TY - JOUR
T1 - Bottom-up versus Top-down designed rehabilitation sessions in chronic stroke survivors
T2 - A pilot randomized controlled trial
AU - Hejazi-Shirmard, Mahnaz
AU - Taghizadeh, Ghorban
AU - Rassafiani, Mehdi
AU - Cheraghifard, Moslem
AU - Yousefi, Mahin
AU - Hosseini, Seyed Hossein
AU - Askary Kachoosangy, Reihaneh
AU - Lajevardi, Laleh
PY - 2025
Y1 - 2025
N2 - PURPOSE: The present study aimed to compare the effectiveness of Top-down and Bottom-up approaches on levels of the International Classification of Functioning, Disability and Health Framework (ICF), including impairments, activities, and participation.MATERIALS AND METHODS: Thirty-nine chronic stroke survivors were recruited for this single-blinded randomized clinical trial. Participants were assigned to Top-down, Bottom-up interventions, or control group, and received a 6-week intervention. They were assessed before/after treatments and at follow-up (6 weeks later). Impairments were measured through kinematic analysis, Trail Making Tests (TMT), and Fugl-Meyer Assessment (FMA). Activity and participation were evaluated via Box and Block Test, Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM), respectively. RESULTS: We found significant improvements in impairment (FMA) and participation (COPM) in all groups, however, COPM scores improved beyond the MCID only in the Top-down, and FMA scores exceeded the MCID in Top-down and Bottom-up groups. Use of the upper limb in daily activities (MAL) enhanced in the Top-down group, although was not clinically significant.CONCLUSION: In most of the outcome measures, no significant difference was observed between groups. It seems that Top-down, Bottom-up, and traditional interventions have relatively comparable effectiveness in chronic stroke survivors.TRIAL REGISTRATION: IRCT20150721023277N2.
AB - PURPOSE: The present study aimed to compare the effectiveness of Top-down and Bottom-up approaches on levels of the International Classification of Functioning, Disability and Health Framework (ICF), including impairments, activities, and participation.MATERIALS AND METHODS: Thirty-nine chronic stroke survivors were recruited for this single-blinded randomized clinical trial. Participants were assigned to Top-down, Bottom-up interventions, or control group, and received a 6-week intervention. They were assessed before/after treatments and at follow-up (6 weeks later). Impairments were measured through kinematic analysis, Trail Making Tests (TMT), and Fugl-Meyer Assessment (FMA). Activity and participation were evaluated via Box and Block Test, Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM), respectively. RESULTS: We found significant improvements in impairment (FMA) and participation (COPM) in all groups, however, COPM scores improved beyond the MCID only in the Top-down, and FMA scores exceeded the MCID in Top-down and Bottom-up groups. Use of the upper limb in daily activities (MAL) enhanced in the Top-down group, although was not clinically significant.CONCLUSION: In most of the outcome measures, no significant difference was observed between groups. It seems that Top-down, Bottom-up, and traditional interventions have relatively comparable effectiveness in chronic stroke survivors.TRIAL REGISTRATION: IRCT20150721023277N2.
KW - stroke
KW - participation
KW - rehabilitation
KW - cognitive orientation to daily occupational performance
KW - exercise
UR - https://www.scopus.com/pages/publications/105001799687
UR - https://www.scopus.com/pages/publications/105001799687#tab=citedBy
U2 - 10.1080/09638288.2024.2384622
DO - 10.1080/09638288.2024.2384622
M3 - Article
C2 - 39078078
SN - 0963-8288
VL - 47
SP - 1807
EP - 1816
JO - Disability and Rehabilitation
JF - Disability and Rehabilitation
IS - 7
ER -
