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Purpose: To establish proof-of-concept of a novel rehabilitation self-management program that aims to optimize walking recovery after stroke through engaging patients in independent walking-related practice outside of supervised physiotherapy sessions. Materials and Methods: The Independent Mobility-related Physical ACTivity (IMPACT) Program is a coach-supported intervention that uses self-management strategies to empower patients to engage in additional autonomous walking-related activities after stroke during and after inpatient rehabilitation. The aim of this study was to assess whether implementation of this intervention would be associated with targeted patient behaviors; goal setting, negotiation and completion of a walking-related practice plan outside of formal therapy sessions. Using a pre-intervention/post-intervention design, the Independent Mobility-related Physical Activity program was implemented with a convenience sample of 10 adults (mean age 62.3; SD 11.7 years) within an inpatient stroke rehabilitation unit (mean stroke onset 25.3 [SD 10.5] days). Results: All participants were able to set a personal goal, negotiate an autonomous walking-related activity practice plan, and partially or completely adhere to that plan. Patients completed an average of 36 min/day of practice outside of supervised physiotherapy, practicing on weekdays and weekend days. All patients indicated that the Independent Mobility-related Physical Activity program helped them increase their activity, and indicated they would continue to practice walking-related activities beyond the coaching period.Implications for rehabilitationThe IMPACT program is a feasible self-management strategy to facilitate walking-related practice outside of supervised therapy time during inpatient stroke rehabilitation.Patients were able to engage in goal-setting and practice plan development with support of a therapist-coach.Patients who are able to stand and walk with minimal assist were able to practice walking-related activities outside of formal therapy sessions.Therapists may benefit from specific training and support to adopt self-management strategies into practice.

Unlabelled: : This special interest article provides a historical framework with a contemporary case example that traces the infusion of the science of motor learning into neurorehabilitation practice. The revolution in neuroscience provided the first evidence for learning-dependent neuroplasticity and presaged the role of motor learning as critical for restorative therapies after stroke. The scientific underpinnings of motor learning have continued to evolve from a dominance of cognitive or information processing perspectives to a blend with neural science and contemporary social-cognitive psychological science. Furthermore, advances in the science of behavior change have contributed insights into influences on sustainable and generalizable gains in motor skills and associated behaviors, including physical activity and other recovery-promoting habits. For neurorehabilitation, these insights have tremendous relevance for the therapist-patient interactions and relationships. We describe a principle-based intervention for neurorehabilitation termed the Accelerated Skill Acquisition Program that we developed. This approach emphasizes integration from a broad set of scientific lines of inquiry including the contemporary fields of motor learning, neuroscience, and the psychological science of behavior change. Three overlapping essential elements-skill acquisition, impairment mitigation, and motivational enhancements-are integrated., Video Abstract Available: (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A71) for more insights from the authors.

Background. Stroke commonly affects upper extremity motor abilities, yet there has been very limited success in developing effective rehabilitation interventions to remediate motor impairments, particularly for the upper extremity. Objective. To determine if task-oriented practice administered soon after stroke is more effective than usual care in improving poststroke upper extremity motor recovery and to explore the optimal amount of practice. Methods. A systematic review of the literature was performed from 1950 to November 2012, to identify randomized controlled trials of task-oriented practice compared to usual care, or to different amounts of task-oriented practice to improve motor impairment and activity. Studies were excluded if specific types of interventions were used as comparators or if they were of poor methodological quality. Results. Six studies met the review criteria. Three of the six studies demonstrated a statistically significant effect of task-oriented practice. Study results could not be pooled because of a lack of homogeneity in populations and intervention. Conclusions. The results demonstrate that an increase in the amount of task-oriented practice after stroke may result in less upper extremity impairment; further research on both effect and required dosage is needed as results are inconsistent. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To review the reporting of key design features in studies of stroke rehabilitation therapies. Study Design and Setting: We used purposive sampling to examine English-language, human-subject, comparative studies focusing on stroke rehabilitation therapy provided the effect of therapy was evaluated in at least one of the following six outcome domains: ambulation, cognition, quality of life, daily activities, dysphagia, or communication. We searched MEDLINE®, CINAHL®, PsycINFO®, and the Cochrane Database of Systematic Reviews (date range: January 2000 through late-January 2008) and extracted data from included studies using standardized forms. We depicted the extracted data in tables and summarized the findings qualitatively in the text. Results: We retrieved 1,674 citations in the literature search and extracted data from 99 studies. Authors’ reporting of key design features in stroke rehabilitation studies was lacking in four areas, that is, the background of persons delivering therapy, timing of therapy, subjects’ receipt of prior or concomitant treatment, and psychometric properties of outcome measurement instruments. Conclusions: Except for four areas, reporting of key design features in studies of stroke rehabilitation therapies was quite comprehensive. Researchers should pay particular attention to reporting blinding, and they should rationalize the number of outcome measurement instruments used in their studies. [Copyright &y& Elsevier]

Abstract: Objective: A “review of reviews” was undertaken to assess methodological issues in studies evaluating nondrug rehabilitation interventions in stroke patients. Study Design and Setting: MEDLINE, CINAHL, PsycINFO, and the Cochrane Database of Systematic Reviews were searched from January 2000 to January 2008 within the stroke rehabilitation setting. Electronic searches were supplemented by reviews of reference lists and citations identified by experts. Eligible studies were systematic reviews; excluded citations were narrative reviews or reviews of reviews. Review characteristics and criteria for assessing methodological quality of primary studies within them were extracted. Results: The search yielded 949 English-language citations. We included a final set of 38 systematic reviews. Cochrane reviews, which have a standardized methodology, were generally of higher methodological quality than non-Cochrane reviews. Most systematic reviews used standardized quality assessment criteria for primary studies, but not all were comprehensive. Reviews showed that primary studies had problems with randomization, allocation concealment, and blinding. Baseline comparability, adverse events, and cointervention or contamination were not consistently assessed. Blinding of patients and providers was often not feasible and was not evaluated as a source of bias. Conclusions: The eligible systematic reviews identified important methodological flaws in the evaluated primary studies, suggesting the need for improvement of research methods and reporting. [Copyright &y& Elsevier]