Task-Oriented training in a Patient with Triplegia: Post-Stroke Hemiparesis Complicating Pre-Existing Contralateral...

Area of Science:

• Neurology
• Rehabilitation Medicine
• Neuroscience

Background:

• Triplegia, resulting from stroke, presents significant rehabilitative challenges.
• Pre-existing paralysis in one upper extremity (UE) complicates recovery after a subsequent stroke affecting the contralateral side.

Purpose of the Study:

• To evaluate the effectiveness of task-oriented training in enhancing functional independence in a patient with triplegia.
• To assess long-term functional outcomes following intensive inpatient rehabilitation.

Main Methods:

• A 75-year-old male with left UE paralysis and right hemiparesis post-stroke underwent intensive inpatient therapy (physical and occupational therapy) for 20 weeks.
• The rehabilitation program incorporated impairment-based interventions augmented with task-oriented training focused on UE function for feeding and gait.
• Functional outcomes were assessed using the Fugl-Meyer Assessment-UE and the Motor Activity Log-14 at 23 weeks and 1 year post-onset.

Main Results:

• Fugl-Meyer Assessment-UE scores improved significantly from 3 to 43 by 23 weeks, maintained at 41 at 1 year.
• The number of activities performed with the paretic UE increased from 2 to 8 by 1 year, with the Amount of Use score improving from 0.77 to 2.9.
• Independent walking with an orthosis and eating were achieved by 23 weeks, with continued functional gains observed through 1 year.

Conclusions:

• Task-oriented training is an effective intervention for improving functional independence in patients with complex triplegia.
• The pre-existing contralateral UE paralysis may have contributed to enhanced recovery through a "natural" forced-use effect.
• This case study highlights the potential for substantial long-term functional recovery with targeted rehabilitation strategies.