Stroke Structured Abstract - S #13
Purpose may enhance stroke clients' upper limb performance
CITATION: Nelson, D. L., Konosky, K., Fleharty, K., Webb, R., Newer, K., Hazboun, V. P., Fontane, C., & Licht, B. C. (1996). The effects of an occupationally embedded exercise on bilateral assisted supination in persons with hemiplegia. American Journal of Occupation Therapy, 50, 639-645.
LEVEL OF EVIDENCE: IC2c
What is the effect of an occupationally embedded exercise on bilateral assisted supination?
Randomized Controlled Trial (RCT)
Subjects were randomly assigned in a stratified balanced way to either the occupationally embedded condition or to the rote condition.
SAMPLING PROCEDURE/INCLUSION CRITERIA
Eight occupational therapists recruited subjects at their places of employment in California, Michigan, and Texas in accordance with a written protocol developed by the first author of this study. Selection criteria were unilateral hemiplegia caused by a first and only cerebral vascular accident (CVA), at least 45 years of age, and time post-onset of between 9 days and 7 months.
Potential subjects were further screened for (a) pronator spasticity, (b) full passive range of motion (PROM) of supination after brief warm-up exercise, (c) no functional supination, (d) ability to grasp a 3cm dowel bilaterally with overlapping fingers, (e) no contraindications to supination exercises, and (f) sufficient visual perception and comprehension to participate in the experimental conditions as evaluated by the ability to match playing cards by number.
N = 30
Male = 14
Female = 12
Mean age = 68.4
LCVA = 11
RCVA = 15
Attrition = 13% (4 subjects)
Four subjects were not reported as either LCVA or RCVA.
Four subjects were not reported as either male or female.
Degrees of handle rotation (interclass correlation = .85)
Experimental Group: Occupationally embedded exercise involving an apparatus that required supination to dump out the dice to score.
Control Group: Rote exercise with no dice game, but using the same apparatus.
WHO DELIVERED INTERVENTION
FREQUENCY & DURATION
The treatment was done only once in two sets of 10 trials.
The occupationally embedded exercise group (Experimental Group) achieved significantly greater handle rotation (requiring greater supination) than the rote exercise Group (Control) (t
= 2.28, p = .016, r = .42).
The mean gain for the Experimental Group was 13.4 degrees more than the Control Group.
Within Groups/Conditions/Times: Not tested
THREATS TO VALIDITY
Experimenter expectancies: All therapists who delivered the treatment and assessed the outcome knew the hypothesis of the study.
This study advances the experimental analysis of therapeutic occupation in the area of occupationally embedded exercise. Clinicians are urged to consider the multidimensional nature of occupationally embedded exercise.
The findings suggest the use of occupationally embedded exercise rather than rote exercise to enhance stroke patients' motor performance.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.