Abstract
Background.
Priming results in a type of implicit memory that prepares the brain
for a more plastic response, thereby changing behavior. New evidence in
neurorehabilitation points to the use of priming interventions to
optimize functional gains of the upper extremity in poststroke
individuals.
Objective.
To determine the effects of priming on
task-oriented training on upper extremity outcomes (body function and
activity) in chronic stroke.
Methods.
The PubMed, CINAHL, Web of
Science, EMBASE, and PEDro databases were searched in October 2019.
Outcome data were pooled into categories of measures considering the
International Classification Functional (ICF) classifications of body
function and activity. Means and standard deviations for each group were
used to determine group effect sizes by calculating mean differences
(MDs) and 95% confidence intervals via a fixed effects model.
Heterogeneity among the included studies for each factor evaluated was
measured using the I2 statistic.
Results.
Thirty-six studies with 814 patients undergoing various types of
task-oriented training were included in the analysis. Of these studies,
17 were associated with stimulation priming, 12 with sensory priming, 4
with movement priming, and 3 with action observation priming.
Stimulation priming showed moderate-quality evidence of body function.
Only the Wolf Motor Function Test (time) in the activity domain showed
low-quality evidence. However, gains in motor function and in use of
extremity members were measured by the Fugl-Meyer Assessment (UE-FMA).
Regarding sensory priming, we found moderate-quality evidence and effect
size for UE-FMA, corresponding to the body function domain (MD 4.77,
95% CI 3.25-6.29, Z = 6.15, P < .0001), and for the Action Research Arm Test, corresponding to the activity domain (MD 7.47, 95% CI 4.52-10.42, Z = 4.96, P < .0001). Despite the low-quality evidence, we found an effect size (MD 8.64, 95% CI 10.85-16.43, Z = 2.17, P = .003) in movement priming. Evidence for action observation priming was inconclusive.
Conclusion.
Combining priming and task-oriented training for the upper extremities
of chronic stroke patients can be a promising intervention strategy.
Studies that identify which priming techniques combined with
task-oriented training for upper extremity function in chronic stroke
yield effective outcomes in each ICF domain are needed and may be
beneficial for the recovery of upper extremities poststroke.
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