Duazary / Vol. 20, No.

1 - 2023 / 56-70
Doi: https://doi.org/10.21676/2389783X.5104

Review article

Motor relearning program in patients with stroke sequels: a

systematic review
Programa de reaprendizaje motor en pacientes con secuelas de ACV:
una revisión sistemática

Oscar Eduardo Mateus-Arias1 , Angela Camperos-Toro2 , Ashley Rangel-Silva3 , Sonia Mantilla-

Toloza4 , Javier Martínez-Torres5

1 Universidad de Pamplona. Pamplona, Colombia. Correo: [email protected] - https://orcid.org/0000-0001-9373-2443

2 Universidad de Pamplona. Pamplona, Colombia. Correo: [email protected] - https://orcid.org/0000-0002-2864-1868
3 Universidad de Pamplona. Pamplona, Colombia. Correo: [email protected] - https://orcid.org/0000-0002-4963-3445
4 Universidad de Pamplona. Pamplona, Colombia. Correo: [email protected] - https://orcid.org/0000-0001-9397-0599
5 Universidad de los Llanos. Villavicencio, Colombia. Correo: [email protected] - https://orcid.org/0000-0001-8991-5079

How to cite this article: Mateus-Arias OE, Camperos-Toro A, Rangel-Silva A, Mantilla-Toloza S, Martínez-Tor-
res J. Programa de reaprendizaje motor en pacientes con secuelas de ACV: una revisión sistemática. Duazary.
2023; 20(1): 56-70. https://doi.org/10.21676/2389783X.5104

Received on July 25, 2022

Accepted on March 27, 2023
Posted online March 30, 2023

ABSTRACT
Introduction: 90% of the population with stroke suffer sequelae that disable the individual for their independence in the
activities of daily life. Objective: to determine the effects of interventions in adults after stroke of the motor relearning
program vs different physiotherapeutic treatments on functional independence. Methods: a systematic review of the
literature was carried out. in PubMed, PEDro, LILACS, Cochrane, Scopus and ScienceDirect databases, and a manual
search, taking into account clinical trials, Spanish, English or Portuguese. The methodological quality was carried out
using the PEDro scale and the risk of bias assessment was applied according to the Cochrane Manual. Eight studies
out of a potential 984 were included. Results: a clinically significant improvement was found in the motor relearning
groups and only in one study is this improvement significant compared to another intervention. Conclusion: there are
significant clinical effects in the use of the motor relearning program.
AÑO S

Keywords: Rehabilitation; Exercise Therapy; Stroke; Activities of daily living.

RESUMEN
DUAZARY

Introducción: el 90% de la población con accidente cerebrovascular sufre secuelas que incapacitan al individuo para su
independencia en las actividades de la vida diaria. Objetivo: determinar los efectos de las intervenciones del programa
de reaprendizaje motor en personas adultas después del accidente cerebrovascular vs diferentes tratamientos fisioter-
apéuticos en la independencia funcional. Método: se realizó una revisión sistemática de la literatura. en bases de datos

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 Mateus-Arias, Camperos-Toro, Rangel-Silva, Mantilla-Toloza and Martínez-Torres

PubMed, PEDro, LILACS, Cochrane, Scopus y ScienceDirect, y una búsqueda manual, teniendo en cuenta ensayos
clínicos, idioma español, inglés o portugués. La calidad metodológica se realizó por escala de PEDro y la evaluación
del riesgo de sesgo fue aplicada según el Manual Cochrane. Se incluyeron 8 estudios de 984 potenciales. Resultados:
se encontró una mejora clínicamente significativa en los grupos de reaprendizaje motor y solamente en un estudio esta
mejora es significativa con respecto a otra intervención. Conclusión: existen efectos clínicos significativos en el uso del
programa de reaprendizaje motor.

Palabras clave: rehabilitación; tratamiento por actividad física; accidente cerebrovascular; actividades de la vida diaria.

at the time of stroke discharged from the hospital.

INTRODUCTION The incidence of dependence on activities of daily
living is highest immediately after a stroke and de-
In Western countries, cerebrovascular accident creases significantly afterwards8. Wade et al.9 found
(CVA) is the third cause of mortality after cardio- that the incidence of total dependence in ADLs de-
vascular diseases and neoplasias, corresponding to creased from 58% one week after the stroke to 9%
approximately 10% of deaths1. In Colombia, in the six months after the stroke.
year 2016, it was described that transient cerebral
ischemia and cerebral infarction showed the high- Rehabilitation has proven helpful in improving the
est prevalence (29 and 279 per 100,000, respec- patient since it increases autonomy10,11, the frequen-
tively); concerning mortality, it was reported that cy of return to home, and reduces hospitalization12,13.
non-traumatic intracranial hemorrhage presented a Among the strategies developed to counteract the
rate of mortality of 15 per 100,0002. sequelae of this phenomenon are: Rood’s sensorim-
otor approach, Brunnstorm’s movement therapy, the
Due to the advent of new medical treatments, mor- neurodevelopmental approach (Bobath), and the
tality from stroke has decreased notably in recent proprioceptive neuromuscular facilitation (PNF)
years, leaving an increasing number of survivors approach14.
with a greater number of sequelae and a probability
of recurrence3. 90% of the population with stroke Starting in 1980, new ways of approaching re-edu-
suffer alterations that, in 30% of cases, generate cation in stroke patients were proposed, one of the
mobility disabilities that can compromise function- most important being task-oriented motor relearning
al independence for the development of activities or motor relearning program (MRP); Then comes
of daily living, generating a demand for care and treadmill training with full weight support or partial
a need for institutionalization with considerable weight suspension, movement therapy induced by
health and social spending1. Approximately 85% restriction of the healthy side, muscle strengthening,
of the stroke population presents with initial pare- and physical reconditioning programs, robot-assist-
sis in the arm, which is the most disabling conse- ed sensory-motor stimulation15,16, mental imagery,
quence; this alteration persists in 55% to 75% of and virtual reality17-20.
patients even after three to six months of the epi-
sode4,5; only 5% to 20% of patients show complete The MRP aims to train or retrain the stroke patient
recovery of the hemiparetic arm6. to improve motor control when performing essential
tasks or actions. In this way, relearning is promoted
Preston et al.7 reported that for initially non-ambu- through the teaching of movement21, emphasizing
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latory stroke patients managed in a rehabilitation the transfer of skills between corrective and func-
unit, the probability of independent walking was tional tasks; in other words, the transfer of exercise
60% at three months, 65% at six months, and 91% skills learned in the training of the daily life of the
DUAZARY

at 12 months. patient improves the functional independence of

these and can lead to a better physical capacity22
A retrospective analysis of data from 292 people af- compared with other interventions, concluding that
ter their first stroke indicated that 75% were depen- this model is more effective than others in the treat-
dent on activities of daily living (ADLs) at stroke on- ment of stroke sequelae and. Therefore, it is recom-
set, and only 57% of survivors remained dependent mended as a treatment for managing upper extremi-

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 Motor relearning program in patients with stroke sequels

ty deficiencies. However, some research also points reviewers (AC and AR) examined the titles and
to significant limitations that indicate that there is abstracts of potentially relevant articles; each one
still not enough good-quality evidence to make de- evaluated the articles’ relevance in case of dis-
finitive and conclusive recommendations on its im- agreement it was resolved through a third evalua-
plementation and that, although previous reviews, tor (OM). Full-text copies of the articles were then
when addressing the upper extremity, describe re- obtained for those that met the initial assessment
sults on the hand, they do not There are studies that and were reviewed in full text by two independent
have studied the application of the MRP in function- reviewers according to meeting the inclusion crite-
al independence23. Therefore, a systematic review ria as primary studies with randomized clinical tri-
of this topic is justified, considering that it allows al designs, reported in English, Spanish, or Portu-
the synthesis of the available evidence and its use in guese; whose participants were adults with stroke
clinical decision-making in rehabilitating this type sequelae to whom the MRP was applied and whose
of patient. evaluation measures were Functional Indepen-
dence Measure (FIM), Functional Gait Classifica-
The present systematic review aimed to determine tion (FAC). in English Functional ambulation Cat-
the effects of motor relearning program interven- egories), Motor Assessment Scale (MAS), Barthel
tions in adults after stroke vs. different physiothera- Index (BI, The Barthel Index), Chedoke Inventory
peutic treatments on functional independence. for arm and hand activity (CAHAI, for its acronym
in English Chedoke Arm and Hand Activity Inven-
tory) and Wolf Motor Function Test (WMFT, Wolf
METHOD Motor Function Test) were excluded articles that
were not found in full text.
Design
Data extraction
This report is a systematic review of randomized
clinical trials (RCT). Recommendations described
in the PRISMA 2020 statement for Systematic Re- Each reviewer independently extracted the follow-
views of Interventions version 6.124 were followed. ing information: Reference (author and year of pub-
A meta-analysis was not performed due to the vari- lication), sample information (description of partic-
ability of the interventions. ipants and location), intervention, description of the
exercise (intervention and frequency), and outcomes
of interest.
Search strategy
Methodological quality and risk of bias
It was carried out between June and September
2020, with no time limit on the search. PubMed,
PEDro, LILACS, the Cochrane Central Register of Two raters independently (AC and AR) assessed
Controlled Trials, Scopus, and ScienceDirect, and the methodological quality and mean risk of bias of
hand searching and crawling through bibliographies the PEDro (Physiotherapy Evidence Database)25. A
were used; from the terms: («Motor Relearning third evaluator (OM) resolved it in case of disagree-
Program»), («Stroke»), («Activities of Daily Liv- ment. And the Cochrane Handbook of Systematic
ing») and («Functional Independence »). Boolean Reviews of Interventions version 5.1.024.
connectors were considered to narrow the search for
potentially eligible articles.
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RESULTS
Selection of studies
Resultados de la búsqueda
DUAZARY

Study abstracts were taken from each database and

imported into Rayyan management software. Ini- Nine hundred eighty-four articles were identified in
tially, duplicate studies were eliminated; this pro- databases (PubMed, PEDro, LILACS, the Cochrane
cess was done manually by supporting Rayyan’s Central Register of Controlled Trials, Scopus, and
same function. Subsequently, two independent ScienceDirect). Additionally, a manual search was

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 Mateus-Arias, Camperos-Toro, Rangel-Silva, Mantilla-Toloza and Martínez-Torres

performed. The first filter returned 79 duplicates, excluded; among them: two did not report the func-
leaving 905 articles. Subsequently, 894 records were tional results, one was a follow-up of another article
excluded when reading the title and abstract, leaving and did not present an intervention protocol. Finally,
11 articles for reading the full text; After their analysis eleven articles were chosen to meet all the criteria for
according to the selection criteria, three reports were this systematic review, all in English (Figure 1).

Figure 1. Document search and selection process.

Location of studies and patient characteristics alone26,28-30,32 and protocols where the MRP was ap-
plied combined with usual physiotherapy27,31,33. In-
terventions in the comparator groups included mirror
Physical medicine and rehabilitation institutes in therapy neurorehabilitation treatments, Constraint
civil, rehabilitation, multispecialty, and university Induced Movement Therapy (CIMT), the Bobath
hospitals: four reports were developed in India26-29 concept, training program (body weight supported
and one in Pakistan30, China31, Norway32, and Swe- treadmill training), and conventional physiotherapy.
den33, respectively. The total number of subjects in
these investigations was 379 participants, aged be- Regarding the dosage of the interventions, it was
tween 21 and 95 years; 56.6% were men; 46 losses found that the weekly frequency parameter was dis-
were recorded for medical reasons, death, removals, tributed as follows: four reports performed six ses-
voluntary withdrawal, absence, travel, or refusal to sions per week27-30, in three articles, they reported
AÑO S

carry out the corresponding intervention. The total a frequency of 5 times per week26,32,33, while only
number of people who completed the interventions one reported a frequency of three times per week31.
was 333 (Table 1). The duration of each treatment session ranged be-
DUAZARY

tween 30 and 120 minutes per session; two articles

Description of the intervention reported 120 minutes30,31; four, 60 minutes26-29; one,
40 minutes32; and finally, another with 30 minutes33.
The duration of the intervention protocol varied
The MRP intervention programs found could be di- between 3 and 19 weeks. The interventions were
vided into two types: treatment based on the MRP generally carried out by physiotherapists26-30,32,33;

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 Motor relearning program in patients with stroke sequels

however, occupational therapists31,32 and physicians self-care, and instrumental activities of daily living
participated in the studies32. and community integration, while in the second26
better results were found in functional recovery.
Along the same lines, Langhammer et al.32 report-
Synthesis of the effects of MRP ed that the women treated with the MRP presented
more significant improvements in the execution of
Eight studies were included in the systematic re- ADLs compared to those treated with Bobath; in
view, and significant improvements were reported turn, Bhalerao et al.28,29 indicates that physiothera-
between the baseline and the final evaluation26-33. py treatment using MRP is more effective than the
When comparing the different interventions, it was Bobath approach and shows early improvement in
found that in five, the MRP had greater efficacy ADLs, ambulation and functional independence in
26,28,29,31,32
; in two, no significant differences were stroke rehabilitation measured at every other ini-
found27,33, and only one reported a better result in tial six-week training interval and rehabilitation. In
the comparison treatment30. contrast, Batool et al.30 reported that the CIMT in-
tervention was superior in improving motor func-
In the reports by Chan et al.31 and Kumar Immadi et tion compared to MRP. Finally, mirror therapy27,
al.26, the MRP was shown to be superior compared and weight-bearing treadmill training33 were not
to conventional therapy; in the first31, better results superior to MRP in hand function27 and functional
were reported in balance functions, performance in gait33.

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DUAZARY

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 Mateus-Arias, Camperos-Toro, Rangel-Silva, Mantilla-Toloza and Martínez-Torres

Table 1. Characteristics of the studies.

Population Intervention with motor relearning
Author Comparator Intervention time Results
characteristics program
The CIMT group showed an improvement in
28 men and 14 women Exercises of reaching, signaling, Six sessions per week
motor function and self-care performance of
Batool et al 30
between 35 and 60 years weight-bearing, and different manual tasks ITAC lasting 2 hours each, over
the hemiplegic upper extremity compared to
old. subacute stroke in different positions with both extremities three weeks
the MRP group

Identifying missing performance compo-

nents; recovery exercises; training with
functional task components; transfer of The MRP group presented improved functional
28 men and 24 women,
skills to task performance. Three sessions per week recovery than the conventional therapy group
mean age of 54.1 years, Conventional
Chan et al31 Twenty-four recovery tasks and ten func- lasting 2 hours each, over in balance functions, performance in self-care
with a single vascular therapy
tional tasks to cover deficits in sitting and six weeks and instrumental activities of daily living, and
event
standing balance. integration into the community.
Physiotherapy: exercises to strengthen
the lower limbs and trunk balance

Stimulate muscle activity and train mo-

tor control for reaching and pointing and
31 male participants,
for manipulation of wrist extension; train
Kumar and 29 female partici- Five sessions per week
palmar abduction and thumb rotation (op- Conventional Patients in the MRP performed better on self-
Immadi pants, mean age of 51 lasting 1 hour each, over
position); train opposition of the radial therapy care and ADL tasks
et al26 years, with a single vas- eight weeks
and ulnar sides of the hand; train object
cular event
manipulations; improve the use of hold-
ing objects

36 male participants, Manual with MRP procedures to apply to

Five sessions per week
and 25 female partici- patients during hospitalization. After dis- Patients in the MRP group had a shorter hospi-
Langhammer Bobath lasting 40 minutes each,
pants, mean age of 78 charge, the patients received physiothera- tal stay and improved motor function more than
et al32 Concept throughout the hospital-
years, with a single vas- py with an individual treatment program those treated, according to the Bobath concept.
ization time

AÑO S
cular event and instructions from the physiotherapist.

Walking, standing exercises to allow

weight bearing on the hemiparetic leg,

DUAZARY
and training to maintain proper segmen- Weight-bear-
40 male participants, 33
tal alignment for balance ing treadmill Five sessions per week Both groups improved to an equal extent after
female participants,
Nilsson et Physiotherapy treatment: improving training lasting 30 minutes each, treatment for these variables. However, no dif-
younger than 70 years
al33 motor control and strengthening func- for between 3 and 19 ferences were found in walking ability, balance,
with a single vascular
tionally weak muscles through transfers conventional weeks or sensorimotor performance.
event
and range of motion exercises, as well as therapy
techniques to improve motor function on
the paretic side

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 Motor relearning program in patients with stroke sequels

Características de la Intervención con programa de Tiempo de

Autor Comparador Resultados
población reaprendizaje motor intervención

Wrist extensor training, object holding,

forearm supination, thumb opposition,
hand cupping, and object manipulation Mirror therapy Improvement in hand function in both groups
12 patients
Rehani et training. Six sessions per week separately. It was concluded that there was no
patients with a mean age
al27 Physiotherapy treatment: moist heat, Conventional lasting 1 hour each, over difference between the two therapeutic ap-
of 54.9 years with a sin-
stretching of the wrist flexors with a therapy four weeks proaches regarding hand function.
gle vascular event
30-second hold, and electrical stimulation
of the wrist extensors

Activities of daily living (sitting from su-

22 patients Functional gains in acute rehabilitation using
pine decubitus, sitting, standing, sitting to
patients with a mean age MRP, with improvement in functional mobility
standing, walking, and upper extremity Both groups received
Bhalerao et of 52.9 years with their Bobath and activities of daily living compared to the
function), and followed the steps described physiotherapy for 1 hour
al28 first, middle cerebral Concept Bobath approach. Subjects in the MRP group
by Carr and Sheperd (task analysis, miss- a day, six days a week for
artery cerebrovascular showed early independence and improved
ing components practice, complete task six weeks, for 36 hours.
event. walking.
practice and training transfer)

Evaluation and training in seven different

tasks of daily life: a) Upper limb function.
32 patients MRP showed better improvement than the Bo-
b) Orofacial function. c) Sitting supine. d)
19 male participants, Both groups received bath approach in the Barthel index, the measure
Sitting. e) Standing and sitting. e) Standing.
Bhalerao et and 13 female partici- Bobath physiotherapy for 1 hour of functional independence, and the functional
g) Walking.
al29 pants, mean age of 54 Concept a day, six days a week for ambulation category in the second, fourth, and
Four steps of the MRP were followed: 1)

AÑO S
years with the first cere- six weeks, for 36 hours. sixth weeks, and in the dynamic gait index, it
Task analysis. 2) Practice missing compo-
brovascular event was shown only in the sixth week.
nents. 3) Practice the task. 4) Transfer of
learning.

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MRP: Motor Relearning; CIMT: healthy side restriction therapy; ADL: Activities of Daily Living

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 Mateus-Arias, Camperos-Toro, Rangel-Silva, Mantilla-Toloza and Martínez-Torres

The methodological quality of the articles there was no blinding of the subjects and therapists
who administered the intervention, 37.5% of the
studies had blinded evaluators31-33, 50% maintained
Performed using the PEDro Scale25, it ranged from 3 many participants greater than 85% of the total
to 7 with a mean score of 5. All the articles presented population30,32,33, in none of the studies was an
adequate randomization of the subjects26-33, 37.5% intention-to-treat analysis performed, in 100% of the
reported hidden allocation30,31,33 in the 87.5% of the articles the results of comparisons Between-group
studies, the groups were similar at the beginning statistics were reported and 87.5% of studies provided
about the most critical prognostic indicators27-33, point and variability measures26-28,30-33 (Table 2).

Table 2. The methodological quality of the selected studies.

Pedro
Study 1 2 3 4 5 6 7 8 9 10 11
Score

Batool et al30 6/10 Y Y Y Y N N N Y N Y Y

Bhalerao et al28 5/10 Y Y N Y N N N Y N Y Y

Bhalerao et al29 3/10 N Y N Y N N N N N Y N

Chan et al31 6/10 Y Y Y Y N N Y N N Y Y

Kumar Immadi
3/10 Y Y N N N N N N N Y Y
et al26
Langhammer
6/10 Y Y N Y N N Y Y N Y Y
& Stanghelle32

Nilsson et al33 7/10 Y Y Y Y N N Y Y N Y Y

Rehani et al27 4/10 N Y N Y N N N N N Y Y

Nota: N: No. Y: Yes. (1) Eligibility criteria; (2) Random assignment; (3) Hidden assignment; (4) Comparability of the
baseline; (5) Blind subjects; (6) Blind therapists; (7) Blind raters; (8) Adequate follow-up; (9) Intention-to-treat analysis;
(10) Comparisons between groups; (11) Point estimates and variability.

Risk of bias ticles had a low risk of bias27-31, and the other three
had an unclear risk of bias26,32,33. The most common
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methods used for proper sequence generation were:

The risk of bias in the articles included in this systematic computer-generated random numbers27,28,30 and
review was assessed using the Cochrane Collaboration block randomization29,31.
DUAZARY

tool for determining bias in randomized clinical trials24.

Allocation concealment: Three articles presented a
Selection low risk of bias30,31,33; the method used was sealed
envelopes. In five articles, it needed to be described
or was insufficiently described, presenting uncertain
Adequate sequence generation: Five of eight ar- or unclear risk26-29,32.

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 Motor relearning program in patients with stroke sequels

Realization
Wear
Blinding of participants and personnel: One
study presented blinding of the participants and per- Incomplete results data: a total of three articles
sonnel, obtaining a low risk of bias32. No masking presented low risk since they met one of these two
was performed in four articles 28,29,31, or it was in- items28,30,32, three articles presented high risk since
complete33. In three articles, insufficient informa- they did not meet any of the items27,31,33 and two
tion was provided, considering an unclear risk of studies they did not provide sufficient data on loss-
bias26,27,30. es or exclusions, considering the unclear risk of
bias26,29.
Detection
Notification
Blinding of outcome assessors: Two articles re-
ported the blinding of the evaluators of the results, Selective reporting of results: seven articles in-
qualifying them as low risk of bias31,32; on the other cluded in this review described the intervention
hand, four articles were classified as unclear risk of protocol, and all prespecified study outcomes of
bias because they did not provide sufficient informa- interest to the review were fully described, obtain-
tion on the blinding of the evaluators or this result ing a low risk of bias26-28,30-33; only one article29 did
was not addressed in the study26,27,30,33; in two arti- not meet this criterion, being evaluated as high risk
cles there was no blinding of the evaluators28,29. (Table 3).

Table 3. Assessment of bias according to Cochrane.

Performance Attrition Reporting

Selection bias Detection bias
bias bias bias

Authors Blinding of
Random Blinding Incomplete Selective
Allocation participants
sequence of outcome outcome reporting of
concealment and
generation assessors data results
personnel

Batool et al30 ? ?
Bhalerao et al28 ?
Bhalerao et al29 ? ?
Chan et al31
Kumar Immadi
et al26 ? ? ? ? ?

Langhammer et
? ?
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al32
Nilsson et al33 ? ?
Rehani et al27
DUAZARY

? ? ?

Note. The symbol represents “low risk,” represents “high risk,” and ? “uncertain risk.”

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 Mateus-Arias, Camperos-Toro, Rangel-Silva, Mantilla-Toloza and Martínez-Torres

to have an impact on rehabilitation practice21.

DISCUSSION Some authors have described that research related
to functional recovery from brain injury has been
Optimal functional recovery is the primary objec- based on: the benefits of early interventions since
tive in rehabilitation, especially in neurology34,35. this minimizes the severity of the initial damage
Due to the frequent changes and the more signif- and reduces functional loss42; and brain reorgani-
icant development of procedures36, it is necessary zation in restoration and compensation of altered
to redefine these approaches, expanding the pos- functions37. It is essential to highlight that early
sibilities of rehabilitation treatments that consider intervention in acute stroke rehabilitation plays a
the new knowledge and concepts of neuroscience transcendental role in restoring function and reduc-
and neuropsychology for neurorehabilitation37. ing the degree of disability28.
Task-oriented motor relearning or MRP emerges
as a rehabilitation option based on neuroscience The clinical data strongly favor early mobilization
research that includes the practice of tasks with and training, but no study has shown to what ex-
the possibility of stimulating the neuroplasticity tent the beneficial effect is due to specific rehabil-
potential in the individual from the fractionation itation strategies. A study conducted by Nilsson et
and direction in phases of the practice of activities, al.33, where walking training on a treadmill with
movement learning, and feedback mechanisms body weight support was compared with walking
given by repetition are used21. training on the ground based on the MRP, showed
a significant improvement between admission and
There is a large number of publications that study discharge (ten weeks) for the FIM (56.1 and 76.4
the application of the MRP in the rehabilitation of respectively) and FAC (at admission 19 (51%) pa-
people with stroke sequelae38-40. However, very few tients could not walk independently, at discharge the
studies focus specifically on the recovery of func- number decreased to three (9%)), in the MRP group.
tional independence; therefore, this study aimed It also improved significantly from admission to
to determine the effects of the intervention of the 10-month follow-up, but no significant difference
motor relearning program in adults with stroke se- existed between treatment groups. Therefore, it was
quelae compared to another type of intervention by concluded that both methods are similar options at
reviewing and evaluating the available literature an early stage in stroke patients. The functional re-
on its application in the rehabilitation of functional sults regarding gait rehabilitation coincide with the
independence, finding six articles as a result of a study by Richards et al.9, which reports that the vast
systematic search for evidence. majority of clinical studies have described recovery
as occurring primarily in the first three months after
Among the outcome measures described in the stroke with a plateau at approximately six months
analysis of each of the articles included in this re- after stroke.
view, it was evidenced that the measure of func-
tional independence was the most used28-31,33. In ad- On the other hand, several investigations report that
dition, measures were found for the functionality the MRP improves restoring the function of the up-
of the upper limb and hand, motor function, func- per extremity43. This is in line with the study carried
tional ambulation, and activities of daily living. out by Batool et al.30, who evaluated motor func-
With these outcome measures, through a critical tion in the hemiplegic upper limb in subacute stroke
analysis of the evidence, there are indications that patients, concluding in their research that the out-
the application of the motor relearning program come measures increased significantly in all items
could have clinical effects in treating functional of the MAS and all items of the FIM after apply-
AÑO S

independence26–33. ing the MRP. However, no significant differences

were found in advanced manual activities, groom-
Motor recovery can be characterized as a “relearn- ing activities, and upper limb dressing. The study
DUAZARY

ing” process that responds to the demands of dai- compares the effectiveness of Constraint-Induced
ly life37 and is based on the premise that training Movement Therapy (CIMT) versus MRP and con-
after brain injury improves motor performance in cludes that CIMT is a more statistically significant
acquiring new skills and adaptation or refinement and clinically effective intervention compared to
of previously acquired skills41. Despite these find- this program among 35- and 60-year-old patients in
ings, motor learning research has only just begun terms of muscle recovery motor function and self-

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 Motor relearning program in patients with stroke sequels

care performance of upper extremity. The results of tion into the community, these authors emphasize
this review further support the view that functional that this must be a sequential treatment to reach
recovery after a stroke can occur after three months the expected results. In the same way, Pinzón et
up to at least six months. al.8, in a non-randomized clinical trial, were able
to conclude that the intervention program based
Different clinical trials suggest that task-oriented on motor relearning is more effective than a con-
relearning is more effective than traditional thera- ventional physiotherapeutic program to improve
pies and that the effect is specific to the retrained antigravity postural control and the quality of se-
activity15. Kumar Immadi26 evaluated the efficacy lective lower limb patterns in adults with hemipa-
of the relearning motor model compared to conven- resis.
tional therapy to promote upper extremity function
after stroke. The results showed an improvement Bhalerao et al.28,29 and Langhammer et al.32 con-
in upper extremity function in both groups; how- ducted randomized controlled trials that compared
ever, patients in the MRP were found to perform the Bobath approach and the MRP in stroke re-
significantly better on self-care tasks and activities habilitation. The results showed that both groups
of daily living. The results of this clinical trial cor- improved, but the improvement in motor function
roborate that “role-based” task-oriented training is was significantly more significant in the MRP
equally important in improving the functional re- group. From their study of the population in the
covery of patients after stroke. acute phase of this condition, the authors con-
clude that, despite not finding statistically signifi-
Motor tasks involving arm and hand movement are cant differences between the groups based on the
highly complex combinations of muscle action. measurement of performance in activities of daily
As soon as the isolated muscle action is elicited, it living through the Barthel index, Given the com-
should be practiced and extended to a meaningful prehensiveness of the MRP approach, they recom-
task44. Rehani et al.27, in an evaluation of the effica- mend its use in the first stage of the rehabilitation
cy of two therapeutic approaches (MRP and mirror of people with stroke32. The same authors further
therapy) that can be used to improve hand function conducted a follow-up study to investigate wheth-
in stroke, concluded that there was no statistically er the initial physiotherapy approach has long-term
significant difference between the two therapeutic effects on mortality, motor function, postural con-
approaches in terms of hand function and found trol, activities of daily living, quality of life, and
that the results were not significant in the compar- patient follow-up community services. Their data
ison between the scores before and after the inter- suggested that the initial physiotherapy approach
vention in both groups. Despite this, clinically, an did not significantly influence the long-term func-
improvement in hand function was observed in tional capacity of the subjects. However, they did
terms of CAHAI. Similar results were reported by find a rapid deterioration in basic activities of dai-
French et al.45; they found no evidence of a signif- ly living and increased reliance on family mem-
icant benefit from repetitive training on functional bers47. These results agree with Krutulyte et al.48,
activity of the upper extremity. However, it is im- who have studied the efficacy of physiotherapy
portant to highlight that several factors could have methods (Bobath and MRP) in the rehabilitation
influenced the results of this study, including the of patients with stroke; in their study, the activi-
sample size and the time that elapsed between the ties of daily living were also evaluated using the
stroke and rehabilitation, which varied between 1 Barthel index, concluding that physiotherapy with
and 6. This last point is crucial since it has been strategies oriented to tasks represented by MRP is
described that performance improvement is related preferable to physical therapy with facilitation/in-
AÑO S

to the early start of treatment46. hibition strategies, such as the Bobath program in
the rehabilitation of stroke patients.
Chan et al.31 inquired about the efficacy of MRP
DUAZARY

in promoting function and performance in people Although there is evidence that early and intense
after stroke, applying for the program in compari- rehabilitation is associated with a decrease in asso-
son with conventional therapy, finding significant ciated morbidity and mortality and improves func-
changes specifically for balance functions in per- tional outcomes, it is not entirely clear which of
forming functional activities after six weeks, in- the proposed therapeutic methods is the best since
struments of daily life, personal care, and integra- none has been definitively shown to be superior

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DOI: https://doi.org/10.21676/2389783X.5104
 Mateus-Arias, Camperos-Toro, Rangel-Silva, Mantilla-Toloza and Martínez-Torres

to the others; It can be deduced that no technique

is effective by itself. For its part, the environment
DECLARATION ON CONFLICT OF
also plays a vital role in rehabilitating stroke pa- INTEREST
tients27.
The authors state that there is no conflict of interest.
The MRP approach forces patients to focus on
missing performance components in their daily
tasks, which may help them learn to cope with AUTHORS’ CONTRIBUTION
post-stroke limitations more quickly and positively
affect their overall social participation21. Second, Oscar Eduardo Mateus Arias: participated in con-
considerable evidence shows that lack of physical ceptualization, research, methodology, and writing.
activity and functional impairment may contribute
to restrictions in social participation49. Motor re- Angela Camperos Toro: participated in research,
learning emphasizes the transfer of skills between methodology, and writing.
corrective and functional tasks; in other words, the
transfer of exercise skills learned in training to the Ashley Rangel Silva: participated in research,
patient’s daily life. This improves patients’ func- methodology, and writing.
tional independence and can lead to a better phys-
ical ability to reintegrate into society. However, it Sonia Mantilla Toloza: participated in supervision
is still being determined whether these effects can and writing.
diminish after more extended periods due to the
lack of long-term follow-up in the included MRP Javier Martínez Torres: participated in supervi-
studies50. sion and writing.
Taking into account the above, the vast majority
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