New directions in occupational therapy: implementation of the task-oriented approach in conjunction with cortical stimulation after stroke.

Chronic upper extremity hemiparesis following stroke is a significant impairment that can limit a person's independence in all aspects of ADL, IADL, and functional mobility. Although recovery of functional independence may be more efficient using traditional compensatory techniques, these therapeutic methods often do not encourage integration of the hemiparetic arm and hand. In contrast, the task-oriented approach to motor recovery of poststroke hemiparesis emphasizes integration of the impaired limb into all functional tasks via skill-based training. Cortical changes have been documented following skill-based training of the upper limb in the healthy animal model. Additionally, the combination of subthreshold cortical stimulation combined with skill-based forelimb training in the induced-stroke rat model has demonstrated better outcomes than training alone. Preliminary research with human stroke survivors using task-oriented training and subthreshold cortical stimulation has shown promising results. The purpose of this article is to introduce an upper limb training protocol that was used in a national multisite trial that compares cortical stimulation in conjunction with taskoriented training to training alone.