Task-Oriented training in a Patient with Triplegia: Post-Stroke Hemiparesis Complicating Pre-Existing Contralateral Upper Extremity Paralysis: A Case Report.

Abstract

Triplegia following stroke represents unique rehabilitative challenges. We demonstrated how task-oriented training can facilitate functional independence in a 75-year-old man with pre-existing left upper extremity (UE) paralysis who developed right hemiparesis after a stroke. The patient participated in intensive inpatient therapy (60 min each of daily physical and occupational therapy) 3-23 weeks post-onset. Besides impairment-based motor recovery interventions, the program was augmented with task-oriented training focusing on the UE function for, specifically feeding and gait. A follow-up was conducted 1year post-onset. The Fugl-Meyer Assessment-UE scores improved from 3 to 43 by 23 weeks and remained 41 at 1 year. On the Motor Activity Log-14, the number of activities performed with the paretic UE increased from 2 at 23 weeks to 8 at 1 year, with the mean Amount of Use score improving 0.77-2.9 over the same period. By 23 weeks, walking with an orthosis and eating became independent, with further functional gains through 1 year. Task-oriented training is an effective intervention for managing complex triplegia and can support long-term functional gains. Pre-existing contralateral UE paralysis creates a permanent "natural" forced-use effect similar to that of constraint-induced movement therapy, likely contributing to the newly paretic extremity's functional recovery.