, the evidence has supported the use of this intervention for improving occupational performance in a select subgroup of stroke survivors: those survivors who have some ability to extend the wrist and fingers of the involved hand and have the capacity to handle the intensive training. Thus, the positive results attributed to the intervention cannot be generalized to all stroke survivors. Also, the intervention in its original form may not be amenable to many clinical practice settings. Clinicians are likely to find providing 6 hr of intensive individual training impossible. However, there is evidence that CIMT training can be effective when administered in a group format (Brogårdh & Sjölund, 2006) and when adapted to the home environment (Barzel et al., 2009). Interestingly, mCIMT protocols that reduce and/or distribute the amount of time for intensive training of the affected limb or the restraint time of the nonaffected limb have proven to be effective, and evidence has suggested they may be comparable to traditional CIMT (Barzel et al., 2009). Also, many of the mCIMT studies have included participants at various phases of recovery with wider ranges of motor impairments in the arm and hand, and there is also evidence that mCIMT training can be effective. Therefore, mCIMT protocols may provide training models that are adaptable to a broader range of clinical situations.

What components of these task-oriented interventions are most instrumental in producing the desired effects remains unclear. Future studies will be useful in defining which components (e.g., duration and intensity of practice, contribution of restraining the unimpaired arm and trunk, whole-task practice, part-task practice, shaping, feedback) of CIMT, mCIMT, and RTP are most instrumental in producing the beneficial effects associated with the interventions. In addition to these interventions, the results of the review indicate that combining task-oriented training with cognitive strategies, such as occurs during MP, VR, MT, and AO, can improve UE function and activity and participation. These interventions may complement traditional task-oriented training and provide increased opportunities for self-directed practice. However, future controlled studies with larger sample sizes will be useful in defining the optimal dosing of MP, MT, VR, and AO; the optimal ratio of MP and AO to physical task-oriented training; the best methods of facilitating MP (e.g., audiotape, videotape, self-generated), AO (video or live models), and VR (immersive vs. nonimmersive); and the impact of motor impairment level on the effectiveness of these interventions.

On the basis of this review, task-oriented training may be considered the foundation of interventions focused on improving occupational performance for those with motor impairment after stroke. However, evidence has suggested that various forms of strengthening and exercise can improve occupational performance as well. Although in the past the use of resistance was considered inappropriate for this population, it appears that strengthening interventions can be useful in improving UE function, balance and mobility, and activity and participation.

In summary, evidence has shown that a variety of interventions can improve aspects of occupational performance in stroke survivors who have residual motor impairments. Future individual systematic reviews with pooled data analysis would prove useful in determining the effectiveness of each of the presented interventions.

Limitations to this review include the following: Many of the included studies had small sample sizes; some studies were heterogeneous in terms of participant characteristics, intervention protocols, and outcome measures; long-term effects are not well studied; our search was limited to journals published in English; and the possibility of missing studies or duplication of evidence remains because of combinations of search terms and variations in terminology. Lack of systematic grading of the methodological quality of the included studies and lack of pooled data analysis are additional limitations.

Supplemental Materials

Supplemental Material

Supplementary material for Effectiveness of Interventions to Improve Occupational Performance of People With Motor Impairments After Stroke: An Evidence-Based Review

Supplementary material, sj-pdf-1-aot-10.5014_ajot.2015.011965.pdf for Effectiveness of Interventions to Improve Occupational Performance of People With Motor Impairments After Stroke: An Evidence-Based Review by Dawn M. Nilsen, Glen Gillen, Daniel Geller, Kimberly Hreha, Ellen Osei and Ghazala T. Saleem in The American Journal of Occupational Therapy

6901180030p1_ds001.pdf

Supplementary material for Effectiveness of Interventions to Improve Occupational Performance of People With Motor Impairments After Stroke: An Evidence-Based Review

Supplementary material, sj-pdf-2-aot-10.5014_ajot.2015.011965.pdf for Effectiveness of Interventions to Improve Occupational Performance of People With Motor Impairments After Stroke: An Evidence-Based Review by Dawn M. Nilsen, Glen Gillen, Daniel Geller, Kimberly Hreha, Ellen Osei and Ghazala T. Saleem in The American Journal of Occupational Therapy

Footnotes

Acknowledgments

We thank Marian Arbesman and Deborah Lieberman for their support and guidance during the evidence-based review process.

Indicates studies included in this review.

References

Ada

Dorsch

, & Canning

C. G.

(2006). Strengthening interventions increase strength and improve activity after stroke: A systematic review. Australian Journal of Physiotherapy, 52, 241–248. http://dx.doi.org/10.1016/S0004-9514(06)70003-4

Allison

, & Dennett

(2007). Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke. Clinical Rehabilitation, 21, 614–619. http://dx.doi.org/10.1177/0269215507077364

American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. http://dx.doi.org/10.5014/ajot.61.6.613

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48.

Arbesman

Lieberman

, & Berlanstein

D. R.

(2015). Method for the evidence-based reviews on occupational therapy and stroke. American Journal of Occupational Therapy, 69, 6901180020. http://dx.doi.org/10.1054/ajot.2015.013524

Arya

K. N.

Verma

Garg

R. K.

Sharma

V. P.

Agarwal

, & Aggarwal

G. G.

(2012). Meaningful task-specific training (MTST) for stroke rehabilitation: A randomized controlled trial. Topics in Stroke Rehabilitation, 19, 193–211. http://dx.doi.org/10.1310/tsr1903-193

Au-Yeung

S. S.

Hui-Chan

C. W.

, & Tang

J. C.

(2009). Short-form tai chi improves standing balance of people with chronic stroke. Neurorehabilitation and Neural Repair, 23, 515–522. http://dx.doi.org/10.1177/1545968308326425

Azab

Al-Jarrah

Nazzal

Maayah

Sammour

M. A.

, & Jamous

(2009). Effectiveness of constraint-induced movement therapy (CIMT) as home-based therapy on Barthel Index in patients with chronic stroke. Topics in Stroke Rehabilitation, 16, 207–211. http://dx.doi.org/10.1310/tsr1603-207

Barclay-Goddard

R. E.

Stevenson

T. J.

Poluha

, & Thalman

(2011). Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database of Systematic Reviews, 2011, CD005950. http://dx.doi.org/10.1002/14651858.CD005950.pub4.

10.

Barzel

Liepert

Haevernick

Eisele

Ketels

Rijntjes

, & van den Bussche

(2009). Comparison of two types of constraint-induced movement therapy in chronic stroke patients: A pilot study. Restorative Neurology and Neuroscience, 27, 673–680.

11.

Bonaiuti

Rebasti

, & Sioli

(2007). The constraint induced movement therapy: A systematic review of randomised controlled trials on the adult stroke patients. Europa Medicophysica, 43, 139–146.

12.

Bovend’Eerdt

T. J.

Dawes

Sackley

Izadi

, & Wade

D. T.

(2010). An integrated motor imagery program to improve functional task performance in neurorehabilitation: A single-blind randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 91, 939–946. http://dx.doi.org/10.1016/j.apmr.2010.03.008

13.

Braun

S. M.

Beurskens

A. J.

Kleynen

Oudelaar

Schols

J. M.

, & Wade

D. T.

(2012). A multicenter randomized controlled trial to compare subacute “treatment as usual” with and without mental practice among persons with stroke in Dutch nursing homes. Journal of the American Medical Directors Association, 13, 85.e1–85.e7. http://dx.doi.org/10.1016/j.jamda.2010.07.009

14.

Brazzelli

Saunders

D. H.

Greig

C. A.

, & Mead

G. E.

(2011). Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews, 2011, CD003316. http://dx.doi.org/10.1002/14651858.CD003316.pub4.

15.

Brogårdh

, & Lexell

(2010). A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke. Archives of Physical Medicine and Rehabilitation, 91, 460–464. http://dx.doi.org/10.1016/j.apmr.2009.11.009

16.

Brogårdh

, & Sjölund

B. H.

(2006). Constraint-induced movement therapy in patients with stroke: A pilot study on effects of small group training and of extended mitt use. Clinical Rehabilitation, 20, 218–227. http://dx.doi.org/10.1191/0269215506cr937oa

17.

Buschfort

Brocke

Hess

Werner

Waldner

, & Hesse

(2010). Arm studio to intensify the upper limb rehabilitation after stroke: Concept, acceptance, utilization and preliminary clinical results. Journal of Rehabilitation Medicine, 42, 310–314. http://dx.doi.org/10.2340/16501977-0517

18.

Byl

N. N.

Pitsch

E. A.

, & Abrams

G. M.

(2008). Functional outcomes can vary by dose: Learning-based sensorimotor training for patients stable poststroke. Neurorehabilitation and Neural Repair, 22, 494–504. http://dx.doi.org/10.1177/1545968308317431

19.

Chan

D. Y.

Chan

C. C.

, & Au

D. K.

(2006). Motor relearning programme for stroke patients: A randomized controlled trial. Clinical Rehabilitation, 20, 191–120. http://dx.doi.org/10.1191/0269215506cr930oa

20.

Cirstea

M. C.

, & Levin

M. F.

(2007). Improvement of arm movement patterns and endpoint control depends on type of feedback during practice in stroke survivors. Neurorehabilitation and Neural Repair, 21, 398–411. http://dx.doi.org/10.1177/1545968306298414

21.

Cirstea

C. M.

Ptito

, & Levin

M. F.

(2006). Feedback and cognition in arm motor skill reacquisition after stroke. Stroke, 37, 1237–1242. http://dx.doi.org/10.1161/01.STR.0000217417.89347.63

22.

Corbetta

Sirtori

Moja

, & Gatti

(2010). Constraint-induced movement therapy in stroke patients: Systematic review and meta-analysis. European Journal of Physical and Rehabilitation Medicine, 46, 537–544.

23.

da Silva Cameirão

Bermúdez I Badia

Duarte

, & Verschure

P. F. M. J.

(2011). Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: A randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system. Restorative Neurology and Neuroscience, 29, 287–298. http://dx.doi.org/10.3233/RNN-2011-0599.

24.

Duncan

P. W.

Zorowitz

Bates

Choi

J. Y.

Glasberg

J. J.

Graham

G. D.

… Reker

(2005). Management of adult stroke rehabilitation care: A clinical practice guideline. Stroke, 36, e100–e143. http://dx.doi.org/10.1161/01.STR.0000180861.54180.FF

25.

English

, & Hillier

(2011). Circuit class therapy for improving mobility after stroke: A systematic review. Journal of Rehabilitation Medicine, 43, 565–571. http://dx.doi.org/10.2340/16501977-0824

26.

Ertelt

Small

Solodkin

Dettmers

McNamara

Binkofski

, & Buccino

(2007). Action observation has a positive impact on rehabilitation of motor deficits after stroke. NeuroImage, 36(Suppl. 2), T164–T173. http://dx.doi.org/10.1016/j.neuroimage.2007.03.043

27.

Feys

De Weerdt

Verbeke

Steck

G. C.

Capiau

Kiekens

… Cras

(2004). Early and repetitive stimulation of the arm can substantially improve the long-term outcome after stroke: A 5-year follow-up study of a randomized trial. Stroke, 35, 924–929. http://dx.doi.org/10.1161/01.STR.0000121645.44752.f7

28.

Franceschini

Ceravolo

M. G.

Agosti

Cavallini

Bonassi

Dall’Armi

… Sale

(2012). Clinical relevance of action observation in upper-limb stroke rehabilitation: A possible role in recovery of functional dexterity. A randomized clinical trial. Neurorehabilitation and Neural Repair, 26, 456–462. http://dx.doi.org/10.1177/1545968311427406

29.

French

Leathley

Sutton

McAdam

Thomas

Forster

… Watkins

(2008). A systematic review of repetitive functional task practice with modeling of resource use, costs and effectiveness. Health Technology Assessment, 12(30), iii, ix–x, 1–117.

30.

French

Thomas

Leathley

Sutton

McAdam

Forster

… Watkins

(2010). Does repetitive task training improve functional activity after stroke? A Cochrane systematic review and meta-analysis. Journal of Rehabilitation Medicine, 42, 9–14. http://dx.doi.org/10.2340/16501977-0473

31.

Galvin

Murphy

Cusack

, & Stokes

(2008). The impact of increased duration of exercise therapy on functional recovery following stroke—What is the evidence? Topics in Stroke Rehabilitation, 15, 365–377. http://dx.doi.org/10.1310/tsr1504-365

32.

Gillen

Nilsen

D. M.

Attridge

Banakos

Morgan

Winterbottom

, & York

(2015). Effectiveness of interventions to improve occupational performance of people with cognitive impairments after stroke: An evidence-based review. American Journal of Occupational Therapy, 69, 6901180040. http://dx.doi.org/10.5014/ajot.2015.012138

33.

Hakkennes

, & Keating

J. L.

(2005). Constraint-induced movement therapy following stroke: A systematic review of randomised controlled trials. Australian Journal of Physiotherapy, 51, 221–231. http://dx.doi.org/10.1016/S0004-9514(05)70003-9

34.

Harrington

Taylor

Hollinghurst

Reed

Kay

, & Wood

V. A.

(2010). A community-based exercise and education scheme for stroke survivors: A randomized controlled trial and economic evaluation. Clinical Rehabilitation, 24, 3–15. http://dx.doi.org/10.1177/0269215509347437

35.

Harris

J. E.

, & Eng

J. J.

(2010). Strength training improves upper-limb function in individuals with stroke: A meta-analysis. Stroke, 41, 136–140. http://dx.doi.org/10.1161/STROKEAHA.109.567438

36.

Harris

J. E.

Eng

J. J.

Miller

W. C.

, & Dawson

A. S.

(2009). A self-administered Graded Repetitive Arm Supplementary Program (GRASP) improves arm function during inpatient stroke rehabilitation: A multi-site randomized controlled trial. Stroke, 40, 2123–2128. http://dx.doi.org/10.1161/STROKEAHA.108.544585

37.

Harris

J. E.

Eng

J. J.

Miller

W. C.

, & Dawson

A. S.

(2010). The role of caregiver involvement in upper-limb treatment in individuals with subacute stroke. Physical Therapy, 90(9), 1302–1310. http://dx.doi.org/10.2522/ptj.20090349

38.

Hart

Kanner

Gilboa-Mayo

Haroeh-Peer

Rozenthul-Sorokin

, & Eldar

(2004). Tai chi chuan practice in community-dwelling persons after stroke. International Journal of Rehabilitation Research/Internationale Zeitschrift fur Rehabilitationsforschung/Revue Internationale de Recherches de Readaptation, 27, 303–304. http://dx.doi.org/10.1097/00004356-200412000-00008

39.

Hayner

Gibson

, & Giles

G. M.

(2010). Comparison of constraint-induced movement therapy and bilateral treatment of equal intensity in people with chronic upper-extremity dysfunction after cerebrovascular accident. American Journal of Occupational Therapy, 64, 528–539. http://dx.doi.org/10.5014/ajot.2010.08027

40.

Henderson

Korner-Bitensky

Levin

, & Roth

E. J.

(2007). Virtual reality in stroke rehabilitation: A systematic review of its effectiveness for upper limb motor recovery. Topics in Stroke Rehabilitation, 14, 52–61. http://dx.doi.org/10.1310/tsr1402-52

41.

Holmgren

Gosman-Hedström

Lindström

, & Wester

(2010). What is the benefit of a high-intensive exercise program on health-related quality of life and depression after stroke? A randomized controlled trial. Advances in Physiotherapy, 12, 115–124. http://dx.doi.org/10.3109/14038196.2010.491555

42.

Ietswaart

Johnston

Dijkerman

H. C.

Joice

Scott

C. L.

MacWalter

R. S.

, & Hamilton

S. J.

(2011). Mental practice with motor imagery in stroke recovery: Randomized controlled trial of efficacy. Brain, 134, 1373–1386. http://dx.doi.org/10.1093/brain/awr077

43.

Jackson

P. L.

Lafleur

M. F.

Malouin

Richards

, & Doyon

(2001). Potential role of mental practice using motor imagery in neurologic rehabilitation. Archives of Physical Medicine and Rehabilitation, 82, 1133–1141. http://dx.doi.org/10.1053/apmr.2001.24286

44.

Kawahira

Shimodozono

Etoh

Kamada

Noma

, & Tanaka

(2010). Effects of intensive repetition of a new facilitation technique on motor functional recovery of the hemiplegic upper limb and hand. Brain Injury, 24, 1202–1213. http://dx.doi.org/10.3109/02699052.2010.506855

45.

Kelly-Hayes

Beiser

Kase

C. S.

Scaramucci

D’Agostino

R. B.

, & Wolf

P. A.

(2003). The influence of gender and age on disability following ischemic stroke: The Framingham study. Journal of Stroke and Cerebrovascular Diseases, 12, 119–126. http://dx.doi.org/10.1016/S1052-3057(03)00042-9

46.

Kim

D. G.

Cho

Y. W.

Hong

J. H.

Song

J. C.

Chung

H. A.

Bai

D. S.

… Jang

S. H.

(2008). Effect of constraint-induced movement therapy with modified opposition restriction orthosis in chronic hemiparetic patients with stroke. NeuroRehabilitation, 23, 239–244.

47.

Langhammer

Stanghelle

J. K.

, & Lindmark

(2008). Exercise and health-related quality of life during the first year following acute stroke: A randomized controlled trial. Brain Injury, 22, 135–145. http://dx.doi.org/10.1080/02699050801895423

48.

Langhammer

Stanghelle

J. K.

, & Lindmark

(2009). An evaluation of two different exercise regimes during the first year following stroke: A randomised controlled trial. Physiotherapy Theory and Practice, 25, 55–68. http://dx.doi.org/10.1080/09593980802686938

49.

Laver

K. E.

George

Thomas

Deutsch

J. E.

, & Crotty

(2011). Virtual reality for stroke rehabilitation. Cochrane Database of Systematic Reviews, 2011, CD008349 http://dx.doi.org/10.1002/14651858.CD008349.pub2.

50.

Lee

M. M.

Cho

H. Y.

, & Song

C. H.

(2012). The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients. American Journal of Physical Medicine and Rehabilitation, 91, 689–696, quiz 697–700. http://dx.doi.org/10.1097/PHM.0b013e31824fa86d

51.

Lin

K. C.

Chung

H. Y.

C. Y.

Liu

H. L.

Hsieh

Y. W.

Chen

I. H.

… Wai

Y. Y.

(2010). Constraint-induced therapy versus control intervention in patients with stroke: A functional magnetic resonance imaging study. American Journal of Physical Medicine and Rehabilitation, 89, 177–185. http://dx.doi.org/10.1097/PHM.0b013e3181cf1c78

52.

Liu

K. P.

Chan

C. C.

Lee

T. M.

, & Hui-Chan

C. W.

(2004). Mental imagery for promoting relearning for people after stroke: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 85, 1403–1408. http://dx.doi.org/10.1016/j.apmr.2003.12.035

53.

Liu

K. P. Y.

Chan

C. C. H.

Wong

R. S. M.

Kwan

I. W. L.

Yau

C. S. F.

L. S. W.

, & Lee

T. M. C.

(2009). A randomized controlled trial of mental imagery augment generalization of learning in acute poststroke patients. Stroke, 40, 2222–2225. http://dx.doi.org/10.1161/STROKEAHA.108.540997

54.

McClellan

, & Ada

(2004). A six-week, resource-efficient mobility program after discharge from rehabilitation improves standing in people affected by stroke: Placebo-controlled, randomised trial. Australian Journal of Physiotherapy, 50, 163–167. http://dx.doi.org/10.1016/S0004-9514(14)60154-9

55.

Mead

G. E.

Greig

C. A.

Cunningham

Lewis

S. J.

Dinan

Saunders

D. H.

… Young

(2007). Stroke: A randomized trial of exercise or relaxation. Journal of the American Geriatrics Society, 55, 892–899. http://dx.doi.org/10.1111/j.1532-5415.2007.01185.x

56.

Michaelsen

S. M.

Dannenbaum

, & Levin

M. F.

(2006). Task-specific training with trunk restraint on arm recovery in stroke: Randomized control trial. Stroke, 37, 186–192. http://dx.doi.org/10.1161/01.STR.0000196940.20446.c9

57.

Mouawad

M. R.

Doust

C. G.

Max

M. D.

, & McNulty

P. A.

(2011). Wii-based movement therapy to promote improved upper extremity function post-stroke: A pilot study. Journal of Rehabilitation Medicine, 43, 527–533. http://dx.doi.org/10.2340/16501977-0816

58.

Nakayama

Jørgensen

H. S.

Raaschou

H. O.

, & Olsen

T. S.

(1994). Recovery of upper extremity function in stroke patients: The Copenhagen Stroke Study. Archives of Physical Medicine and Rehabilitation, 75, 394–398. http://dx.doi.org/10.1016/0003-9993(94)90161-9

59.

National Board for Certification in Occupational Therapy. (2012). Practice analysis of the occupational therapist registered. Gaithersburg, MD: Author.

60.

Nilsen

D. M.

Gillen

DiRusso

, & Gordon

A. M.

(2012). Effect of imagery perspective on occupational performance after stroke: A randomized controlled trial. American Journal of Occupational Therapy, 66, 320–329. http://dx.doi.org/10.5014/ajot.2012.003475

61.

Nilsen

D. M.

Gillen

Geller

Hreha

Osei

, & Saleem

(2014). What is the evidence for the effectiveness of interventions to improve occupational performance for those with motor deficits after stroke? [Critically Appraised Topic]. Bethesda, MD: American Occupational Therapy Association, Evidence-Based Practice Project. Retrieved from http://www.aota.org/-/media/Corporate/Files/Secure/Practice/CCL/Stroke/Stroke-CAT-3-Motor.ashx

62.

Nilsen

D. M.

Gillen

, & Gordon

A. M.

(2010). Use of mental practice to improve upper-limb recovery after stroke: A systematic review. American Journal of Occupational Therapy, 64, 695–708. http://dx.doi.org/10.5014/ajot.2010.09034

63.

Olney

S. J.

Nymark

Brouwer

Culham

Day

Heard

… Parvataneni

(2006). A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. Stroke, 37, 476–481. http://dx.doi.org/10.1161/01.STR.0000199061.85897.b7

64.

Page

S. J.

Dunning

Hermann

Leonard

, & Levine

(2011). Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: A randomized controlled trial. Clinical Rehabilitation, 25, 627–637. http://dx.doi.org/10.1177/0269215510395793

65.

Pak

, & Patten

(2008). Strengthening to promote functional recovery poststroke: An evidence-based review. Topics in Stroke Rehabilitation, 15, 177–199. http://dx.doi.org/10.1310/tsr1503-177

66.

Pang

M. Y.

Harris

J. E.

, & Eng

J. J.

(2006). A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 87, 1–9. http://dx.doi.org/10.1016/j.apmr.2005.08.113

67.

Peurala

S. H.

Kantanen

M. P.

Sjögren

Paltamaa

Karhula

, & Heinonen

(2012). Effectiveness of constraint-induced movement therapy on activity and participation after stroke: A systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation, 26, 209–223. http://dx.doi.org/10.1177/0269215511420306

68.

Platz

van Kaick

Mehrholz

Leidner

Eickhof

, & Pohl

(2009). Best conventional therapy versus modular impairment-oriented training for arm paresis after stroke: A single-blind, multicenter randomized controlled trial. Neurorehabilitation and Neural Repair, 23, 706–716. http://dx.doi.org/10.1177/1545968309335974

69.

Ramachandran

V. S.

, & Altschuler

E. L.

(2009). The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain, 132, 1693–1710. http://dx.doi.org/10.1093/brain/awp135

70.

Sabari

(2008). Occupational therapy practice guidelines for adults with stroke. Bethesda, MD: AOTA Press.

71.

Saposnik

, & Levin

; Outcome Research Canada Working Group. (2011). Virtual reality in stroke rehabilitation: A meta-analysis and implications for clinicians. Stroke, 42, 1380–1386. http://dx.doi.org/10.1161/STROKEAHA.110.605451

72.

Schmid

A. A.

Van Puymbroeck

Altenburger

P. A.

Schalk

N. L.

Dierks

T. A.

Miller

K. K.

… Williams

L. S.

(2012). Poststroke balance improves with yoga: A pilot study. Stroke, 43, 2402–2407. http://dx.doi.org/10.1161/STROKEAHA.112.658211

73.

Schneider

Münte

Rodriguez-Fornells

Sailer

, & Altenmüller

(2010). Music-supported training is more efficient than functional motor training for recovery of fine motor skills in stroke patients. Music Perception: An Interdisciplinary Journal, 27, 271–280. http://dx.doi.org/10.1525/mp.2010.27.4.271

74.

Schneider

Schönle

P. W.

Altenmüller

, & Münte

T. F.

(2007). Using musical instruments to improve motor skill recovery following a stroke. Journal of Neurology, 254, 1339–1346. http://dx.doi.org/10.1007/s00415-006-0523-2

75.

Shi

Y. X.

Tian

J. H.

Yang

K. H.

, & Zhao

(2011). Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper-extremity dysfunction after stroke: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 92, 972–982. http://dx.doi.org/10.1016/j.apmr.2010.12.036

76.

Sirtori

Corbetta

Moja

, & Gatti

(2009). Constraint-induced movement therapy for upper extremities in stroke patients. Cochrane Database of Systematic Reviews, 2009, CD004433. http://dx.doi.org/10.1002/14651858.CD004433.pub2.

77.

Stuart

Benvenuti

Macko

Taviani

Segenni

Mayer

… Weinrich

(2009). Community-based adaptive physical activity program for chronic stroke: Feasibility, safety, and efficacy of the Empoli model. Neurorehabilitation and Neural Repair, 23, 726–734. http://dx.doi.org/10.1177/1545968309332734

78.

Taub

Uswatte

King

D. K.

Morris

Crago

J. E.

, & Chatterjee

(2006). A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke, 37, 1045–1049. http://dx.doi.org/10.1161/01.STR.0000206463.66461.97

79.

Thielman

(2010). Rehabilitation of reaching poststroke: A randomized pilot investigation of tactile versus auditory feedback for trunk control. Journal of Neurologic Physical Therapy, 34, 138–144. http://dx.doi.org/10.1097/NPT.0b013e3181efa1e8

80.

Thielman

G. T.

Dean

C. M.

, & Gentile

A. M.

(2004). Rehabilitation of reaching after stroke: Task-related training versus progressive resistive exercise. Archives of Physical Medicine and Rehabilitation, 85, 1613–1618. http://dx.doi.org/10.1016/j.apmr.2004.01.028

81.

Thielman

Kaminski

, & Gentile

A. M.

(2008). Rehabilitation of reaching after stroke: Comparing 2 training protocols utilizing trunk restraint. Neurorehabilitation and Neural Repair, 22, 697–705. http://dx.doi.org/10.1177/1545968308315998

82.

Thieme

Bayn

Wurg

Zange

Pohl

, & Behrens

(2013). Mirror therapy for patients with severe arm paresis after stroke—A randomized controlled trial. Clinical Rehabilitation, 27, 314–324. http://dx.doi.org/10.1177/0269215512455651

83.

Thieme

Mehrholz

Pohl

Behrens

, & Dohle

(2012). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews, 2012, CD008449. http://dx.doi.org/10.1002/14651858.CD008449.pub2.

84.

Tung

F. L.

Yang

Y. R.

Lee

C. C.

, & Wang

R. Y.

(2010). Balance outcomes after additional sit-to-stand training in subjects with stroke: A randomized controlled trial. Clinical Rehabilitation, 24, 533–542. http://dx.doi.org/10.1177/0269215509360751

85.

Uswatte

Taub

Morris

Barman

, & Crago

(2006). Contribution of the shaping and restraint components of constraint-induced movement therapy to treatment outcome. NeuroRehabilitation, 21, 147–156.

86.

Wang

Zhao

J. L.

Zhu

Q. X.

, & Meng

P. P.

(2011). Comparison of conventional therapy, intensive therapy and modified constraint-induced movement therapy to improve upper extremity function after stroke. Journal of Rehabilitation Medicine, 43, 619–625. http://dx.doi.org/10.2340/16501977-0819

87.

Wolf

S. L.

Thompson

P. A.

Winstein

C. J.

Miller

J. P.

Blanton

S. R.

Nichols-Larsen

D. S.

… Sawaki

(2010). The EXCITE stroke trial: Comparing early and delayed constraint-induced movement therapy. Stroke, 41, 2309–2315. http://dx.doi.org/10.1161/STROKEAHA.110.588723

88.

Wolf

, & Nilsen

D. M.

(2015). Occupational therapy practice guidelines for adults with stroke. Bethesda, MD: AOTA Press.

89.

Woodbury

M. L.

Howland

D. R.

McGuirk

T. E.

Davis

S. B.

Senesac

C. R.

Kautz

, & Richards

L. G.

(2009). Effects of trunk restraint combined with intensive task practice on poststroke upper extremity reach and function: A pilot study. Neurorehabilitation and Neural Repair, 23, 78–91. http://dx.doi.org/10.1177/1545968308318836

90.

C. Y.

Chuang

L. L.

Lin

K. C.

Chen

H. C.

, & Tsay

P. K.

(2011). Randomized trial of distributed constraint-induced therapy versus bilateral arm training for the rehabilitation of upper-limb motor control and function after stroke. Neurorehabilitation and Neural Repair, 25, 130–139. http://dx.doi.org/10.1177/1545968310380686

91.

Yelnik

A. P.

Le Breton

Colle

F. M.

Bonan

I. V.

Hugeron

Egal

… Vicaut

(2008). Rehabilitation of balance after stroke with multisensorial training: A single-blind randomized controlled study. Neurorehabilitation and Neural Repair, 22, 468–476. http://dx.doi.org/10.1177/1545968308315996

92.

Yen

J. G.

Wang

R. Y.

Chen

H. H.

, & Hong

C. T.

(2005). Effectiveness of modified constraint-induced movement therapy on upper limb function in stroke subjects. Acta Neurologica Taiwanica, 14, 16–20.

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