30 Chapter 2 rehabilitation process, which helps prepare them for when the spouse/relative returns home.46 Additional practice with caregivers led to an increased amount of time spent in exercise which, in turn, led to an improvement in body function, more activities, and better participation after stroke.47-50 Caregiver support accounted for 5-9% of upper-limb improvement by increasing the amount of time spent in exercise.49 The increased involvement of the caregiver reduced the levels of caregiver burden and facilitated transition to the home setting, with patients becoming more integrated into their community.50 One study compared the effects of voluntary training with family members to voluntary training with a physical therapist. Both groups received standard care and the amount of voluntary training was the same. Although there was no significant difference in functional recovery, the family participation group had a significantly shorter length of stay and higher rates of discharge home.51 Training of caregivers on common stroke-related problems, and training in lifting and handling techniques, led to decreased costs of care in the year after rehabilitation. Furthermore, after this training, the reported caregiver burden was lower. Both patients and caregivers had less anxiety and depression, and better quality of life.52 Task-oriented training Task-oriented training involves the active practice of task-specific motor activities and is a component of current therapy approaches in stroke rehabilitation. A circuit class format is a practical and effective way to provide supervised task-oriented training. Multiple trials and reviews on task-oriented training after stroke showed benefits for functional outcome compared with traditional therapies. These benefits were seen in both upper/lower limb functions and activities (eg, arm/hand function, lower limb function, walking distance, gait speed, and functional ambulation). Task-oriented training led to improvements in functional outcomes and overall health-related quality of life.38,53-56
RkJQdWJsaXNoZXIy MTk4NDMw