- Title
- Enhancing the efficacy of task-specific training on upper limb motor recovery after stroke
- Creator
- Valkenborghs, Sarah
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Many people after stroke are left with chronic upper limb impairment which affects their ability to perform even basic activities of daily living. Upper limb impairment is a major contributor to poor well-being and quality of life and advancing therapy for upper limb recovery is a research priority. To date, task-specific training has demonstrated the most promise, but effect sizes are usually small. Objective: This thesis includes three distinct but complementary studies aiming to address the overarching research question, “Can the effectiveness of task-specific training be enhanced by combining it with another intervention to further improve upper limb recovery after stroke?”. Methods: Study 1: A systematic review and meta-analysis was conducted to identify what other interventions have been combined with task-specific training to improve upper limb recovery after stroke, and which combinations are more effective than task-specific training alone. Study 2: A phase I case series study was conducted to explore the feasibility of implementing a combined intervention, aerobic exercise and task‐specific training, to improve upper limb motor function in two people: one in the subacute and one in the chronic stage of recovery from stroke. Study 3: A phase II pilot study was conducted to assess the feasibility of conducting a randomised controlled trial to compare the effects of task-specific training preceded by aerobic exercise to task-specific training alone on upper limb motor function after stroke. Results: Study 1: 120 papers were included and 21 categories of intervention that had been combined with task-specific training to improve upper limb motor recovery after stroke were identified. Four intervention categories were able to be included in a meta-analysis. Only peripheral nerve stimulation demonstrated small but significant (p<0.001) additional benefits over those of task-specific training alone for upper limb impairment (Fugl-Meyer scale: MD 2.69, 95% CI 1.12, 4.26). Study 2: The phase I case series study demonstrated that combining aerobic exercise with task-specific training was safe, feasible, acceptable and beneficial to a person in the chronic stage of recovery from stroke, as well as to a person in the subacute stage of recovery from stroke. Study 3: Findings from the phase II pilot study indicate that a future phase III randomised controlled trial is feasible with respect to recruitment, adherence, acceptability, retention and adverse events. Additional concerns were identified that would need to be addressed before proceeding further. Conclusion: To date, adding another intervention to task-specific training confers little or additional benefits. Further research is required as heterogeneity of studies limited ability to conduct meta-analyses, and many questions about the parameters of pairing aerobic exercise with task-specific training (e.g. timing, intensity, etc) remain. The findings from this research thesis have identified research gaps including lack of focused recruitment of people with severe impairment and/or in the chronic stage of recovery, as well as key areas for improving the design and reporting or stroke rehabilitation research trials. Overall, the results from this thesis have implications for stroke rehabilitation practice and research, and key recommendations are provided.
- Subject
- stroke; motor function; aerobic exercise; task-specific training; exercise; motor learning/control; neuroplasticity; rehabilitation; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1402475
- Identifier
- uon:35032
- Rights
- Copyright 2019 Sarah Valkenborghs
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 3 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 221 KB | Adobe Acrobat PDF | View Details Download |