151
|
Peters KM, Kelly VE, Chang T, Weismann MC, Westcott McCoy S, Steele KM. Muscle recruitment and coordination during upper-extremity functional tests. J Electromyogr Kinesiol 2018; 38:143-150. [PMID: 29253840 PMCID: PMC5808900 DOI: 10.1016/j.jelekin.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/07/2017] [Accepted: 12/06/2017] [Indexed: 12/18/2022] Open
Abstract
Performance-based tests, such as the Jebsen Taylor Hand Function Test or Chedoke Arm and Hand Activity Inventory, are commonly used to assess functional performance after neurologic injury. However, the muscle activity required to execute these tasks is not well understood, even for unimpaired individuals. The purpose of this study was to evaluate unimpaired muscle recruitment and coordination of the dominant and non-dominant limbs during common clinical tests. Electromyography (EMG) recordings from eight arm muscles were monitored bilaterally for twenty unimpaired participants while completing these tests. Average signal magnitudes, activation times, and cocontraction levels were calculated from the filtered EMG data, normalized by maximum voluntary isometric contractions (MVICs). Overall, performance of these functional tests required low levels of muscle activity, with average EMG magnitudes less than 6.5% MVIC for all tests and muscles, except the extensor digitorum, which had higher activations across all tasks (11.7 ± 2.7% MVIC, dominant arm). When averaged across participants, cocontraction was between 25 and 62% for all tests and muscle pairs. Tasks evaluated by speed of completion, rather than functional quality of movement demonstrated higher levels of muscle recruitment. These results provide baseline measurements that can be used to evaluate muscle-specific deficits after neurologic injury and track recovery using common clinical tests.
Collapse
Affiliation(s)
- Keshia M Peters
- Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Valerie E Kelly
- Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Tasha Chang
- Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Madeline C Weismann
- Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | | | - Katherine M Steele
- Mechanical Engineering, University of Washington, Seattle, WA, United States; University of Washington, Institute for Neuroengineering, Seattle, WA, United States.
| |
Collapse
|
152
|
Tran VD, Dario P, Mazzoleni S. Kinematic measures for upper limb robot-assisted therapy following stroke and correlations with clinical outcome measures: A review. Med Eng Phys 2018; 53:13-31. [PMID: 29361407 DOI: 10.1016/j.medengphy.2017.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/10/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
AIM OF THE STUDY This review classifies the kinematic measures used to evaluate post-stroke motor impairment following upper limb robot-assisted rehabilitation and investigates their correlations with clinical outcome measures. METHODS An online literature search was carried out in PubMed, MEDLINE, Scopus and IEEE-Xplore databases. Kinematic parameters mentioned in the studies included were categorized into the International Classification of Functioning, Disability and Health (ICF) domains. The correlations between these parameters and the clinical scales were summarized. RESULTS Forty-nine kinematic parameters were identified from 67 articles involving 1750 patients. The most frequently used parameters were: movement speed, movement accuracy, peak speed, number of speed peaks, and movement distance and duration. According to the ICF domains, 44 kinematic parameters were categorized into Body Functions and Structure, 5 into Activities and no parameters were categorized into Participation and Personal and Environmental Factors. Thirteen articles investigated the correlations between kinematic parameters and clinical outcome measures. Some kinematic measures showed a significant correlation coefficient with clinical scores, but most were weak or moderate. CONCLUSIONS The proposed classification of kinematic measures into ICF domains and their correlations with clinical scales could contribute to identifying the most relevant ones for an integrated assessment of upper limb robot-assisted rehabilitation treatments following stroke. Increasing the assessment frequency by means of kinematic parameters could optimize clinical assessment procedures and enhance the effectiveness of rehabilitation treatments.
Collapse
Affiliation(s)
- Vi Do Tran
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy.
| |
Collapse
|
153
|
Alamri FF, Shoyaib AA, Biggers A, Jayaraman S, Guindon J, Karamyan VT. Applicability of the grip strength and automated von Frey tactile sensitivity tests in the mouse photothrombotic model of stroke. Behav Brain Res 2018; 336:250-255. [DOI: 10.1016/j.bbr.2017.09.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 08/29/2017] [Accepted: 09/04/2017] [Indexed: 12/19/2022]
|
154
|
Ranganathan R, Wang R, Dong B, Biswas S. Identifying compensatory movement patterns in the upper extremity using a wearable sensor system. Physiol Meas 2017; 38:2222-2234. [PMID: 29099724 DOI: 10.1088/1361-6579/aa9835] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Movement impairments such as those due to stroke often result in the nervous system adopting atypical movements to compensate for movement deficits. Monitoring these compensatory patterns is critical for improving functional outcomes during rehabilitation. The purpose of this study was to test the feasibility and validity of a wearable sensor system for detecting compensatory trunk kinematics during activities of daily living. APPROACH Participants with no history of neurological impairments performed reaching and manipulation tasks with their upper extremity, and their movements were recorded by a wearable sensor system and validated using a motion capture system. Compensatory movements of the trunk were induced using a brace that limited range of motion at the elbow. MAIN RESULTS Our results showed that the elbow brace elicited compensatory movements of the trunk during reaching tasks but not manipulation tasks, and that a wearable sensor system with two sensors could reliably classify compensatory movements (~90% accuracy). SIGNIFICANCE These results show the potential of the wearable system to assess and monitor compensatory movements outside of a lab setting.
Collapse
Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, East Lansing, MI, United States of America. Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States of America
| | | | | | | |
Collapse
|
155
|
Raffin E, Hummel FC. Restoring Motor Functions After Stroke: Multiple Approaches and Opportunities. Neuroscientist 2017; 24:400-416. [DOI: 10.1177/1073858417737486] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More than 1.5 million people suffer a stroke in Europe per year and more than 70% of stroke survivors experience limited functional recovery of their upper limb, resulting in diminished quality of life. Therefore, interventions to address upper-limb impairment are a priority for stroke survivors and clinicians. While a significant body of evidence supports the use of conventional treatments, such as intensive motor training or constraint-induced movement therapy, the limited and heterogeneous improvements they allow are, for most patients, usually not sufficient to return to full autonomy. Various innovative neurorehabilitation strategies are emerging in order to enhance beneficial plasticity and improve motor recovery. Among them, robotic technologies, brain-computer interfaces, or noninvasive brain stimulation (NIBS) are showing encouraging results. These innovative interventions, such as NIBS, will only provide maximized effects, if the field moves away from the “one-fits all” approach toward a “patient-tailored” approach. After summarizing the most commonly used rehabilitation approaches, we will focus on NIBS and highlight the factors that limit its widespread use in clinical settings. Subsequently, we will propose potential biomarkers that might help to stratify stroke patients in order to identify the individualized optimal therapy. We will discuss future methodological developments, which could open new avenues for poststroke rehabilitation, toward more patient-tailored precision medicine approaches and pathophysiologically motivated strategies.
Collapse
Affiliation(s)
- Estelle Raffin
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
| |
Collapse
|
156
|
Hand Passive Mobilization Performed with Robotic Assistance: Acute Effects on Upper Limb Perfusion and Spasticity in Stroke Survivors. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2796815. [PMID: 29094043 PMCID: PMC5637828 DOI: 10.1155/2017/2796815] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022]
Abstract
This single arm pre-post study aimed at evaluating the acute effects induced by a single session of robot-assisted passive hand mobilization on local perfusion and upper limb (UL) function in poststroke hemiparetic participants. Twenty-three patients with subacute or chronic stroke received 20 min passive mobilization of the paretic hand with robotic assistance. Near-infrared spectroscopy (NIRS) was used to detect changes in forearm tissue perfusion. Muscle tone of the paretic UL was assessed by the Modified Ashworth Scale (MAS). Symptoms concerning UL heaviness, joint stiffness, and pain were evaluated as secondary outcomes by self-reporting. Significant (p = 0.014) improvements were found in forearm perfusion when all fingers were mobilized simultaneously. After the intervention, MAS scores decreased globally, being the changes statistically significant for the wrist (from 1.6 ± 1.0 to 1.1 ± 1.0; p = 0.001) and fingers (from 1.2 ± 1.1 to 0.7 ± 0.9; p = 0.004). Subjects reported decreased UL heaviness and stiffness after treatment, especially for the hand, as well as diminished pain when present. This study supports novel evidence that hand robotic assistance promotes local UL circulation changes, may help in the management of spasticity, and acutely alleviates reported symptoms of heaviness, stiffness, and pain in subjects with poststroke hemiparesis. This opens new scenarios for the implications in everyday clinical practice. Clinical Trial Registration Number is NCT03243123.
Collapse
|
157
|
Hebert DA, Bowen JM, Ho C, Antunes I, O’Reilly DJ, Bayley M. Examining a new functional electrical stimulation therapy with people with severe upper extremity hemiparesis and chronic stroke: A feasibility study. Br J Occup Ther 2017. [DOI: 10.1177/0308022617719807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Deborah A Hebert
- Practice Lead, Occupational Therapy, Toronto Rehabilitation Inst., University Health Network, Toronto, Canada
- Rocket Family Upper Extremity Clinic Lead, Toronto Rehabilitation Inst., University Health Network, Toronto, Canada
- Associate Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - James M Bowen
- Assistant Professor (Part-time), Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University Programs for Assessment of Technology in Health (PATH), St. Joseph’s Healthcare Hamilton, Canada
- Research Associate, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University Programs for Assessment of Technology in Health (PATH), St. Joseph’s Healthcare Hamilton, Canada
| | - Cindy Ho
- Occupational Therapist, Brain and Spinal Cord Rehabilitation Program, Toronto Rehab, University Health Network, Toronto, Canada
| | - Irene Antunes
- Physiotherapist, Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Daria J O’Reilly
- Associate Professor, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University Programs for Assessment of Technology in Health (PATH), St. Joseph’s Healthcare Hamilton, Canada
| | - Mark Bayley
- Medical Director, Brain and Spinal Cord Rehabilitation Program, UHN Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Professor, Division of Physiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
158
|
Just F, Ozen O, Tortora S, Riener R, Rauter G. Feedforward model based arm weight compensation with the rehabilitation robot ARMin. IEEE Int Conf Rehabil Robot 2017; 2017:72-77. [PMID: 28813796 DOI: 10.1109/icorr.2017.8009224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Highly impaired stroke patients at early stages of recovery are unable to generate enough muscle force to lift the weight of their own arm. Accordingly, task-related training is strongly limited or even impossible. However, as soon as partial or full arm weight support is provided, patients are enabled to perform arm rehabilitation training again throughout an increased workspace. In the literature, the current solutions for providing arm weight support are mostly mechanical. These systems have components that restrict the freedom of movement or entail additional disturbances. A scalable weight compensation for upper and lower arm that is online adjustable as well as generalizable to any robotic system is necessary. In this paper, a model-based feedforward weight compensation of upper and lower arm fulfilling these requirements is introduced. The proposed method is tested with the upper extremity rehabilitation robot ARMin V, but can be applied in any other actuated exoskeleton system. Experimental results were verified using EMG measurements. These results revealed that the proposed weight compensation reduces the effort of the subjects to 26% on average and more importantly throughout the entire workspace of the robot.
Collapse
|
159
|
DAUNORAVIČENĖ KRISTINA, LINKEL ARTURAS, ŽIŽIENĖ JURGITA, GRIŠKEVIČIUS JULIUS, JUOCEVIČIUS ALVYDAS, RAUDONYTĖ INGA, PAUK JOLANTA, IDZKOWSKI ADAM, WALENDZIUK WOJCIECH. ALTERNATIVE METHOD OF UPPER EXTREMITY FUNCTION ASSESSMENT OF STROKE PATIENTS BY ANGULAR KINEMATIC PARAMETERS. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This study focuses on the functional assessment of the upper extremity of stroke patients via analysis of angular kinematics features. Amplitudes and angular velocities of multi-joint movements more precisely describe functional state at different impairment levels. However, the arm movement as a whole could be analyzed by means of joint angle–angle diagrams, which illustrate the 2D trajectory of upper extremity during movement and show the visual ranges of upper extremity in different cycles of motion. The functional range of motion of each upper extremity segment in all patient groups for more accurate assessment of capability was calculated. Moreover, we calculated the area (S) between two curves in joint angle–angle diagrams as a novel index of the complete upper extremity movement range evaluation. Our findings correspond to clinical rates and upper extremity assessment based on joint angle–angle diagrams seems to be a promising method for accurate assessment and/or predicting the outcomes of rehabilitation programs.
Collapse
Affiliation(s)
- KRISTINA DAUNORAVIČENĖ
- Department of Biomechanics, Vilnius Gediminas Technical University, J. Basanavicius str. 28, MR-II 2-109 Vilnius, LT-03224, Lithuania
| | - ARTURAS LINKEL
- Department of Biomechanics, Vilnius Gediminas Technical University, J. Basanavicius str. 28, MR-II 2-109 Vilnius, LT-03224, Lithuania
| | - JURGITA ŽIŽIENĖ
- Department of Biomechanics, Vilnius Gediminas Technical University, J. Basanavicius str. 28, MR-II 2-109 Vilnius, LT-03224, Lithuania
| | - JULIUS GRIŠKEVIČIUS
- Department of Biomechanics, Vilnius Gediminas Technical University, J. Basanavicius str. 28, MR-II 2-109 Vilnius, LT-03224, Lithuania
| | - ALVYDAS JUOCEVIČIUS
- Faculty of Medicine, Vilnius University, M.K. Ciurlionio str. 21 Vilnius, LT-03101, Lithuania
| | - INGA RAUDONYTĖ
- Faculty of Medicine, Vilnius University, M.K. Ciurlionio str. 21 Vilnius, LT-03101, Lithuania
| | - JOLANTA PAUK
- Mechanical Engineering Faculty, Bialystok University of Technology, Wiejska 45C, Bialystok, 15-351, Poland
| | - ADAM IDZKOWSKI
- Faculty of Electrical Engineering, Bialystok University of Technology, Wiejska 45D, Bialystok, 15-351, Poland
| | - WOJCIECH WALENDZIUK
- Faculty of Electrical Engineering, Bialystok University of Technology, Wiejska 45D, Bialystok, 15-351, Poland
| |
Collapse
|
160
|
Wolny T, Linek P, Michalski P. Inter-rater reliability of two-point discrimination in acute stroke patients. NeuroRehabilitation 2017; 41:127-134. [DOI: 10.3233/nre-171464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tomasz Wolny
- Department of Kinesiotherapy and Special Physiotherapy Methods, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- The Academy of Business, Dkabrowa G’ornicza, Poland
| | - Paweł Linek
- Department of Kinesiotherapy and Special Physiotherapy Methods, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Paweł Michalski
- Kinesis Research Team, Department of Kinesiotherapy and Special Physiotherapy Methods, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| |
Collapse
|
161
|
Mace M, Guy S, Hussain A, Diane Playford E, Ward N, Balasubramanian S, Burdet E. Validity of a sensor-based table-top platform to measure upper limb function. IEEE Int Conf Rehabil Robot 2017; 2017:652-657. [PMID: 28813894 DOI: 10.1109/icorr.2017.8009322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective measurement is an essential part of the assessment process in neurological dysfunction such as stroke. However, current clinical scores are insensitive and based on subjective observation from experts. Technology provides an opportunity for enhanced accuracy and specificity of objective measurement. This study describes the use of an interactive force-sensitive table-top platform for the assessment of reach in post-stroke patients, admitted as part of a three week intensive upper limb training programme. Objective measures from the reachable workspace were extracted and included normalised reach distance, normalised reached speed and reach dragging. The data was compared to standardised Fugl-Meyer (FM) clinical scores, recorded at admission (FMPRE) and discharge (FMPOST). Results indicate strong relationships between the three objective measures and subjective FM scores, with significant Spearman correlations found in all cases (|ρ| > 0.5, p < 0.05). The results highlight the validity for a sensor-based table-top system to provide a simple, flexible, and objective platform for assessment of impaired upper limb motor function.
Collapse
|
162
|
Koh CL, Lin JH, Jeng JS, Huang SL, Hsieh CL. Effects of Transcranial Direct Current Stimulation With Sensory Modulation on Stroke Motor Rehabilitation: A Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:2477-2484. [PMID: 28652065 DOI: 10.1016/j.apmr.2017.05.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/10/2017] [Accepted: 05/25/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To test whether a multistrategy intervention enhanced recovery immediately and longitudinally in patients with severe to moderate upper extremity (UE) paresis. DESIGN Double-blind, randomized controlled trial with placebo control. SETTING Outpatient department of a local medical center. PARTICIPANTS People (N=25) with chronic stroke were randomly assigned to 1 of 2 groups: a transcranial direct current stimulation with sensory modulation (tDCS-SM) group (n=14; mean age ± SD, 55.3±11.4y) or a control group (n=11; mean age ± SD, 56.9±13.5y). INTERVENTIONS Eight-week intervention. The tDCS-SM group received bilateral tDCS, bilateral cutaneous anesthesia, and high repetitions of passive movements on the paretic hand. The control group received the same passive movements but with sham tDCS and sham anesthesia. During the experiment, all participants continued their regular rehabilitation. MAIN OUTCOME MEASURES Voluntary UE movement, spasticity, UE function, and basic activities of daily living. Outcomes were assessed at baseline, at postintervention, and at 3- and 6-month follow-ups. RESULTS No significant differences were found between groups. However, there was a trend that the voluntary UE movement improved more in the tDCS-SM group than in the control group, with a moderate immediate effect (partial η2 [ηp2]=.14, P=.07) and moderate long-term effects (3-mo follow-up: ηp2=.17, P=.05; 6-mo follow-up: ηp2=.12, P=.10). Compared with the control group, the tDCS-SM group had a trend of a small immediate effect (ηp2=.02-.04) on reducing spasticity, but no long-term effect. A trend of small immediate and long-term effects in favor of tDCS-SM was found on UE function and daily function recovery (ηp2=.02-.09). CONCLUSIONS Accompanied with traditional rehabilitation, tDCS-SM had a nonsignificant trend of having immediate and longitudinal effects on voluntary UE movement recovery in patients with severe to moderate UE paresis after stroke, but its effects on spasticity reduction and functional recovery may be limited.
Collapse
Affiliation(s)
- Chia-Lin Koh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jau-Hong Lin
- Department of Physical Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan; Department and Graduate Institute of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheau-Ling Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
163
|
O’Brien AT, Torrealba Acosta G, Huerta R, Thibaut A. Does non-invasive brain stimulation modify hand dexterity? Protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e015669. [PMID: 28645972 PMCID: PMC5734405 DOI: 10.1136/bmjopen-2016-015669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Dexterity is described as coordinated hand and finger movement for precision tasks. It is essential for day-to-day activities like computer use, writing or buttoning a shirt. Integrity of brain motor networks is crucial to properly execute these fine hand tasks. When these networks are damaged, interventions to enhance recovery are frequently accompanied by unwanted side effects or limited in their effect. Non-invasive brain stimulation (NIBS) are postulated to target affected motor areas and improve hand motor function with few side effects. However, the results across studies vary, and the current literature does not allow us to draw clear conclusions on the use of NIBS to promote hand function recovery. Therefore, we developed a protocol for a systematic review and meta-analysis on the effects of different NIBS technologies on dexterity in diverse populations. This study will potentially help future evidence-based research and guidelines that use these NIBS technologies for recovering hand dexterity. METHODS AND ANALYSIS This protocol will compare the effects of active versus sham NIBS on precise hand activity. Records will be obtained by searching relevant databases. Included articles will be randomised clinical trials in adults, testing the therapeutic effects of NIBS on continuous dexterity data. Records will be studied for risk of bias. Narrative and quantitative synthesis will be done. ETHICS AND DISSEMINATION No private health information is included; the study is not interventional. Ethical approval is not required. The results will be reported in a peer-review journal. REGISTRATION DETAILS PROSPERO International prospective register of systematic reviews registration number: CRD42016043809.
Collapse
Affiliation(s)
- Anthony Terrence O’Brien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Gabriel Torrealba Acosta
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Rodrigo Huerta
- Department of Medicine, Universidad Nacional Autonoma de Mexico, Coyoacan, Mexico
| | - Aurore Thibaut
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Coma Science Group, GIGA-Consciousness, University and University Hospital of Liège, Liège, Belgium
| |
Collapse
|
164
|
Lang CE, Waddell KJ, Klaesner JW, Bland MD. A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers. J Vis Exp 2017. [PMID: 28518079 PMCID: PMC5565027 DOI: 10.3791/55673] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. It has become important to measure a person's activities in daily life, and not just measure their capacity for activity in the structured environment of a clinic or laboratory. A wearable sensor that is now enabling measurement of daily movement is the accelerometer. Accelerometers are commercially-available devices resembling large wrist watches that can be worn throughout the day. Data from accelerometers can quantify how the limbs are engaged to perform activities in peoples' homes and communities. This report describes a methodology to collect accelerometry data and turn it into clinically-relevant information. First, data are collected by having the participant wear two accelerometers (one on each wrist) for 24 h or longer. The accelerometry data are then downloaded and processed to produce four different variables that describe key aspects of upper limb activity in daily life: hours of use, use ratio, magnitude ratio, and the bilateral magnitude. Density plots can be constructed that visually represent the data from the 24 h wearing period. The variables and their resultant density plots are highly consistent in neurologically-intact, community-dwelling adults. This striking consistency makes them a useful tool for determining if upper limb daily performance is different from normal. This methodology is appropriate for research studies investigating upper limb dysfunction and interventions designed to improve upper limb performance in daily life in people with stroke and other patient populations. Because of its relative simplicity, it may not be long before it is also incorporated in clinical neurorehabilitation practice.
Collapse
Affiliation(s)
- Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine; Program in Occupational Therapy, Washington University School of Medicine; Department of Neurology, Washington University School of Medicine;
| | | | - Joseph W Klaesner
- Program in Physical Therapy, Washington University School of Medicine; Mallinckrodt Institute of Radiology, Washington University School of Medicine; Department of Biomedical Engineering, Washington University
| | - Marghuretta D Bland
- Program in Physical Therapy, Washington University School of Medicine; Program in Occupational Therapy, Washington University School of Medicine; Department of Neurology, Washington University School of Medicine
| |
Collapse
|
165
|
Mottet D, van Dokkum LEH, Froger J, Gouaïch A, Laffont I. Trajectory formation principles are the same after mild or moderate stroke. PLoS One 2017; 12:e0173674. [PMID: 28329000 PMCID: PMC5362058 DOI: 10.1371/journal.pone.0173674] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/26/2017] [Indexed: 11/19/2022] Open
Abstract
When we make rapid reaching movements, we have to trade speed for accuracy. To do so, the trajectory of our hand is the result of an optimal balance between feed-forward and feed-back control in the face of signal-dependant noise in the sensorimotor system. How far do these principles of trajectory formation still apply after a stroke, for persons with mild to moderate sensorimotor deficits who recovered some reaching ability? Here, we examine the accuracy of fast hand reaching movements with a focus on the information capacity of the sensorimotor system and its relation to trajectory formation in young adults, in persons who had a stroke and in age-matched control participants. We find that persons with stroke follow the same trajectory formation principles, albeit parameterized differently in the face of higher sensorimotor uncertainty. Higher directional errors after a stroke result in less feed-forward control, hence more feed-back loops responsible for segmented movements. As a consequence, movements are globally slower to reach the imposed accuracy, and the information throughput of the sensorimotor system is lower after a stroke. The fact that the most abstract principles of motor control remain after a stroke suggests that clinicians can capitalize on existing theories of motor control and learning to derive principled rehabilitation strategies.
Collapse
Affiliation(s)
- Denis Mottet
- EuroMov, Univ. Montpellier, Montpellier, France
- * E-mail:
| | | | - Jérôme Froger
- EuroMov, Univ. Montpellier, Montpellier, France
- Physical and Rehabilitation Medicine, University Hospital of Nimes, Nimes, France
| | - Abdelkader Gouaïch
- Laboratoire d’Informatique de Robotique et de Microelectronique de Montpellier, Univ. Montpellier, Montpellier, France
| | - Isabelle Laffont
- EuroMov, Univ. Montpellier, Montpellier, France
- Physical and Rehabilitation Medicine, University Hospital of Montpellier, Montpellier, France
| |
Collapse
|
166
|
Kumar KV, Joshua AM, Kedambadi R, Mithra PP. Eclectic/mixed model method for upper extremity functional recovery in stroke rehabilitation: A pilot study. J Nat Sci Biol Med 2017; 8:75-81. [PMID: 28250679 PMCID: PMC5320828 DOI: 10.4103/0976-9668.198357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Eclectic treatment method is a flexible approach that uses techniques drawn from various schools of thought involving several treatment methods and allows the therapist to adapt to each client's individual needs. Wider application for eclectic approach is however limited in stroke rehabilitation. Aim: The objective is to find out whether eclectic approach improves upper extremity (UE) functional recovery in acute stroke rehabilitation. Methodology: Twenty-five postacute unilateral supratentorial stroke subjects recruited from tertiary care hospitals recovered with Stage 2–5 in Brunnstorm stage of UE motor recovery (BRS-UE) underwent 45 min of eclectic approach for UE every day involving seven different treatment methods (5 min for each method) for 6 days consecutively. The outcome was UE subscale of the Fugl-Meyer Motor test (UE-FM), UE subscale of the Stroke Rehabilitation Assessment of Movement (UE-STREAM), Wolf Motor Function test (WMFT-FAS), and Stroke Impact Scale-16 (SIS-16) was collected at the end of the sixth session. Results: All the participants showed significant improvement in all the outcome measures. The Stage 2 and 3 subjects showed UE-STREAM (P = 0.007) WMFT-FAS (P < 0.001), SIS (P = 0.023) respectively and for Stage 4 and 5 the subjects have shown UE FM (P < 0.001), WMFT-FAS (P < 0.001), SIS (P = 0.004) with large magnitude of treatment effect for all stages of BRS-UE. Conclusion: Our study findings are in favor of integrating eclectic approach than single intervention/approach in clinical practice to improve the UE functional recovery for motor rehabilitation when the stroke occurs.
Collapse
Affiliation(s)
- K Vijaya Kumar
- Department of Physiotherapy, Center for Basic Sciences, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Abraham M Joshua
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Rakshith Kedambadi
- Department of Neurology, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - P Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| |
Collapse
|
167
|
Rane SS, Paul A, Mullerpatan RP. Reference values of manual dexterity using Minnesota Rate of Manipulation Test for Indian adults. HAND THERAPY 2017. [DOI: 10.1177/1758998317694474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Dexterity assessment is an integral component of hand function evaluation. The Minnesota Rate of Manipulation Test is a valid and reliable tool to evaluate manual dexterity and has been used to study prognosis of therapy. Information available on its reference values is limited. Reference values are required to interpret, set realistic treatment goals, and assess the ability to return to employment. Therefore, manual dexterity was studied in healthy Indian adults to generate reference values. Methods A descriptive study was conducted on 900 subjects divided into three groups: Group 1: 18–30 years ( n = 300): Group 2: 31–60 years (n = 300), and Group 3: ≥61 years ( n = 300). The Minnesota Rate of Manipulation Test was used to evaluate manual dexterity. All subjects performed three trials (one practice + two test trials) of the five subtests. The average of two test trials was used to compute the Minnesota Rate of Manipulation Test score. Results The total score of the Minnesota Rate of Manipulation Test in Groups 1, 2, and 3 was 275.7 ± 24.1 s, 299.3 ± 31.9 s, and 357.4 ± 48.6 s, respectively. Manual dexterity was moderately associated with age ( r = 0.707, p < 0.001); however, differences between males and females were nonsignificant ( p = 0.306). Conclusion Manual dexterity declined with advancing age; however, differences between genders were not significant. These reference values of manual hand dexterity for healthy adult Indian people will be relevant for clinical assessment of hand function.
Collapse
Affiliation(s)
- Shamita S Rane
- MGM School of Physiotherapy, Kamothe, Navi Mumbai, India
| | - Anila Paul
- Medical Trust Institute of Medical Sciences, College of Physiotherapy, Thirpunithura, Kochi, Kerala
| | | |
Collapse
|
168
|
Maris A, Coninx K, Seelen H, Truyens V, De Weyer T, Geers R, Lemmens M, Coolen J, Stupar S, Lamers I, Feys P. The impact of robot-mediated adaptive I-TRAVLE training on impaired upper limb function in chronic stroke and multiple sclerosis. Disabil Rehabil Assist Technol 2017; 13:1-9. [DOI: 10.1080/17483107.2016.1278467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anneleen Maris
- Faculty of Medicine and Life Sciences, REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Karin Coninx
- Expertise Centre for Digital Media – tUL – iMinds, Hasselt University, Diepenbeek, Belgium
| | - Henk Seelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | | | - Tom De Weyer
- Expertise Centre for Digital Media – tUL – iMinds, Hasselt University, Diepenbeek, Belgium
| | - Richard Geers
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | | | | | - Sandra Stupar
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Ilse Lamers
- Faculty of Medicine and Life Sciences, REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Peter Feys
- Faculty of Medicine and Life Sciences, REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
169
|
Hussain A, Balasubramanian S, Roach N, Klein J, Jarrassé N, Mace M, David A, Guy S, Burdet E. SITAR: a system for independent task-oriented assessment and rehabilitation. J Rehabil Assist Technol Eng 2017; 4:2055668317729637. [PMID: 31186936 PMCID: PMC6453030 DOI: 10.1177/2055668317729637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/30/2017] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Over recent years, task-oriented training has emerged as a dominant approach in neurorehabilitation. This article presents a novel, sensor-based system for independent task-oriented assessment and rehabilitation (SITAR) of the upper limb. METHODS The SITAR is an ecosystem of interactive devices including a touch and force-sensitive tabletop and a set of intelligent objects enabling functional interaction. In contrast to most existing sensor-based systems, SITAR provides natural training of visuomotor coordination through collocated visual and haptic workspaces alongside multimodal feedback, facilitating learning and its transfer to real tasks. We illustrate the possibilities offered by the SITAR for sensorimotor assessment and therapy through pilot assessment and usability studies. RESULTS The pilot data from the assessment study demonstrates how the system can be used to assess different aspects of upper limb reaching, pick-and-place and sensory tactile resolution tasks. The pilot usability study indicates that patients are able to train arm-reaching movements independently using the SITAR with minimal involvement of the therapist and that they were motivated to pursue the SITAR-based therapy. CONCLUSION SITAR is a versatile, non-robotic tool that can be used to implement a range of therapeutic exercises and assessments for different types of patients, which is particularly well-suited for task-oriented training.
Collapse
Affiliation(s)
- Asif Hussain
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- School of Mechanical and Aerospace
Engineering, Nanyang Technological
University, Singapore
| | - Sivakumar Balasubramanian
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- Department of Bioengineering, Christian Medical College, Vellore, India
| | - Nick Roach
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Julius Klein
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- Tecnalia Research and Innovation, San
Sebastian, Spain
| | - Nathanael Jarrassé
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- CNRS, Institut des Systèmes Intelligents et de Robotique, Université Pierre et Marie Curie, Paris, France
| | - Michael Mace
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Ann David
- Department of Bioengineering, Christian Medical College, Vellore, India
| | - Sarah Guy
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
- School of Mechanical and Aerospace
Engineering, Nanyang Technological
University, Singapore
| |
Collapse
|
170
|
Waddell KJ, Strube MJ, Bailey RR, Klaesner JW, Birkenmeier RL, Dromerick AW, Lang CE. Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke? Neurorehabil Neural Repair 2016; 31:290-300. [PMID: 27909071 DOI: 10.1177/1545968316680493] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A common assumption is that changes in upper limb (UL) capacity, or what an individual is capable of doing, translates to improved UL performance in daily life, or what an individual actually does. This assumption should be explicitly tested for individuals with UL paresis poststroke. OBJECTIVE To examine changes in UL performance after an intensive, individualized, progressive, task-specific UL intervention for individuals at least 6 months poststroke. METHODS Secondary analysis on 78 individuals with UL paresis who participated in a phase II, single-blind, randomized parallel dose-response trial. Participants were enrolled in a task-specific intervention for 8 weeks. Participants were randomized into 1 of 4 treatment groups with each group completing different amounts of UL movement practice. UL performance was assessed with bilateral, wrist-worn accelerometers once a week for 24 hours throughout the duration of the study. The 6 accelerometer variables were tested for change and the influence of potential modifiers using hierarchical linear modeling. RESULTS No changes in UL performance were found on any of the 6 accelerometer variables used to quantify UL performance. Neither changes in UL capacity nor the overall amount of movement practice influenced changes in UL performance. Stroke chronicity, baseline UL capacity, concordance, and ADL status significantly increased the baseline starting points but did not influence the rate of change (slopes) for participants. CONCLUSIONS Improved motor capacity resulting from an intensive outpatient UL intervention does not appear to translate to increased UL performance outside the clinic.
Collapse
Affiliation(s)
| | | | | | | | | | - Alexander W Dromerick
- 2 Georgetown University, Washington, DC, USA.,3 MedStar National Rehabilitation Hospital, Washington DC, USA
| | | |
Collapse
|
171
|
Yadav RK, Sharma R, Borah D, Kothari SY. Efficacy of Modified Constraint Induced Movement Therapy in the Treatment of Hemiparetic Upper Limb in Stroke Patients: A Randomized Controlled Trial. J Clin Diagn Res 2016; 10:YC01-YC05. [PMID: 28050492 DOI: 10.7860/jcdr/2016/23468.8899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Paretic upper limb in stroke patients has a significant impact on the quality of life. Modified Constraint Induced Movement Therapy (mCIMT) is one of the treatment options used for the improvement of the function of the paretic limb. AIM To investigate the efficacy of four week duration mCIMT in the management of upper extremity weakness in hemiparetic patients due to stroke. MATERIALS AND METHODS Prospective single blind, parallel randomized controlled trial in which 30 patients received conventional rehabilitation programme (control group) and 30 patients participated in a mCIMT programme in addition to the conventional rehabilitation programme (study group). The mCIMT included three hours therapy sessions emphasizing the affected arm use in general functional tasks, three times a week for four weeks. Their normal arm was also constrained for five hours per day over five days per week. All the patients were assessed at baseline, one month and three months after completion of therapy using Fugl-Meyer Assessment (FMA) score for upper extremity and Motor Activity Log (MAL) scale comprising of Amount of Use (AOU) score and Quality of Use (QOU) score. RESULTS All the 3 scores improved significantly in both the groups at each follow-up. Post-hoc analysis revealed that compared to conventional rehabilitation group, mCIMT group showed significantly better scores at 1 month {FMA1 (p-value <0.0001, es0.2870), AOU1 (p-value 0.0007, es0.1830), QOU1 (p-value 0.0015, es0.1640)} and 3 months {FMA3 (p-value <.0001, es0.4240), AOU3 (p-value 0.0003, es 0.2030), QOU3 (p-value 0.0008, es 0.1790)}. CONCLUSION Four weeks duration for mCIMT is effective in improving the motor function in paretic upper limb of stroke patients.
Collapse
Affiliation(s)
- Raj Kumar Yadav
- Senior Resident, Department of Physical Medicine & Rehabilitation, VMMC & Safdarjung Hospital , New Delhi, India
| | | | - Diganta Borah
- Professor, Department of Physical Medicine & Rehabilitation, VMMC & Safdarjung Hospital , New Delhi, India
| | - S Y Kothari
- Retired Special DGHS and Professor, Department of Physical Medicine & Rehabilitation, VMMC & Safdarjung Hospital , New Delhi, India
| |
Collapse
|
172
|
Ekstrand E, Lexell J, Brogårdh C. Test-Retest Reliability and Convergent Validity of Three Manual Dexterity Measures in Persons With Chronic Stroke. PM R 2016; 8:935-943. [PMID: 26972364 DOI: 10.1016/j.pmrj.2016.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/20/2016] [Accepted: 02/25/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Decreased manual dexterity is common in persons after stroke. Different measures are used to assess manual dexterity, but a lack of knowledge exists about their reliability and how they are related. OBJECTIVE To evaluate the test-retest reliability and convergent validity of 3 manual dexterity measures after stroke. DESIGN A test-retest design. SETTING University Hospital. PARTICIPANTS Forty-five persons (mean age 65 years) with mild-to-moderate impairments in the upper extremity at least 6 months after stroke. MAIN OUTCOME MEASURES Manual dexterity was assessed on 2 occasions, 1 week apart using the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the modified Sollerman Hand Function Test (mSHFT). The reliability of the BBT and NHPT was evaluated with the intraclass correlation coefficient together with systematic and random measurement errors. Reliability of the mSHFT was evaluated with the Kappa coefficient and the Svensson rank-invariant method (percent agreement and systematic and random disagreements). Convergent validity of the total scores was evaluated with the Spearman rank correlation coefficients (rho). RESULTS The intraclass correlation coefficient for the BBT and the NHPT ranged from 0.83 to 0.99. Significant systematic measurement errors were found for both tests and hands. The Kappa coefficient for the total sum score of the mSHFT was 0.95 for the more affected hand and 0.59 for the less affected hand. One of the 3 items showed systematic disagreements for both hands. The convergent validity (rho) for the more affected hand ranged from 0.41 (BBT versus mSHFT) to -0.68 (NHPT versus mSHFT). CONCLUSION The test-retest reliability of the BBT, NHPT and mSHFT was high but all measures showed learning effects. The relationships between the 3 measures indicate that they partly complement one another. The BBT may be preferred for persons with moderate impairments of the upper extremity and the NHPT and the mSHFT for persons with milder impairments. As the mSHFT has the advantage of reflecting activities in daily life it may be a suitable alternative to the NHPT. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Elisabeth Ekstrand
- Department of Health Sciences, Lund University, Box 157, SE-221 00, Lund, Sweden; and Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden; and Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Lund University, and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
173
|
Panarese A, Pirondini E, Tropea P, Cesqui B, Posteraro F, Micera S. Model-based variables for the kinematic assessment of upper-extremity impairments in post-stroke patients. J Neuroeng Rehabil 2016; 13:81. [PMID: 27609062 PMCID: PMC5016877 DOI: 10.1186/s12984-016-0187-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/26/2016] [Indexed: 11/22/2022] Open
Abstract
Background Common scales for clinical evaluation of post-stroke upper-limb motor recovery are often complemented with kinematic parameters extracted from movement trajectories. However, there is no a general consensus on which parameters to use. Moreover, the selected variables may be redundant and highly correlated or, conversely, may incompletely sample the kinematic information from the trajectories. Here we sought to identify a set of clinically useful variables for an exhaustive but yet economical kinematic characterization of upper limb movements performed by post-stroke hemiparetic subjects. Methods For this purpose, we pursued a top-down model-driven approach, seeking which kinematic parameters were pivotal for a computational model to generate trajectories of point-to-point planar movements similar to those made by post-stroke subjects at different levels of impairment. Results The set of kinematic variables used in the model allowed for the generation of trajectories significantly similar to those of either sub-acute or chronic post-stroke patients at different time points during the therapy. Simulated trajectories also correctly reproduced many kinematic features of real movements, as assessed by an extensive set of kinematic metrics computed on both real and simulated curves. When inspected for redundancy, we found that variations in the variables used in the model were explained by three different underlying and unobserved factors related to movement efficiency, speed, and accuracy, possibly revealing different working mechanisms of recovery. Conclusion This study identified a set of measures capable of extensively characterizing the kinematics of upper limb movements performed by post-stroke subjects and of tracking changes of different motor improvement aspects throughout the rehabilitation process. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0187-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alessandro Panarese
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale R. Piaggio 34, 56025, Pontedera, Pisa, Italy.
| | - Elvira Pirondini
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Peppino Tropea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale R. Piaggio 34, 56025, Pontedera, Pisa, Italy
| | - Benedetta Cesqui
- Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy.,Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Federico Posteraro
- Rehabilitation Department Versilia Hospital, AUSL 12, Viareggio, Italy.,Bioengineering Rehabilitation Laboratory, Auxilium Vitae Rehabilitation Centre, Volterra, Italy
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale R. Piaggio 34, 56025, Pontedera, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| |
Collapse
|
174
|
Lohse K, Bland MD, Lang CE. Quantifying Change During Outpatient Stroke Rehabilitation: A Retrospective Regression Analysis. Arch Phys Med Rehabil 2016; 97:1423-1430.e1. [PMID: 27109329 PMCID: PMC5003650 DOI: 10.1016/j.apmr.2016.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine change and individual trajectories for balance, upper extremity motor capacity, and mobility in people poststroke during the time they received outpatient therapies. DESIGN Retrospective analyses of an observational cohort using hierarchical linear modeling. SETTING Outpatient rehabilitation. PARTICIPANTS Persons poststroke (N=366). INTERVENTIONS Usual outpatient physical and occupational therapy. MAIN OUTCOMES MEASURES Berg Balance Scale (BBS), Action Research Arm Test (ARAT), and walking speed were used to assess the 3 domains. Initial scores at the start of outpatient therapy (intercepts), rate of change during outpatient therapy (slopes), and covariance between slopes and intercepts were modeled as random effects. Additional variables modeled as fixed effects were duration (months of outpatient therapy), time (days poststroke), age (y), and inpatient status (if the patient went to an inpatient rehabilitation facility [IRF]). RESULTS A patient with average age and time started at 37 points on the BBS with a change of 1.8 points per month, at 35 points on the ARAT with a change of 2 points per month, and with a walking speed of .59m/s with a change of .09m/s per month. When controlling for other variables, patients started with lower scores on the BBS and ARAT or had slower walking speeds at admission if they started outpatient therapy later than average or went to an IRF. CONCLUSIONS Patients generally improved over the course of outpatient therapy, but there was considerable variability in individual trajectories. Average rates of change across all 3 domains were small.
Collapse
Affiliation(s)
- Keith Lohse
- School of Kinesiology, Auburn University, Auburn, AL
| | - Marghuretta D Bland
- Program in Physical Therapy, Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, Saint Louis, MO
| | - Catherine E Lang
- Program in Physical Therapy, Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, Saint Louis, MO.
| |
Collapse
|
175
|
Lang CE, Strube MJ, Bland MD, Waddell KJ, Cherry-Allen KM, Nudo RJ, Dromerick AW, Birkenmeier RL. Dose response of task-specific upper limb training in people at least 6 months poststroke: A phase II, single-blind, randomized, controlled trial. Ann Neurol 2016; 80:342-54. [PMID: 27447365 DOI: 10.1002/ana.24734] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/31/2016] [Accepted: 06/03/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objectives of this work were to (1) determine whether higher doses of motor therapy in chronic poststroke hemiparesis result in better outcomes, compared to lower doses, and (2) evaluate potential modifiers of the dose-response relationship. METHODS Eighty-five adults with upper extremity paresis ≥6 months poststroke were randomized to one of four dose groups in this single-blind, parallel, randomized, control trial. The dosing parameter manipulated was amount of task-specific training, as indexed by the number of task repetitions. Groups received 3,200, 6,400, 9,600, or individualized maximum (IM) repetitions, during 1-hour sessions, 4 days/week for 8 weeks. The intervention was an individualized, progressive, task-specific upper-limb training program designed to improve upper-limb functional motor capacity. The primary outcome was the slope of the Action Research Arm Test (ARAT) during the intervention. Effects of dose and potential modifiers of the dose-response relationship were evaluated with hierarchical linear models. RESULTS ARAT scores for the 3,200, 9,600, and IM groups improved over time as indicated by slopes (ΔARAT/week, mean ± standard errors) of 0.40 ± 0.15, 0.31 ± 0.16, and 0.66 ± 0.14, respectively (p < 0.05). The slope of the 6,400 group was smaller (-0.05 ± 0.15) and significantly different from the 3,200 and IM groups (p < 0.001). Initial motor capacity, neglect, and other tested characteristics did not modify the dose-response relationship. INTERPRETATION Overall, treatment effects were small. There was no evidence of a dose-response effect of task-specific training on functional capacity in people with long-standing upper-limb paresis poststroke. Ann Neurol 2016;80:342-354.
Collapse
Affiliation(s)
- Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO. .,Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO. .,Department of Neurology, Washington University School of Medicine, St. Louis, MO.
| | - Michael J Strube
- Department of Psychological and Brain Sciences, Washington University, St. Louis, MO
| | - Marghuretta D Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO.,Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO.,Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Kimberly J Waddell
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Kendra M Cherry-Allen
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Randolph J Nudo
- Department of Rehabilitation Medicine, Kansas University Medical Center, Kansas City, KS
| | - Alexander W Dromerick
- Department of Rehabilitation Medicine, Georgetown University and MedStar National Rehabilitation Hospital, Washington, DC
| | - Rebecca L Birkenmeier
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO.,Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO.,Department of Neurology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
176
|
Bertrand AM, Fournier K, Wick Brasey MG, Kaiser ML, Frischknecht R, Diserens K. Reliability of maximal grip strength measurements and grip strength recovery following a stroke. J Hand Ther 2016. [PMID: 26206167 DOI: 10.1016/j.jht.2015.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical measurement. PURPOSE The test-retest reliability of maximal grip strength measurements (MGSM) is examined in subjects for 12 weeks post-stroke together with maximal grip strength recovery and the maximal-grip and upper-extremity strength measurements' relationship with capacity and performance test scores. METHODS A Jamar dynamometer and the Motricity Index (MI) were used for strength measurements. The Chedoke Arm and Hand Activity Inventory and ABILHAND questionnaire for evaluating capacities and performances. RESULTS MGSM were reliable (Intraclass Correlation Coefficients = 0.97-0.99, Minimal Detectable Differences = 2.73-4.68 kg). Among the 34 participants, 47% did not have a measurable grip strength one week post-stroke but 50% of these recovered some strength within the first eight weeks. The MGSM and MI scores were correlated with scores of tests of capacity and performance (Spearman's Rank Correlation Coefficients = 0.69-0.94). CONCLUSIONS MGSM are reliable in the first weeks after a stroke. LEVEL OF EVIDENCE N/A.
Collapse
Affiliation(s)
- Anne Martine Bertrand
- Haute école de travail social et de la santé, EESP, University of Applied Sciences and Arts Western Switzerland, Chemin des Abeilles 14, 1010 Lausanne, Switzerland.
| | - Katia Fournier
- BMI Healthcare, Hand Therapy Service, London Region, 3 Paris Garden, Southwark, SE1 8ND London, UK
| | - Marie-Gabrielle Wick Brasey
- Occupational Therapy Service, Health Department, University Hospital of Lausanne (CHUV), Av. Pierre-Decker 5, 1011 Lausanne, Switzerland
| | - Marie-Laure Kaiser
- Occupational Therapy Service, Health Department, University Hospital of Lausanne (CHUV), Av. Pierre-Decker 5, 1011 Lausanne, Switzerland
| | - Rolf Frischknecht
- Unit of Neurorehabilitation and Physical Medicine, Service NPR, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Av. Pierre-Decker 5, 1011 Lausanne, Switzerland
| | - Karin Diserens
- Acute Neurological Rehabilitation Unit, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| |
Collapse
|
177
|
Lewis LK, Hunt T, Williams MT, English C, Olds TS. Sedentary Behavior in People with and without a Chronic Health Condition: How Much, What and When? AIMS Public Health 2016; 3:503-519. [PMID: 29546179 PMCID: PMC5689813 DOI: 10.3934/publichealth.2016.3.503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/26/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To describe sedentary behaviors (duration, bouts and context) in people with and without a chronic health condition. METHODS Design: Secondary analysis of two cross-sectional studies. Participants: People with stable chronic obstructive pulmonary disease (COPD) (n = 24, male:female 18:6) and their spousal carers (n = 24, 6:18); stroke survivors (n = 24, 16:8) and age- and sex-matched healthy adults (n = 19, 11:8). Level of physiological impairment was measured with post-bronchodilator spirometry (FEV1 %predicted) for people with COPD, and walking speed for people with stroke. Outcomes: Participants were monitored over seven days (triaxial accelerometer, Sensewear armband) to obtain objective data on daily sedentary time, and prolonged sedentary bouts (≥ 30 min). During the monitoring period, a 24-hour use of time recall instrument was administered by telephone interview to explore the context of sedentary activities (e.g. television, computer or reading). Sedentary time was quantified using accelerometry and recall data, and group differences were explored. Linear regression examined associations between physiological impairment and sedentary time. RESULTS Participant groups were similar in terms of age (COPD 75 ± 8, carers 70 ± 11, stroke 69 ± 10, healthy 73 ± 7 years) and body mass index (COPD 28 ± 4, carers 27 ± 4, stroke 31 ± 4, healthy 26 ± 4 kg.m-2). The healthy group had the lowest sedentary time (45% of waking hours), followed by the carer (54%), stroke (60%) and COPD (62%) groups (p < 0.0001). Level of physiological impairment was an independent predictor of waking sedentary time (p = 0.001). CONCLUSIONS People with a chronic health condition spent more time sedentary than those without a chronic condition, and there were small but clear differences between groups in the types of activities undertaken during sedentary periods. The study findings may aid in the design of targeted interventions to decrease sedentary time in people with chronic health conditions.
Collapse
Affiliation(s)
- Lucy K. Lewis
- School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Toby Hunt
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
- Respiratory Clinical Research Unit, Repatriation General Hospital, Adelaide, SA, Australia
| | - Marie T. Williams
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Coralie English
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
- School of Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Tim S. Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
178
|
Doman CA, Waddell KJ, Bailey RR, Moore JL, Lang CE. Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke. Am J Occup Ther 2016; 70:7003290040p1-7003290040p11. [PMID: 27089298 DOI: 10.5014/ajot.2016.020891] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study explored how upper-extremity (UE) functional capacity and daily performance change during the course of outpatient rehabilitation in people with stroke. METHOD Fifteen participants receiving outpatient occupational therapy services for UE paresis poststroke were enrolled. UE motor capacity was measured with the Action Research Arm Test (ARAT), and UE performance was measured using bilateral, wrist-worn accelerometers. Measurements were taken at or near the start of therapy, at every 10th visit or every 30 days throughout the duration of services, and at discharge. RESULTS Three patterns were observed: (1) increase in ARAT scores and more normalized accelerometry profiles, (2) increase in ARAT scores but no change in accelerometry profiles, and (3) no change in ARAT scores or in accelerometry profiles. CONCLUSION UE performance in daily life was highly variable, with inconsistencies between change in UE capacity and change in UE performance. UE capacity and performance are important constructs to assess separately during rehabilitation.
Collapse
Affiliation(s)
- Caitlin A Doman
- Caitlin A. Doman, MS, OTR/L, is Occupational Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - Kimberly J Waddell
- Kimberly J. Waddell, MS, OTR/L, is Graduate Student, Movement Science and Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Ryan R Bailey
- Ryan R. Bailey, MSOT, MSCI, PhD, was Graduate Student, Movement Science Program and Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, at the time of the study
| | - Jennifer L Moore
- Jennifer L. Moore, PT, DHS, NCS, is Physical Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - Catherine E Lang
- Catherine E. Lang, PT, PhD, is Professor, Program in Physical Therapy, Program in Occupational Therapy, and Department of Neurology, Washington University School of Medicine, St. Louis, MO;
| |
Collapse
|
179
|
Longhi M, Merlo A, Prati P, Giacobbi M, Mazzoli D. Instrumental indices for upper limb function assessment in stroke patients: a validation study. J Neuroeng Rehabil 2016; 13:52. [PMID: 27278277 PMCID: PMC4898355 DOI: 10.1186/s12984-016-0163-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/03/2016] [Indexed: 01/17/2023] Open
Abstract
Background Robotic exoskeletons are increasingly being used in objective and quantitative assessment of upper limb (UL) movements. A set of instrumental indices computed during robot-assisted reaching tasks with the Armeo®Spring has been proven to assess UL functionality. The aim of this study was to test the construct validity of this indices-based UL assessment when used with patients who have had a stroke. Methods Forty-four 45- to 79-year-old stroke patients with a Wolf Motor Function Test ability score (WMFT-FAS) ranging from 10 to 75 and a Motricity Index (MI) ranging from 14 to 33 at shoulder and elbow were enrolled, thus covering a wide range of impairments. Residual UL function was assessed by both the WMFT-FAS and the WMFT-TIME, as well as by a set of 9 numerical indices assessing movement accuracy, velocity and smoothness computed from a 3D endpoint trajectory obtained during the “Vertical Capture” task of the Armeo®Spring device. To explore which variables better represented motor control deficits, the Mann-Whitney U Test was used to compare patients’ indices to those obtained from 25 healthy individuals. To explore the inner relationships between indices and construct validity in assessing accuracy, velocity and smoothness, a factor analysis was carried out. To verify the indices concurrent validity, they were compared to both WMFT-FAS and WMFT-TIME by the Spearman’s correlation coefficient. Results Seven indices of stroke subjects were significantly different from those of healthy controls, with effect sizes in the range 0.35–0.74. Factor analysis confirmed that specific subsets of indices belonged to the domains of accuracy, velocity and smoothness (discriminant validity). One accuracy index, both velocity indices and two smoothness indices were significantly correlated with WMFT-FAS and WMFT-TIME (|rho| = 0.31–0.50) (concurrent validity). One index for each of the assessed movement domains was proven to have construct validity (discriminant and concurrent) and was selected. Moreover, the indices were able to detect differences in accuracy, velocity and/or smoothness in patients with the same WMFT level. Conclusions The proposed index-based UL assessment can be used to integrate and support clinical evaluation of UL function in stroke patients.
Collapse
Affiliation(s)
- Maria Longhi
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy
| | - Andrea Merlo
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy. .,Rehabilitation Department, Motion Analysis Laboratory, AUSL of Reggio Emilia, via Mandriolo Superiore 11, Correggio, 42015, Reggio Emilia, Italy.
| | - Paolo Prati
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy
| | - Meris Giacobbi
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy
| | - Davide Mazzoli
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, viale San Salvador 204, Rimini, 47922, Torre Pedrera di Rimini, Italy
| |
Collapse
|
180
|
Baker K, Barrett L, Playford ED, Aspden T, Riazi A, Hobart J. Measuring arm function early after stroke: is the DASH good enough? J Neurol Neurosurg Psychiatry 2016; 87:604-10. [PMID: 26180212 DOI: 10.1136/jnnp-2015-310557] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/18/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Despite a growing call to use patient-reported outcomes in clinical research, few are available for measuring upper limb function post-stroke. We examined the Disabilities of the Arm, Shoulder and Hand (DASH) to evaluate its measurement performance in acute stroke. In doing so, we compared results from traditional and modern psychometric methods. METHODS 172 people with acute stroke completed the DASH. Those with upper limb impairments completed the DASH again at 6 weeks (n=99). Data (n=271) were analysed using two psychometric paradigms: traditional psychometric (Classical Test Theory, CTT) analyses examined data completeness, scaling assumptions, targeting, reliability and responsiveness; Rasch Measurement Theory (RMT) analyses examined scale-to-sample targeting, scale performance and person measurement. RESULTS CTT analyses implied the DASH was psychometrically robust in this sample. Data completeness was high, criteria for scaling assumptions were satisfied (item-total correlations 0.55-0.95), targeting was good, internal consistency reliability was high (Cronbach's α=0.99) and responsiveness was clinically moderate (effect size=0.51). However, RMT analyses identified important limitations: scale-to-sample targeting was suboptimal, 4 items had disordered response category thresholds, 16 items exhibited misfit, 3 pairs of items had high residual correlations (>0.60) and 84 person fit residuals exceeded the recommended range. CONCLUSIONS RMT methods identified limitations missed by CTT and indicate areas for improvement of the DASH as an upper limb measure for acute stroke. Findings, similar to those identified in multiple sclerosis, highlight the need for scales to have strong conceptual underpinnings, with their development and modification guided by sophisticated psychometric methods.
Collapse
Affiliation(s)
- Karen Baker
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Louise Barrett
- Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - E Diane Playford
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Trefor Aspden
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, UK
| | - Afsane Riazi
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, UK
| | - Jeremy Hobart
- Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| |
Collapse
|
181
|
Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1571] [Impact Index Per Article: 196.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
Collapse
|
182
|
Reinkensmeyer DJ, Burdet E, Casadio M, Krakauer JW, Kwakkel G, Lang CE, Swinnen SP, Ward NS, Schweighofer N. Computational neurorehabilitation: modeling plasticity and learning to predict recovery. J Neuroeng Rehabil 2016; 13:42. [PMID: 27130577 PMCID: PMC4851823 DOI: 10.1186/s12984-016-0148-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/13/2016] [Indexed: 01/19/2023] Open
Abstract
Despite progress in using computational approaches to inform medicine and neuroscience in the last 30 years, there have been few attempts to model the mechanisms underlying sensorimotor rehabilitation. We argue that a fundamental understanding of neurologic recovery, and as a result accurate predictions at the individual level, will be facilitated by developing computational models of the salient neural processes, including plasticity and learning systems of the brain, and integrating them into a context specific to rehabilitation. Here, we therefore discuss Computational Neurorehabilitation, a newly emerging field aimed at modeling plasticity and motor learning to understand and improve movement recovery of individuals with neurologic impairment. We first explain how the emergence of robotics and wearable sensors for rehabilitation is providing data that make development and testing of such models increasingly feasible. We then review key aspects of plasticity and motor learning that such models will incorporate. We proceed by discussing how computational neurorehabilitation models relate to the current benchmark in rehabilitation modeling - regression-based, prognostic modeling. We then critically discuss the first computational neurorehabilitation models, which have primarily focused on modeling rehabilitation of the upper extremity after stroke, and show how even simple models have produced novel ideas for future investigation. Finally, we conclude with key directions for future research, anticipating that soon we will see the emergence of mechanistic models of motor recovery that are informed by clinical imaging results and driven by the actual movement content of rehabilitation therapy as well as wearable sensor-based records of daily activity.
Collapse
Affiliation(s)
- David J Reinkensmeyer
- Departments of Anatomy and Neurobiology, Mechanical and Aerospace Engineering, Biomedical Engineering, and Physical Medicine and Rehabilitation, University of California, Irvine, USA.
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Maura Casadio
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - John W Krakauer
- Departments of Neurology and Neuroscience, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Catherine E Lang
- Department of Neurology, Program in Physical Therapy, Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Stephan P Swinnen
- Department of Kinesiology, KU Leuven Movement Control & Neuroplasticity Research Group, Leuven, KU, Belgium
- Leuven Research Institute for Neuroscience & Disease (LIND), KU, Leuven, Belgium
| | - Nick S Ward
- Sobell Department of Motor Neuroscience and UCLPartners Centre for Neurorehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA
| |
Collapse
|
183
|
Bissolotti L, Villafañe JH, Gaffurini P, Orizio C, Valdes K, Negrini S. Changes in skeletal muscle perfusion and spasticity in patients with poststroke hemiparesis treated by robotic assistance (Gloreha) of the hand. J Phys Ther Sci 2016; 28:769-73. [PMID: 27134356 PMCID: PMC4842437 DOI: 10.1589/jpts.28.769] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/25/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this case series was to determine the effects of robot-assisted
hand rehabilitation with a Gloreha device on skeletal muscle perfusion, spasticity, and
motor function in subjects with poststroke hemiparesis. [Subjects and Methods] Seven
patients, 2 women and 5 men (mean ± SD age: 60.5 ±6.3 years), with hemiparesis (>6
months poststroke), received passive mobilization of the hand with a Gloreha (Idrogenet,
Italy), device (30 min per day; 3 sessions a week for 3 weeks). The outcome measures were
the total hemoglobin profiles and tissue oxygenation index (TOI) in the muscle tissue
evaluated through near-infrared spectroscopy. The Motricity Index and modified Ashworth
Scale for upper limb muscles were used to assess mobility of the upper extremity.
[Results] Robotic assistance reduced spasticity after the intervention by 68.6% in the
upper limb. The Motricity Index was unchanged in these patients after treatment. Regarding
changes in muscle perfusion, significant improvements were found in total hemoglobin.
There were significant differences between the pre- and posttreatment modified Ashworth
scale. [Conclusion] The present work provides novel evidence that robotic assistance of
the hand induced changes in local muscle blood flow and oxygen supply, diminished
spasticity, and decreased subject-reported symptoms of heaviness and stiffness in subjects
with post-stroke hemiparesis.
Collapse
Affiliation(s)
- Luciano Bissolotti
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | | | - Paolo Gaffurini
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | - Claudio Orizio
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | | | - Stefano Negrini
- IRCCS Don Gnocchi Foundation, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy
| |
Collapse
|
184
|
Calabrò RS, Russo M, Naro A, Milardi D, Balletta T, Leo A, Filoni S, Bramanti P. Who May Benefit From Armeo Power Treatment? A Neurophysiological Approach to Predict Neurorehabilitation Outcomes. PM R 2016; 8:971-978. [PMID: 26902866 DOI: 10.1016/j.pmrj.2016.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/08/2016] [Accepted: 02/14/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The Armeo Power, a rehabilitation exoskeleton that allows early treatment of motor disabilities, provides intelligent arm support in a large 3-dimensional work space, thus enabling patients to perform intensive, repetitive, and goal-oriented exercises. This device could efficiently induce new connections and facilitate plasticity phenomena potentiation. Knowledge of the potential brain plasticity reservoir after brain damage constitutes a prerequisite for an optimal rehabilitation strategy. OBJECTIVE To identify potential neurophysiologic markers predicting the responsiveness of stroke patients to upper limb robotic treatment. DESIGN Prospective cohort study. SETTING Behavioral and Robotic Neurorehabilitation Laboratory of IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy. PATIENTS We enrolled 35 patients who had sustained a first-ever ischemic supratentorial stroke at least 2 months before enrollment and had unilateral hemiplegia. METHODS All patients underwent 40 Armeo Power training sessions that lasted 1 hour each (ie, 5 times a week for 8 weeks). MAIN OUTCOME MEASUREMENTS We assessed the spasticity and motor function of the upper limb by means of the Modified Ashworth scale and Fugl-Meyer assessment, respectively. Moreover, we evaluated the cortical excitability and plasticity potential of the bilateral primary motor areas in response to the repetitive paired associative stimulation paradigm using transcranial magnetic stimulation and Armeo Power kinematic parameters. RESULTS The patients who showed significant repetitive paired associative stimulation aftereffects at baseline exhibited an evident increase of cortical plasticity in the affected hemisphere (motor evoked potential amplitude increase, P = .03), a decrease of interhemispheric inhibition (affected hemisphere cortical silent period duration decrease, P = .01; unaffected hemisphere cortical silent period duration increase, P = .004; repetitive paired associative stimulation aftereffect increase, P = .008). Such findings were paralleled by clinical improvements (Fugl-Meyer, P = .04) and Armeo Power kinematic improvements (elbow flexion/extension, P = .02; shoulder range of movement, P = .002). CONCLUSIONS Our data suggest that use of Armeo Power may improve upper limb motor function recovery as predicted by reshaping of cortical and transcallosal plasticity, according to the baseline cortical excitability. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
| | | | - Antonino Naro
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Demetrio Milardi
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy; Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Tina Balletta
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo (FG), Italy
| | | |
Collapse
|
185
|
Waddell KJ, Birkenmeier RL, Moore JL, Hornby TG, Lang CE. Feasibility of high-repetition, task-specific training for individuals with upper-extremity paresis. Am J Occup Ther 2016; 68:444-53. [PMID: 25005508 DOI: 10.5014/ajot.2014.011619] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE. We investigated the feasibility of delivering an individualized, progressive, high-repetition upper-extremity (UE) task-specific training protocol for people with stroke in the inpatient rehabilitation setting. METHOD. Fifteen patients with UE paresis participated in this study. Task-specific UE training was scheduled for 60 min/day, 4 days/wk, during occupational therapy for the duration of a participant's inpatient stay. During each session, participants were challenged to complete ≥300 repetitions of various tasks. RESULTS. Participants averaged 289 repetitions/session, spending 47 of 60 min in active training. Participants improved on impairment and activity level outcome measures. CONCLUSION. People with stroke in an inpatient setting can achieve hundreds of repetitions of task-specific training in 1-hr sessions. As expected, all participants improved on functional outcome measures. Future studies are needed to determine whether this high-repetition training program results in better outcomes than current UE interventions.
Collapse
Affiliation(s)
- Kimberly J Waddell
- Kimberly J. Waddell, MS, OTR/L, is Occupational Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - Rebecca L Birkenmeier
- Rebecca L. Birkenmeier, OTD, OTR/L, is Research Assistant Professor, Program in Occupational Therapy, Program in Physical Therapy, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Jennifer L Moore
- Jennifer L. Moore, PT, DHS, NCS, is Clinical Therapy Lead and Physical Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - T George Hornby
- T. George Hornby, PhD, PT, is Research Scientist, Rehabilitation Institute of Chicago, Chicago, IL, and Associate Professor, Department of Physical Therapy and Kinesiology and Nutrition, University of Illinois at Chicago
| | - Catherine E Lang
- Catherine E. Lang, PhD, PT, is Associate Professor, Program in Physical Therapy, Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8502, St. Louis, MO 63108-2212;
| |
Collapse
|
186
|
Validity of body-worn sensor acceleration metrics to index upper extremity function in hemiparetic stroke. J Neurol Phys Ther 2015; 39:111-8. [PMID: 25742378 DOI: 10.1097/npt.0000000000000085] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Accelerometers have been used to capture real-world use of the paretic upper extremity in people with stroke. It may be possible to characterize different aspects of the recorded acceleration to gain insight about movement capabilities during task-specific behavior. These measures may be of value for guiding rehabilitation. We undertook a study to identify the acceleration characteristics that have a stable association with upper extremity function and sensitivity to within-participant fluctuations in function over multiple sessions of task-specific training. METHODS Twenty-seven adults 6 months or more poststroke with upper extremity paresis participated. Signals from wrist-worn accelerometers were sampled at 30 Hz during 7 sessions of task-specific training. Paretic upper extremity function was evaluated with the Action Research Arm Test. We used Spearman correlations to examine within-session associations between acceleration metrics and Action Research Arm Test performance. A mixed model was used to determine which metrics were sensitive to within-participant fluctuations in upper extremity function across the 7 training sessions. RESULTS Upper extremity function correlated with bilateral acceleration variability and use ratio during 5 and 6 sessions, respectively. Time accelerating between 76% and 100% of peak acceleration correlated with function in 6 sessions. Variability of the paretic upper extremity acceleration and the ratio of acceleration variability between upper extremities were associated with function during all 7 sessions. Variability in both the acceleration of the paretic upper extremity, and acceleration of the paretic and nonparetic extremities combined were sensitive to within-participant fluctuations in function across training sessions. DISCUSSION AND CONCLUSIONS Multiple features of the acceleration profile track with upper extremity function within and across sessions of task-specific training. It may be possible to monitor these features with accelerometers to index upper extremity function outside of clinical settings.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A91).
Collapse
|
187
|
Exploring the Role of Accelerometers in the Measurement of Real World Upper-Limb Use After Stroke. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.21] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ultimate goal of upper-limb rehabilitation after stroke is to promote real-world use, that is, use of the paretic upper-limb in everyday activities outside the clinic or laboratory. Although real-world use can be collected through self-report questionnaires, an objective indicator is preferred. Accelerometers are a promising tool. The current paper aims to explore the feasibility of accelerometers to measure upper-limb use after stroke and discuss the translation of this measurement tool into clinical practice. Accelerometers are non-invasive, wearable sensors that measure movement in arbitrary units called activity counts. Research to date indicates that activity counts are a reliable and valid index of upper-limb use. While most accelerometers are unable to distinguish between the type and quality of movements performed, recent advancements have used accelerometry data to produce clinically meaningful information for clinicians, patients, family and care givers. Despite this, widespread uptake in research and clinical environments remains limited. If uptake was enhanced, we could build a deeper understanding of how people with stroke use their arm in real-world environments. In order to facilitate greater uptake, however, there is a need for greater consistency in protocol development, accelerometer application and data interpretation.
Collapse
|
188
|
Levin MF, Liebermann DG, Parmet Y, Berman S. Compensatory Versus Noncompensatory Shoulder Movements Used for Reaching in Stroke. Neurorehabil Neural Repair 2015; 30:635-46. [PMID: 26510934 DOI: 10.1177/1545968315613863] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The extent to which the upper-limb flexor synergy constrains or compensates for arm motor impairment during reaching is controversial. This synergy can be quantified with a minimal marker set describing movements of the arm-plane. Objectives To determine whether and how (a) upper-limb flexor synergy in patients with chronic stroke contributes to reaching movements to different arm workspace locations and (b) reaching deficits can be characterized by arm-plane motion. Methods Sixteen post-stroke and 8 healthy control subjects made unrestrained reaching movements to targets located in ipsilateral, central, and contralateral arm workspaces. Arm-plane, arm, and trunk motion, and their temporal and spatial linkages were analyzed. Results Individuals with moderate/severe stroke used greater arm-plane movement and compensatory trunk movement compared to those with mild stroke and control subjects. Arm-plane and trunk movements were more temporally coupled in stroke compared with controls. Reaching accuracy was related to different segment and joint combinations for each target and group: arm-plane movement in controls and mild stroke subjects, and trunk and elbow movements in moderate/severe stroke subjects. Arm-plane movement increased with time since stroke and when combined with trunk rotation, discriminated between different subject groups for reaching the central and contralateral targets. Trunk movement and arm-plane angle during target reaches predicted the subject group. Conclusions The upper-limb flexor synergy was used adaptively for reaching accuracy by patients with mild, but not moderate/severe stroke. The flexor synergy, as parameterized by the amount of arm-plane motion, can be used by clinicians to identify levels of motor recovery in patients with stroke.
Collapse
Affiliation(s)
- Mindy F Levin
- McGill University, Montreal, Quebec, Canada Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
| | | | | | - Sigal Berman
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
189
|
Bae JH, Kang SH, Seo KM, Kim DK, Shin HI, Shin HE. Relationship Between Grip and Pinch Strength and Activities of Daily Living in Stroke Patients. Ann Rehabil Med 2015; 39:752-62. [PMID: 26605173 PMCID: PMC4654082 DOI: 10.5535/arm.2015.39.5.752] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/16/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the relationship between grip and pinch strength and independence in activities of daily living (ADL) in stroke patients. Methods Medical records of 577 stroke patients from January 2010 to February 2013 were retrospectively reviewed. Patients' grip and pinch strength of both hemiplegic and non-hemiplegic hands and the Korean version of Modified Barthel Index (K-MBI) score were collected. These patients were divided into three groups: group A (onset duration: ≤3 months), group B (onset duration: >3 months and <2 years), and group C (onset duration: ≥2 years). The correlation between grip and pinch strength and the K-MBI score was analyzed. Results In group A (95 patients), the K-MBI score was significantly (p<0.05) correlated with the grip and pinch strength of both hands in patients with right hemiplegia. Significant (p<0.05) correlation between the K-MBI score and the grip and pinch strength of the hemiplegic hand was shown in patients with left hemiplegia. In group B (69 patients) and group C (73 patients), the K-MBI score was significantly (p<0.05) correlated with the grip and pinch strength of the hemiplegic hand. Conclusion Stroke patients in subacute stage mainly performed activities of daily living using their dominant hand. However, independence in ADL was associated with the strength of the affected dominant hand. For stroke patients in chronic and late chronic stages, their hand power of the affected hand was associated with independence in ADL regardless whether the dominant hand was affected.
Collapse
Affiliation(s)
- Jung Hyun Bae
- Departments of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Si Hyun Kang
- Departments of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Mook Seo
- Departments of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Don-Kyu Kim
- Departments of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Iee Shin
- Departments of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Eun Shin
- Departments of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
190
|
Barden HLH, Baguley IJ, Nott MT, Chapparo C. Quantifying patterns of upper limb motor change following BTX-A injection in adult spasticity management. Brain Inj 2015; 29:1452-9. [DOI: 10.3109/02699052.2015.1071429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
191
|
Abstract
This article reviews the most common therapeutic and neuroprosthetic applications of neuromuscular electrical stimulation (NMES) for upper and lower extremity stroke rehabilitation. Fundamental NMES principles and purposes in stroke rehabilitation are explained. NMES modalities used for upper and lower limb rehabilitation are described, and efficacy studies are summarized. The evidence for peripheral and central mechanisms of action is also summarized.
Collapse
|
192
|
Abstract
PURPOSE OF REVIEW Stroke rehabilitation needs to take major steps forward to reduce functional disability for survivors. In this article, we suggest that spatial retraining might greatly increase the efficiency and efficacy of motor rehabilitation, directly addressing the burden and cost of paralysis after stroke. RECENT FINDINGS Combining motor and cognitive treatment may be practical, as well as addressing the needs after moderate-to-severe stroke. Spatial neglect could suppress motor recovery and reduce motor learning, even when patients receive appropriate rehabilitation to build strength, dexterity, and endurance. Spatial neglect rehabilitation acts to promote motor as well as visual-perceptual recovery. These findings, and the previous underemphasized studies, make a strong case for combining spatial neglect treatment with traditional exercise training. Spatial neglect therapies might also provide motor stimulation if people cannot participate in intensive movement therapies because of limited strength and endurance after stroke. SUMMARY Spatial retraining, currently used selectively after right-brain stroke, may be broadly useful after stroke to promote rapid motor recovery.
Collapse
|
193
|
Urbin MA, Harris-Love ML, Carter AR, Lang CE. High-Intensity, Unilateral Resistance Training of a Non-Paretic Muscle Group Increases Active Range of Motion in a Severely Paretic Upper Extremity Muscle Group after Stroke. Front Neurol 2015; 6:119. [PMID: 26074871 PMCID: PMC4445317 DOI: 10.3389/fneur.2015.00119] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/11/2015] [Indexed: 11/30/2022] Open
Abstract
Limited rehabilitation strategies are available for movement restoration when paresis is too severe following stroke. Previous research has shown that high-intensity resistance training of one muscle group enhances strength of the homologous, contralateral muscle group in neurologically intact adults. How this “cross education” phenomenon might be exploited to moderate severe weakness in an upper extremity muscle group after stroke is not well understood. The primary aim of this study was to examine adaptations in force-generating capacity of severely paretic wrist extensors resulting from high intensity, dynamic contractions of the non-paretic wrist extensors. A secondary, exploratory aim was to probe neural adaptations in a subset of participants from each sample using a single-pulse, transcranial magnetic stimulation (TMS) protocol. Separate samples of neurologically intact controls (n = 7) and individuals ≥4 months post stroke (n = 6) underwent 16 sessions of training. Following training, one-repetition maximum of the untrained wrist extensors in the control group and active range of motion of the untrained, paretic wrist extensors in the stroke group were significantly increased. No changes in corticospinal excitability, intracortical inhibition, or interhemispheric inhibition were observed in control participants. Both stroke participants who underwent TMS testing, however, exhibited increased voluntary muscle activation following the intervention. In addition, motor-evoked potentials that were unobtainable prior to the intervention were readily elicited afterwards in a stroke participant. Results of this study demonstrate that high-intensity resistance training of a non-paretic upper extremity muscle group can enhance voluntary muscle activation and force-generating capacity of a severely paretic muscle group after stroke. There is also preliminary evidence that corticospinal adaptations may accompany these gains.
Collapse
Affiliation(s)
- M A Urbin
- Program in Physical Therapy, Washington University School of Medicine , St. Louis, MO , USA
| | - Michelle L Harris-Love
- Georgetown University Medical Center, MedStar National Rehabilitation Hospital , Washington, DC , USA
| | - Alex R Carter
- Department of Neurology, Washington University School of Medicine , St. Louis, MO , USA
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine , St. Louis, MO , USA ; Department of Neurology, Washington University School of Medicine , St. Louis, MO , USA ; Program in Occupational Therapy, Washington University School of Medicine , St. Louis, MO , USA
| |
Collapse
|
194
|
Predicting recovery of voluntary upper extremity movement in subacute stroke patients with severe upper extremity paresis. PLoS One 2015; 10:e0126857. [PMID: 25973919 PMCID: PMC4431803 DOI: 10.1371/journal.pone.0126857] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. DESIGN Prospective cohort study. METHODS 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DC(STREAM-UE)) and changes between admission and discharge (Δ(STREAM-UE)), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. RESULTS The participants showed wide variation in both DC(STREAM-UE) and Δ(STREAM-UE). 3.6% of the participants almost fully recovered at discharge (DC(STREAM-UE) > 15). A large improvement (Δ(STREAM-UE) >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DC(STREAM-UE) (R(2) = 35.0%) were 'baseline STREAM-UE score', 'hemorrhagic stroke', 'baseline National Institutes of Health Stroke Scale (NIHSS) score', and 'cortical lesion excluding primary motor cortex'. The three predictors for the Δ(STREAM-UE) (R(2) = 22.0%) were 'hemorrhagic stroke', 'baseline NIHSS score', and 'cortical lesion excluding primary motor cortex'. CONCLUSIONS Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients with severe UE paresis after stroke.
Collapse
|
195
|
Urbin MA, Waddell KJ, Lang CE. Acceleration metrics are responsive to change in upper extremity function of stroke survivors. Arch Phys Med Rehabil 2015; 96:854-61. [PMID: 25497517 PMCID: PMC4410063 DOI: 10.1016/j.apmr.2014.11.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/14/2014] [Accepted: 11/23/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To (1) determine whether acceleration metrics derived from monitoring outside of treatment are responsive to change in upper extremity (UE) function; and secondarily to (2) compare metric values during task-specific training and while in the free-living environment, and (3) establish metric associations with an in-clinic measure of movement capabilities. DESIGN Before-after observational study. SETTING Inpatient hospital (primary purpose); outpatient hospital (secondary purpose). PARTICIPANTS Individuals (n=8) with UE hemiparesis <30 days poststroke (primary purpose); individuals (n=27) with UE hemiparesis ≥6 months poststroke (secondary purpose). INTERVENTION The inpatient sample was evaluated for UE movement capabilities and monitored with wrist-worn accelerometers for 22 hours outside of treatment before and after multiple sessions of task-specific training. The outpatient sample was evaluated for UE movement capabilities and monitored during a single session of task-specific training and the subsequent 22 hours outside clinical settings. MAIN OUTCOME MEASURES Action Research Arm Test (ARAT) and acceleration metrics quantified from accelerometer recordings. RESULTS Five metrics improved in the inpatient sample, along with UE function as measured on the ARAT: use ratio, magnitude ratio, variation ratio, median paretic UE acceleration magnitude, and paretic UE acceleration variability. Metric values were greater during task-specific training than in the free-living environment, and each metric was strongly associated with ARAT score. CONCLUSIONS Multiple metrics that characterize different aspects of UE movement are responsive to change in function. Metric values are different during training than in the free-living environment, providing further evidence that what the paretic UE does in the clinic may not generalize to what it does in everyday life.
Collapse
Affiliation(s)
- M A Urbin
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO.
| | - Kimberly J Waddell
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO; Department of Neurology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
196
|
Repšaitė V, Vainoras A, Berškienė K, Baltaduonienė D, Daunoravičienė A, Sendžikaitė E. The effect of differential training-based occupational therapy on hand and arm function in patients after stroke: Results of the pilot study. Neurol Neurochir Pol 2015; 49:150-5. [PMID: 26048602 DOI: 10.1016/j.pjnns.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/15/2015] [Accepted: 04/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of differential training-based occupational therapy on the recovery of arm function and to compare these data with the results obtained after conventional occupational therapy. METHODS A total of 27 patients who had suffered a cerebral infarction in the left brain hemisphere were recruited for the study. There were 9 men (33.33%) and 18 women (66.67%). All the patients had paresis of the right arm. The patients were divided into 2 groups: the control group comprised 15 patients who were given conventional occupational therapy (5 times per week) and the study group consisted of 12 patients who underwent conventional occupational therapy (3 times per week) along with occupational therapy based on differential training (2 times per week). RESULTS In the control group, the mean performance time of only 2 tasks, i.e., flip cards and fold towel, improved significantly (P<0.05), while significant deterioration in the mean performance time of the task "lift can" was observed (P<0.05). In the study group, the mean performance time of all the tasks except for forearm to box (side), hand to box (front), and lift paperclip improved significantly (P<0.05), and no deterioration in arm function was observed. CONCLUSION Both patients' groups improved arm function after occupational therapy sessions, but the patients who underwent conventional occupational therapy along with differential training-based occupational therapy recovered their arm function more effectively than their counterparts after conventional occupational therapy.
Collapse
Affiliation(s)
- Viktorija Repšaitė
- Institute of Sports, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Alfonsas Vainoras
- Institute of Sports, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Kristina Berškienė
- Institute of Sports, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Daiva Baltaduonienė
- Department of Rehabilitation, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Algė Daunoravičienė
- Institute of Sports, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Ernesta Sendžikaitė
- Institute of Sports, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| |
Collapse
|
197
|
Lee JA, Hwang PW, Kim EJ. Upper extremity muscle activation during drinking from a glass in subjects with chronic stroke. J Phys Ther Sci 2015; 27:701-3. [PMID: 25931712 PMCID: PMC4395696 DOI: 10.1589/jpts.27.701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/21/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the muscle activities of upper
extremities during a drinking task between the stroke-affected and less-affected sides.
[Subjects] Eight stroke patients (8 men; age 45.3 years; stroke duration 21.9 months)
participated in this study. [Methods] Electromyography (EMG) was used to measure nine
muscle activities of the upper extremity. The drinking task was divided into 5 phases.
[Results] Analysis of the EMG data showed that the percentage of maximum voluntary
isometric contraction (%MVIC) across all phases of drinking differed between the affected
and less-affected sides. Participants used relatively higher levels of %MVIC in the
anterior deltoid, flexor muscles, brachioradialis, and infraspinatus on the stoke-affected
side. [Conclusion] The difference in muscle activation across all phases of the drinking
movement allowed us to determine how upper extremity muscle activation may influence
drinking performance on the stroke-affected and less-affected sides.
Collapse
Affiliation(s)
- Jung Ah Lee
- Department of Motor and Cognitive Rehabilitation, Korea National Rehabilitation Research Institute, Republic of Korea
| | - Pil Woo Hwang
- Department of Motor and Cognitive Rehabilitation, Korea National Rehabilitation Research Institute, Republic of Korea
| | - Eun Joo Kim
- Department of Rehabilitation Medicine, Korea National Rehabilitation Hospital, Republic of Korea
| |
Collapse
|
198
|
Alt Murphy M, Resteghini C, Feys P, Lamers I. An overview of systematic reviews on upper extremity outcome measures after stroke. BMC Neurol 2015; 15:29. [PMID: 25880033 PMCID: PMC4359448 DOI: 10.1186/s12883-015-0292-6] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/25/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although use of standardized and scientifically sound outcome measures is highly encouraged in clinical practice and research, there is still no clear recommendation on which tools should be preferred for upper extremity assessment after stroke. As the aims, objectives and methodology of the existing reviews of the upper extremity outcome measures can vary, there is a need to bring together the evidence from existing multiple reviews. The purpose of this review was to provide an overview of evidence of the psychometric properties and clinical utility of upper extremity outcome measures for use in stroke, by systematically evaluating and summarizing findings from systematic reviews. METHODS A comprehensive systematic search was performed including systematic reviews from 2004 to February 2014. A methodological quality appraisal of the reviews was performed using the AMSTAR-tool. RESULTS From 13 included systematic reviews, 53 measures were identified of which 13 met the standardized criteria set for the psychometric properties. The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND. CONCLUSIONS This overview of systematic reviews provides a comprehensive systematic synthesis of evidence on which outcome measures demonstrate a high level of measurement quality and clinical utility and which can be considered as most suitable for upper extremity assessment after stroke. This overview can provide a valuable resource to assist clinicians, researchers and policy makers in selection of appropriate outcome measures.
Collapse
Affiliation(s)
- Margit Alt Murphy
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3tr, S- 413 45, Göteborg, Sweden.
| | - Carol Resteghini
- School of Health, Sport and Bioscience, University of East London, London, UK.
| | - Peter Feys
- REVAL-Rehabilitation Research Centre, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
| | - Ilse Lamers
- REVAL-Rehabilitation Research Centre, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
| |
Collapse
|
199
|
Bailey RR, Birkenmeier RL, Lang CE. Real-world affected upper limb activity in chronic stroke: an examination of potential modifying factors. Top Stroke Rehabil 2015; 22:26-33. [PMID: 25776118 DOI: 10.1179/1074935714z.0000000040] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Despite improvement in motor function after intervention, adults with chronic stroke experience disability in everyday activity. Factors other than motor function may influence affected upper limb (UL) activity. OBJECTIVE To characterize affected UL activity and examine potential modifying factors of affected UL activity in community-dwelling adults with chronic stroke. METHODS Forty-six adults with chronic stroke wore accelerometers on both ULs for 25 hours and provided information about potential modifying factors [time spent in sedentary activity, cognitive impairment, depressive symptomatology, number of comorbidities, motor dysfunction of the affected UL, age, activities of daily living (ADL) status, and living arrangement]. Accelerometry was used to quantify duration of affected and unaffected UL activity. The ratio of affected-to-unaffected UL activity was also calculated. Associations within and between accelerometry-derived variables and potential modifying factors were examined. RESULTS Mean hours of affected and unaffected UL activity were 5.0 ± 2.2 and 7.6 ± 2.1 hours respectively. The ratio of affected-to-unaffected UL activity was 0.64 ± 0.19, and hours of affected and unaffected UL activity were strongly correlated (r = 0.78). Increased severity of motor dysfunction and dependence in ADLs were associated with decreased affected UL activity. No other factors were associated with affected UL activity. CONCLUSIONS Severity of motor dysfunction and ADL status should be taken into consideration when setting goals for UL activity in people with chronic stroke. Given the strong, positive correlation between affected and unaffected UL activity, encouragement to increase activity of the unaffected UL may increase affected UL activity.
Collapse
|
200
|
Prochazka A, Kowalczewski J. A Fully Automated, Quantitative Test of Upper Limb Function. J Mot Behav 2015; 47:19-28. [DOI: 10.1080/00222895.2014.953442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|