Hubbard Isobel J, Parsons Mark W, Neilson Cheryl, Carey Leeanne M
Acute Stroke Unit, John Hunter Hospital, Hunter New England Area Health Service, Newcastle, and the University of Newcastle, Newcastle, Australia.
Occup Ther Int. 2009;16(3-4):175-89. doi: 10.1002/oti.275.
There is mounting evidence of the value of task-specific training as a neuromotor intervention in neurological rehabilitation. The evidence is founded in the psychology of motor skill learning and in the neuroscience of experience-dependent and learning-dependent neural plastic changes in the brain in animals and humans. Further, there is growing empirical evidence for the effectiveness of task-specific training in rehabilitation and for neural plastic changes following task-oriented training. In this paper, we position the evidence for task-specific training in the context of rehabilitation; review its relevance for occupation-based neurological rehabilitation, particularly in relation to upper limb function and everyday activities; and recommend evidence-driven strategies for its application. We recommend that task-specific training be routinely applied by occupational therapists as a component of their neuromotor interventions, particularly in management related to post-stroke upper limb recovery. Specifically, we propose five implementation strategies based on review of the evidence. These are: task-specific training should be relevant to the patient/client and to the context; be randomly assigned; be repetitive and involve massed practice; aim towards reconstruction of the whole task; and be reinforced with positive and timely feedback.
越来越多的证据表明，特定任务训练作为一种神经运动干预手段在神经康复中具有重要价值。这一证据基于运动技能学习心理学以及动物和人类大脑中依赖经验和学习的神经可塑性变化的神经科学。此外，越来越多的实证证据表明特定任务训练在康复中的有效性以及面向任务训练后的神经可塑性变化。在本文中，我们将特定任务训练的证据置于康复背景下进行考量；审视其与基于职业的神经康复的相关性，尤其是与上肢功能和日常活动相关的方面；并推荐基于证据的应用策略。我们建议职业治疗师将特定任务训练作为其神经运动干预的一个组成部分常规应用，特别是在与中风后上肢恢复相关的管理中。具体而言，我们基于证据审查提出了五项实施策略。这些策略是：特定任务训练应与患者/客户及情境相关；应随机分配；应重复且包含集中练习；旨在重建整个任务；并通过积极及时的反馈予以强化。
