Contextual interference and post-stroke rehabilitation: A scoping review


Background: Decades of research has explored the impact of practice schedule on motor learning, with a major focus on the benefits of contextual interference. Although this literature is primarily limited to healthy learners, there is great potential for its application in the context of stroke rehabilitation. Purpose: The purpose of this scoping review was to map the existing literature on the use and impact of contextual interference in post-stroke rehabilitation. Methods: Four databases (SPORTDiscuss, CINAHL, PubMed, and Ovid (Cochrane)) were used to identify peer-reviewed articles implementing contextual interference as a strategy in post-stroke rehabilitation. Using standard criteria, two reviewers independently screened titles, abstracts, and full texts. Full text data extraction was completed using a standardized form. Results: From a total of 354 articles, eleven were included in the final review. Studies used a range of methodologies (five randomized controlled designs) and sample sizes (minimum 4, maximum 42). Training targeted upper limb (n=5), gait (n=4), and speech (n=2) impairments following sub-acute (n=2) or chronic (n=9) stroke. Training length ranged from one session to 4 weeks, with outcomes assessed same day, to 4 weeks post training. Over half (n=6) reported a positive outcome, including upper limb (n=4), gait (n=1), and speech focused (n=1) outcomes. Conclusions: While there is evidence that use of contextual interference may benefit a variety of stroke-related outcomes, study designs are of variable quality and focus. Further well-designed studies are required to understand the potential of this motor learning strategy to enhance stroke rehabilitation outcomes, particularly earlier after onset.