Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke?

So your insurance company could take the conclusions from this and state that there is no point to therapy since it doesn't translate to actual use. Leaving you on your own once again.
http://journals.sagepub.com/doi/abs/10.1177/1545968316680493

Show all authors

Kimberly J. Waddell, MS, Michael J Strube, PhD, Ryan R. Bailey, PhD, Joseph W. Klaesner, PhD, Rebecca L. Birkenmeier, OTD, Alexander W. Dromerick, MD, Catherine E. Lang, PhD

First Published March 1, 2017 research-article

Abstract

Background. A common assumption is that changes in upper limb (UL) capacity, or what an individual is capable of doing, translates to improved UL performance in daily life, or what an individual actually does. This assumption should be explicitly tested for individuals with UL paresis poststroke.  
Objective. To examine changes in UL performance after an intensive, individualized, progressive, task-specific UL intervention for individuals at least 6 months poststroke.  
Methods. Secondary analysis on 78 individuals with UL paresis who participated in a phase II, single-blind, randomized parallel dose-response trial. Participants were enrolled in a task-specific intervention for 8 weeks. Participants were randomized into 1 of 4 treatment groups with each group completing different amounts of UL movement practice. UL performance was assessed with bilateral, wrist-worn accelerometers once a week for 24 hours throughout the duration of the study. The 6 accelerometer variables were tested for change and the influence of potential modifiers using hierarchical linear modeling.  
Results. No changes in UL performance were found on any of the 6 accelerometer variables used to quantify UL performance. Neither changes in UL capacity nor the overall amount of movement practice influenced changes in UL performance. Stroke chronicity, baseline UL capacity, concordance, and ADL status significantly increased the baseline starting points but did not influence the rate of change (slopes) for participants.  
Conclusions. Improved motor capacity resulting from an intensive outpatient UL intervention does not appear to translate to increased UL performance outside the clinic.