The efficacy of a task model approach to ADL rehabilitation in stroke apraxia and action disorganisation syndrome: A randomised controlled trial.
The efficacy of a task model approach to ADL rehabilitation in stroke apraxia and action disorganisation syndrome: A randomised controlled trial.
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DOI：
10.1371/journal.pone.0264678
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Wing AM
中科院分区：
文献类型：
--
作者：
Howe J;Chua W;Sumner E;Drozdowska B;Laverick R;Bevins RL;Jean-Baptiste E;Russell M;Rotshtein P;Wing AM
脑卒中后失用症和行动紊乱综合征（AADS）可扰乱日常生活活动（ADL）。职业治疗在改善ADL表现方面是有效的，然而，包括多个任务意味着不清楚哪些治疗元素有助于改善。我们评估了ADL康复的任务模型方法的有效性，比较了泡茶训练和步进训练控制条件。在参加这项交叉随机对照可行性试验的29例AADS卒中幸存者中，25例纳入分析[44%为女性;平均（SD）年龄= 71.1（7.8）岁;卒中后年= 4.6（3.3）]。参与者每周参加五次1小时的泡茶培训课程，其中使用基于计算机的系统监控进度并提供反馈，该系统实施了马尔可夫决策过程（MDP）任务模型。在控制条件下，参与者每周接受5次1小时的踏步训练。与步进训练相比，泡茶训练减少了4种不同茶类的错误。制作一杯茶所需的时间减少了，因此准确性的提高不是由于速度-准确性的权衡。在复杂的茶制备任务（同时制作两杯不同的茶）中，与泡茶培训相关的改善并不明显，这表明培训缺乏概括性。明确规定的，但灵活的训练协议，连同错误的分布信息，提供了指针，进一步完善的任务模型的方法，ADL康复。建议在未来的研究中，在更多受损患者的无错误学习条件下测试该方法。Retroplasty于2019年8月5日在ClinicalTrials.gov上注册[NCT 04044911] https://clinicaltrials.gov/ct2/show/NCT04044911? term=Cogwatch&rank=1
Apraxia and action disorganization syndrome (AADS) after stroke can disrupt activities of daily living (ADL). Occupational therapy has been effective in improving ADL performance, however, inclusion of multiple tasks means it is unclear which therapy elements contribute to improvement. We evaluated the efficacy of a task model approach to ADL rehabilitation, comparing training in making a cup of tea with a stepping training control condition. Of the 29 stroke survivors with AADS who participated in this cross-over randomized controlled feasibility trial, 25 were included in analysis [44% females; mean(SD) age = 71.1(7.8) years; years post-stroke = 4.6(3.3)]. Participants attended five 1-hour weekly tea making training sessions in which progress was monitored and feedback given using a computer-based system which implemented a Markov Decision Process (MDP) task model. In a control condition, participants received five 1-hour weekly stepping sessions. Compared to stepping training, tea making training reduced errors across 4 different tea types. The time taken to make a cup of tea was reduced so the improvement in accuracy was not due to a speed-accuracy trade-off. No improvement linked to tea making training was evident in a complex tea preparation task (making two different cups of tea simultaneously), indicating a lack of generalisation in the training. The clearly specified but flexible training protocol, together with information on the distribution of errors, provide pointers for further refinement of task model approaches to ADL rehabilitation. It is recommended that the approach be tested under errorless learning conditions with more impaired patients in future research. Retrospectively registered at ClinicalTrials.gov on 5th August 2019 [NCT04044911] https://clinicaltrials.gov/ct2/show/NCT04044911?term=Cogwatch&rank=1
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