Effects of Bilateral Task-Oriented Training on Arm Function After Stroke

Abstract

Objectives: (1) To determine if the Bilateral Task-Oriented Training (BTOT) protocol results in improved motor performance in unilateral and bilateral upper limb activities following stroke. (2) To understand the participant's experience with the BTOT protocol and to identify barriers and facilitators that influence willingness to participate in this intervention approach. Methods: This study used a mixed methods approach including a quantitative randomized blocked repeated measures design and qualitative description. For the quantitative study, 11 participants were recruited and randomized to a treatment (N = 6) or usual care group (N= 5). Both groups were tested before and after treatment using three instruments: (a) the Wolf Motor Function Test (WMFT) to assess performance time and functional ability in performing activities requiring single-limb function, (b) the Chedoke Arm and Hand Activity Inventory (CAHAI) to measure functional ability in performing activities requiring bilateral arm function, and (c) the Stroke Impact Scale to measure perceived level of difficulty in four domains (strength, activities of daily living, hand function, and social participation). For the qualitative study, two sets of interview questions were used before and after intervention. Coding and thematic analysis were carried out by the research team. Results: In the quantitative study, the BTOT group showed improvements for the affected and less affected limb immediately after intervention on all measures including the WMFT performance time, functional ability in single limb, and grip and arm strength, and on the CAHAI functional ability of the affected limb in tasks requiring bimanual coordination. One month after intervention, gains were either continued or maintained in all measures except for functional ability in bilateral activities. In the qualitative study, an overarching theme of `return to normal' emerged. Pre-intervention and post-intervention themes were also identified. Conclusion: The BTOT program showed positive treatment effects in this preliminary study with potential to improve motor function in individuals with chronic stroke and mild to moderate upper limb impairment. Participants endorsed the program for increasing awareness of affected arm use and increasing use of affected arm in daily living activities. Further research is warranted.