Efficacy of Task-Oriented Interventions in Upper Extremity Rehabilitation Following Stroke: A Systematic Review

Authors

DOI:

https://doi.org/10.14295/bjs.v4i7.746

Keywords:

task-oriented approach, stroke, upper limb rehabilitation, occupational therapy

Abstract

A stroke can cause significant dysfunction of the upper limb, severely affecting performance in everyday occupations. The task-oriented approach is grounded in occupational therapy principles and emphasizes the use of meaningful occupations to promote functional recovery. This review examines the effectiveness of the task-oriented approach during occupational therapy rehabilitation of the upper extremity following stroke. A comprehensive search was conducted on English-language literature published between 2018 and 2023, utilizing the databases Medline, Scopus and Google Scholar, as a supplementary source. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an intensive screening process led to the inclusion of 16 relevant articles in this review. The methodological quality of the studies was assessed using the PEDro Scale. A narrative synthesis was conducted to summarize and interpret the findings of the included studies, which consisted of controlled trials examining the effectiveness of task-oriented interventions delivered alone or in combination with other rehabilitative approaches. The task-oriented approach was studied alongside (a) assistive technology, (b) the Bobath method, (c) mirror therapy, (d) Botulinum Toxin injections, and (e) other therapeutic techniques. Findings indicate that these interventions effectively enhance motor function, self-perceived arm use, and performance in activities of daily living. Integrating task-oriented therapy with the aforementioned therapeutic techniques is effective in managing the hemiplegic upper extremity after stroke. This review supports the implementation of the task-oriented approach in upper limb stroke rehabilitation, either alone or combined with other approaches. Nevertheless, due to the high heterogeneity of the task-oriented interventions studied, further research is required to comprehensively assess their efficacy in upper limb rehabilitation.

References

Afridi, A., Malik, A. N., & Rathore, F. A. (2023). Task Oriented Training for Stroke Rehabilitaton: A Mini Review. The Journal of the Pakistan Medical Associaton, 73(11), 2295–2297. https://doi.org/10.47391/JPMA.23-98

Alsubiheen, A. M., Choi, W., Yu, W., & Lee, H. (2022). The Effect of Task-Oriented Activities Training on Upper-Limb Function, Daily Activities, and Quality of Life in Chronic Stroke Patients: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 19(21). https://doi.org/10.3390/ijerph192114125

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot. 2020.74S2001

Bai, Z., Zhang, J., Zhang, Z., Shu, T., & Niu, W. (2019). Comparison Between Movement-Based and Task-Based Mirror Therapies on Improving Upper Limb Functions in Patients With Stroke: A Pilot Randomized Controlled Trial. Frontiers in Neurology, 10. https://doi.org/10.3389/fneur.2019.00288

Brown, T., Chien, C.-W. (2010). Top-down or Bottom-up Occupational Therapy Assessment: Which Way Do We Go?. British Journal of Occupational Therapy, 73(3). https://doi.org/10.4276/030802210X12682330090334

Cashin, A. G., & McAuley, J. H. (2020). Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. Journal of Physiotherapy, 66(1), 59. https://doi.org/10.10 16/j.jphys.2019.08.005

Chen, Y. W., Chiang, W. C., Chang, C. L., Lo, S. M., & Wu, C. Y. (2022). Comparative effects of EMG-driven robot-assisted therapy versus task-oriented training on motor and daily function in patients with stroke: a randomized cross-over trial. Journal of NeuroEngineering and Rehabilitation, 19(1). https://doi.org/10.1186/s12984-021-00961-w

Choi, W. (2022). The Effect of Task-Oriented Training on Upper-Limb Function, Visual Perception and Activities of Daily Living in Acute Stroke Patients: A Pilot Study. International Journal of Environmental Research and Public Health, 19(6). https://doi.org/10.3390/ijerph19063186

Firoozeh, F., Dehkordi, S. N., Dadgoo, M., Islam, D., & Habibi, S. A. (2019) The effects of task-oriented training combined with Bobath program and task-oriented training alone on upper-limb function in stroke patients. Func Disabil J, 2019. https://doi.org/10.34171/fdj.xx.xx

Franck, J. A., Smeets, R. J. E. M., & Seelen, H. A. M. (2017). Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation. PLoS ONE, 12(6). https://doi.org/10.1371/journal.pone. 0179453

French, B., Thomas, L. H., Coupe, J., McMahon, N. E., Connell, L., Harrison, J., Sutton, C. J., Tishkovskaya, S., & Watkins, C. L. (2016). Repetitive task training for improving functional ability after stroke. The Cochrane database of systematic reviews, 11(11), CD006073. https://doi.org/10.1002/14651858.CD006073.pub3

Fugl-Meyer, A. R., Jääskö, L., Leyman, I., Olsson, S., & Steglind, S. (1975). The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scandinavian journal of rehabilitation medicine, 7(1), 13–31. https://doi.org/10.2340/1650197771331

Geyh, S., Cieza, A., Schouten, J., Dickson, H., Frommelt, P., Omar, Z., Kostanjsek, N., Ring, H., & Stucki, G. (2004). ICF Core Sets for stroke. In Journal of Rehabilitation Medicine, Supplement (Issue 44, pp. 135–141). https://doi.org/10.1080/16501960410016776

Hatem, S. M., Saussez, G., della Faille, M., Prist, V., Zhang, X., Dispa, D., & Bleyenheuft, Y. (2016). Rehabilitation of motor function after stroke: A multiple systematic review focused on techniques to stimulate upper extremity recovery. Frontiers in Human Neuroscience, 10(442). https://doi.org/10.3389/fnhum.2016. 00442

Hildebrand, M. W., Geller, D., & Proffitt, R. (2023). Occupational Therapy Practice Guidelines for Adults with Stroke. American Journal of Occupational Therapy, 77(5). https://doi.org/10.5014/ajot.2023.077501

Hsu, H. Y., Chiu, H. Y., Kuan, T. S., Tsai, C. L., Su, F. C., & Kuo, L. C. (2019). Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial. Australian Occupational Therapy Journal, 66(5), 637–647. https://doi.org/10.1111/1440-1630.12602

Hung, J. W., Yen, C. L., Chang, K. C., Chiang, W. C., Chuang, I. C., Pong, Y. P., Wu, W. C., & Wu, C. Y. (2022). A Pilot Randomized Controlled Trial of Botulinum Toxin Treatment Combined with Robot-Assisted Therapy, Mirror Therapy, or Active Control Treatment in Patients with Spasticity Following Stroke. Toxins, 14(6). https://doi.org/10.3390/toxins14060415

Jeon, B. J., Kim, W. H., & Park, E. Y. (2015). Effect of task-oriented training for people with stroke: a meta-analysis focused on repetitive or circuit training. Topics in stroke rehabilitation, 22(1), 34–43. https://doi.org/10.1179/1074935714Z.0000000035

Katan, M., & Luft, A. (2018). Global Burden of Stroke. Seminars in neurology, 38(2), 208–211. https://doi.org/10.1055/s-0038-1649503

Law, M., Baptiste, S., Mccoll, M., Opzoomer, A., Polatajko, H., & Pollock, N. (1990). The Canadian Occupational Performance Measure: An Outcome Measure for Occupational Therapy. Canadian Journal of Occupational Therapy, 57(2), 82–87. https://doi.org/10.1177/000841749005700207

Lee, C.-Y., & Howe, T.-H. (2024). Effectiveness of Activity-Based Task-Oriented Training on Upper Extremity Recovery for Adults with Stroke: A Systematic Review. American Journal of Occupational Therapy, 78(2). https://doi.org/10.5014/ajot.2024.050391

Lee, H. C., Kuo, F. L., Lin, Y. N., Liou, T. H., Lin, J. C., & Huang, S. W. (2021). Effects of robot-assisted rehabilitation on hand function of people with stroke: A randomized, crossover-controlled, assessor-blinded study. American Journal of Occupational Therapy, 75(1). https://doi.org/10.5014/ajot.2021.038232

Li S. (2017). Spasticity, Motor Recovery, and Neural Plasticity after Stroke. Frontiers in neurology, 8, 120. https://doi.org/10.3389/fneur.2017.00120

Li, Y. C., Wu, C. Y., Hsieh, Y. W., Lin, K. C., Yao, G., Chen, C. L., & Lee, Y. Y. (2019). The Priming Effects of Mirror Visual Feedback on Bilateral Task Practice: A Randomized Controlled Study. Occupational Therapy International, 3180306. https://doi.org/10.1155/2019/3180306

Lin, S. H., & Dionne, T. P. (2018). Interventions to Improve Movement and Functional Outcomes in Adult Stroke Rehabilitation: Review and Evidence Summary. Journal of participatory medicine, 10(1), e3. https://doi.org/10.2196/jopm.8929

Lincoln, N. B., Jackson, J. M., & Adams, S. A. (1998). Reliability and Revision of the Nottingham Sensory Assessment for Stroke Patients. Physiotherapy, 84(8), 358–365. https://doi.org/10.1016/S0031-9406(05)61454-X

Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., & Elkins, M. (2003). Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical therapy, 83(8), 713–721. https://doi.org/10.1093/ptj/83.8.713

Mathiowetz, V. (2020). Task-oriented approach to stroke rehabilitation. In: Gillen, G. & Nilsen, D. M. Stroke rehabilitation a function-based approach. (5th ed., pp. 59-78). Elsevier.

Mathiowetz, V., & Bass-Haugen, J. (1994). Motor behavior research: Implications for therapeutic approaches to central nervous system dysfunction. American Journal of Occupational Therapy, 48(8), 733-745. https://doi.org/10.5014/ ajot.48.8.733

Mathiowetz, V., Volland, G., Kashman, N., & Weber, K. (1985). Adult norms for the Box and Block Test of manual dexterity. American Journal of Occupational Therapy, 39(6), 386–391. https://doi.org/10.5014/ajot.39.6.386

Michimata, A., Kondo, T., Suzukamo, Y., Chiba, M., & Izumi, S. (2008). The manual function test: norms for 20- to 90-year-olds and effects of age, gender, and hand dominance on dexterity. The Tohoku journal of experimental medicine, 214(3), 257–267. https://doi.org/10.1620/tjem.214.257

Moon, J. H., Park, K. Y., Kim, H. J., & Na, C. H. (2018). The effects of task-oriented circuit training using rehabilitation tools on the upper-extremity functions and daily activities of patients with acute stroke: A randomized controlled pilot trial. Osong Public Health and Research Perspectives, 9(5), 225–230. https://doi.org/10.24171/j.phrp.2018.9.5.03

OECD/European Observatory on Health Systems and Policies (2024), Ελλάδα: Προφίλ Υγείας 2023, OECD Publishing, Paris, https://doi.org/10.1787/5753e659-el

Ozen, S., Senlikci, H. B., Guzel, S., & Yemisci, O. U. (2021). Computer Game Assisted Task Specific Exercises in the Treatment of Motor and Cognitive Function and Quality of Life in Stroke: A Randomized Control Study. Journal of Stroke and Cerebrovascular Diseases, 30(9). https://doi.org/10.1016/j.j strokecerebrovasdis.2021.105991

O’Flaherty, D., & Ali, K. (2024). Recommendations for Upper Limb Motor Recovery: An Overview of the UK and European Rehabilitation after Stroke Guidelines (2023). Healthcare, 12(14), 1433. https://doi.org/10.3390/healthcare12141433

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-

Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 2021;372:n71. https://doi.org/10.1136/bmj.n71

Page, S. J., Griffin, C., & White, S. E. (2020). Efficacy of myoelectric bracing in moderately impaired stroke survivors: A randomized, controlled trial. Journal of Rehabilitation Medicine, 52(2). https://doi.org/10.2340/16501977-2644

Peters, H. T., & Page, S. J. (2015). Integrating Mental Practice with Task-specific Training and Behavioral Supports in Poststroke Rehabilitation: Evidence, Components, and Augmentative Opportunities. Physical medicine and rehabilitation clinics of North America, 26(4), 715–727. https://doi.org/10.1016/j.pmr.2015.06.004

Pongtham, P., Chingchit, W., & Dhippayom, J. P. (2022). Improving upper extremity function in chronic stroke using occupational therapy task-oriented approach. Journal of Associated Medical Sciences, 55(1), 52–59. https://doi.org/10.14456/jams.2022.8

Preissner, K. (2010). Use of the occupational therapy task-oriented approach to optimize the motor performance of a client with cognitive limitations. American Journal of Occupational Therapy, 64(5), 727–734. https://doi.org/10.5014/ ajot.2010.08026

Raghavan, P. (2015). Upper Limb Motor Impairment After Stroke. Physical Medicine and Rehabilitation Clinics of North America, 26 (4), 599–610. https://doi.org/10.1016/j.pmr.2015.06.008

Randles, R., & Finnegan, A. (2023). Guidelines for writing a systematic review. Nurse education today, 125, 105803. https://doi.org/10.1016/j.nedt.2023.105803

Rozevink, S. G., Hijmans, J. M., Horstink, K. A., & van der Sluis, C. K. (2021). Effectiveness of task-specific training using assistive devices and task-specific usual care on upper limb performance after stroke: a systematic review and meta-analysis. Disability and Rehabilitation: Assistive Technology 18(7), 1245–1258. https://doi.org/10.1080/17483107.2021.2001061

Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of clinical epidemiology, 42(8), 703–709. https://doi.org/10.1016/0895-4356(89)90065-6

Song, C. S., Lee, O. N., & Woo, H. S. (2019). Cognitive strategy on upper extremity function for stroke: A randomized controlled trials. Restorative Neurology and Neuroscience, 37(1), 61–70. https://doi.org/10.3233/RNN-180853

Umar, M., Masood, T., & Badshah, M. (2018). Effect of botulinum toxin A & task-specific training on upper limb function in post-stroke focal dystonia. The Journal of the Pakistan Medical Association, 68(4), 526–531.

Uswatte, G., Taub, E., Morris, D., Vignolo, M., & McCulloch, K. (2005). Reliability and validity of the upper-extremity motor activity log-14 for measuring real-world arm use. Stroke, 36(11), 2493–2496. https://doi.org/10.1161/01.STR. 0000185928.90848.2e

Wolf, S. L., Lecraw, D. E., Barton, L. A., & Jann, B. B. (1989). Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Experimental neurology, 104(2), 125–132. https://doi.org/10.1016/s0014-4886(89)80005-6

World Health Organizaton (WHO) (2001). International classification of functioning, disability and health: ICF. World Health Organization. https://iris.who.int/handle/10665/42407

Xi, X., Wang, H., Han, L., Ding, M., Li, J., Qiao, C., Zhang, L., Liu, Z., & Qie, S. (2023). Meta-analysis of repetitive transcranial magnetic stimulation combined with task-oriented training on upper limb function in stroke patients with hemiplegia. Medicine, 102(22), e33771. https://doi.org/10.1097/MD.0000000000033771

Yu, C. H., Mathiowetz, V. G., Zieffler, A., & Tomlin, G. S. (2021). Efficacy of a forearm rotation orthosis for people with a hemiparetic arm. American Journal of Occupational Therapy, 75(6). https://doi.org/10.5014/ajot.2021.043455

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Published

2025-06-19

How to Cite

Peraki, R., Tsakni, G., Tsiakiri, A., Katsouri, I.-G., Bablekos, G., & Vlotinou, P. (2025). Efficacy of Task-Oriented Interventions in Upper Extremity Rehabilitation Following Stroke: A Systematic Review. Brazilian Journal of Science, 4(7), 29–45. https://doi.org/10.14295/bjs.v4i7.746