Cumulatively, these factors result in longer reaction time and longer time to accomplish tasks, thus suggesting the need to give adequate time for the performance of multiple repetitive tasks in stroke survivors, well beyond age and gender-matched individuals without history of stroke. These put together will negatively affect daily activities and exercise performance, leading to activity intolerance, increased energy cost of activity, and a decline in overall performance after stroke. Pathophysiologically, the sequelae of an upper motor neuron lesion result in hemiparesis/hemiplegia, marred balance and coordination and decreased proprioceptive feedback. The need to augment the duration of therapy in CCT for stroke survivors can be considered based on pathophysiologic and clinical domains. These may suggest the need for longer duration to tolerate and perform repetitive activities. Stroke survivors demonstrate poor activity tolerance and performance. This signifies the need for rehabilitation professionals to focus on meaningful, repetitive, and intensive specific tasks during a rehabilitation session. By implication the damaged brain will therefore benefit from repeated sensorimotor inputs (efferent-afferent feedback loops) in order to remodel effectively for the attainment of motor/functional recovery in stroke survivors.
These studies identified TST and intensity of multiple repetitions as critical nexuses to enhancing neural reorganisation and “rewiring” in the CNS. Compelling evidence from neuroscientific studies suggest that neuroplastic changes in the cerebral cortex and in other parts of the central nervous system (CNS) are the physiological mechanism for effective motor skill retraining following stroke. To accomplish sustained motor learning, rehabilitation must be geared towards a relatively permanent behavioural change, which is currently believed to manifest as a result of neuroplastic change in the brain itself. The goal of CCT in stroke rehabilitation is to institute an enduring motor learning in order to optimise motor and functional recovery necessary for the achievement of community reintegration of stroke survivors. Several research trials have shown that CCT is effective in improving balance, transfers, gait, gait-related activities (such as climbing stairs) and upper limb functions in stroke survivors, especially when applied within the first six months after stroke and even later. It satisfies the three key characteristics of an effective and efficient skill training programme including: (i) using different workstations that allow people to practice intensively in a meaningful and progressive way to suit their respective needs (ii) efficient utilisation of therapists’/trainees’ time and (iii) it encompasses group dynamics such as peer support and social support.
#GRAVITY CIRCUIT TSW SERIES#
Circuit Class Therapy (CCT) is a form of Task Specific Training (TST) that involves the practice of structuring tasks in a circuit or series of workstations. Substantial evidence suggests that task-specific training can assist functional recovery in stroke rehabilitation, with the goal of achieving true recovery of function based on motor learning principles, including purposefulness, multiple repetitions, and intensified activity. Motor impairments (of upper and lower extremities) are the major recognisable impairments caused by stroke, which are associated with limitations or decline in independent mobility. In most countries, stroke is the second or third most common cause of death, and one of the main causes of acquired adult disability. Stroke is a growing global health-care crisis, with grave and disabling consequences.
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