Stroke Structured Abstract - S #7
Use of materials or imagery, instead of rote exercise, may improve stroke clients endurance
CITATION: Hsieh, C-L., Nelson, D. L., Smith, D. A., & Peterson, C. Q. (1996). A comparison of performance in added-purpose occupations and rote exercise for dynamic standing balance in persons with hemiplegia. American Journal of Occupation Therapy, 50, 10-16.
LEVEL OF EVIDENCE: IC1c
What is the effect of added-purpose occupations, compared with rote exercise, on exercise repetitions in stroke patients?
Counterbalanced repeated-measures design (an RCT)
SAMPLING PROCEDURE/INCLUSION CRITERIA
Subjects who met the inclusion criteria were selected from the Veterans General Hospital in Taipei, Taiwan. Inclusion criteria were: (a) diagnosed with unilateral cerebral vascular accident (CVA) resulting in hemiparesis or hemiplegia, (b) experienced first or second onset of CVA within 6 months before this study, (c) were at least 50 years old, and (d) could follow and interpret verbal instructions, including responding to an imagery-eliciting cue.
N = 21
Male = 12
Female = 9
Mean age = 64.5
LCVA = 14
RCVA = 7
Attrition = 0
Number of repetitions (interobserver reliabilty 98.62%)
Duration (interobserver reliabilty 97.21%)
Frequency of discontinuities (interobserver reliabilty 100%)
Condition 1: Added-materials condition - Bend down, get ball off floor, stand up, throw ball to target.
Condition 2: Imagery-based condition - Imagine picking up the ball and throwing to target.
Condition 3: Rote exercise condition - Bend down to touch the ground, stand up, do throw movement without balls.
WHO DELIVERED INTERVENTION
FREQUENCY & DURATION
Repetition of each condition to fatigue on separate days.
Each subject completed all three conditions within 1 week.
Compared with the Rote Condition, the subjects did significantly more exercise repetitions (endurance) in the Added-Materials Condition (t = 1.53, p < .05, r = .40).
Compared with the Rote Condition, the subjects did significantly more exercise repetitions (endurance) in the Imagery-Based Condition (t = 1.46, p < .05, r = .39). There was no significant difference in number of repetitions between The Added-Materials and Imagery-Based Conditions (t = 0.067, p > .05, r = .02).
The duration data were not analyzed statistically because of their interrelatedness with the frequency data.
Most of the subjects had no discontinuities. The range of distribution of this variable was small (0-2) and not analyzed.
Within Groups/Conditions/Times: Not tested
THREATS TO VALIDITY
This study demonstrates how added purpose can enhance motor performance in persons with hemiplegia. Purpose may be effectively added to an exercise through the use of materials or imagery.
The findings suggest the use of materials or imagery to enhance stroke patients' performance. However, the dependent variables measured in this study were not related to dynamic standing balance, as stated in the title.
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.