Background. Priming results in a type of implicit memory that prepares the brain for a more plastic response, thereby changing behavior. New evidence in neurorehabilitation points to the use of priming interventions to optimize functional gains of the upper extremity in poststroke individuals. Objective. To determine the effects of priming on task-oriented training on upper extremity outcomes (body function and activity) in chronic stroke. Methods. The PubMed, CINAHL, Web of Science, EMBASE, and PEDro databases were searched in October 2019. Outcome data were pooled into categories of measures considering the International Classification Functional (ICF) classifications of body function and activity. Means and standard deviations for each group were used to determine group effect sizes by calculating mean differences (MDs) and 95% confidence intervals via a fixed effects model. Heterogeneity among the included studies for each factor evaluated was measured using the I2 statistic. Results. Thirty-six studies with 814 patients undergoing various types of task-oriented training were included in the analysis. Of these studies, 17 were associated with stimulation priming, 12 with sensory priming, 4 with movement priming, and 3 with action observation priming. Stimulation priming showed moderate-quality evidence of body function. Only the Wolf Motor Function Test (time) in the activity domain showed low-quality evidence. However, gains in motor function and in use of extremity members were measured by the Fugl-Meyer Assessment (UE-FMA). Regarding sensory priming, we found moderate-quality evidence and effect size for UE-FMA, corresponding to the body function domain (MD 4.77, 95% CI 3.25-6.29, Z = 6.15, P < .0001), and for the Action Research Arm Test, corresponding to the activity domain (MD 7.47, 95% CI 4.52-10.42, Z = 4.96, P < .0001). Despite the low-quality evidence, we found an effect size (MD 8.64, 95% CI 10.85-16.43, Z = 2.17, P = .003) in movement priming. Evidence for action observation priming was inconclusive. Conclusion. Combining priming and task-oriented training for the upper extremities of chronic stroke patients can be a promising intervention strategy. Studies that identify which priming techniques combined with task-oriented training for upper extremity function in chronic stroke yield effective outcomes in each ICF domain are needed and may be beneficial for the recovery of upper extremities poststroke.

中文翻译：

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启动对慢性卒中上肢任务导向训练结果的影响：系统评价和荟萃分析

背景。启动会产生一种内隐记忆，使大脑为更具可塑性的反应做好准备，从而改变行为。神经康复方面的新证据表明，使用启动干预来优化中风后个体上肢的功能增益。目标。确定启动对任务导向训练对慢性卒中上肢结果（身体功能和活动）的影响。方法。2019 年 10 月检索了 PubMed、CINAHL、Web of Science、EMBASE 和 PEDro 数据库。考虑到身体功能和活动的国际功能分类 (ICF) 分类，结果数据被汇总到测量类别中。每组的平均值和标准差用于通过固定效应模型计算平均差 (MD) 和 95% 置信区间来确定组效应大小。使用 I2 统计量测量纳入研究中每个评估因素的异质性。结果。对 814 名接受各种类型任务导向训练的患者进行的 36 项研究被纳入分析。在这些研究中，17 项与刺激启动有关，12 项与感觉启动有关，4 项与运动启动有关，3 项与动作观察启动有关。刺激启动显示出中等质量的身体功能证据。只有活动领域的 Wolf 运动功能测试（时间）显示出低质量的证据。然而，通过 Fugl-Meyer 评估 (UE-FMA) 测量运动功能和使用四肢成员的增益。关于感觉启动，我们发现 UE-FMA 的中等质量证据和效应大小，对应于身体功能域（MD 4.77，95% CI 3.25-6.29，Z = 6.15，P < .0001），以及行动研究Arm 测试，对应于活动域（MD 7.47，95% CI 4.52-10.42，Z = 4.96，P < .0001）。尽管证据质量低，但我们发现运动启动的影响大小（MD 8.64，95% CI 10.85-16.43，Z = 2.17，P = .003）。行动观察启动的证据尚无定论。结论。对慢性卒中患者的上肢进行启动训练和任务导向训练相结合可能是一种很有前景的干预策略。