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Sakamoto D, Hamaguchi T, Kanemura N, Yasojima T, Kubota K, Suwabe R, Nakayama Y, Abo M. Feature analysis of joint motion in paralyzed and non-paralyzed upper limbs while reaching the occiput: A cross-sectional study in patients with mild hemiplegia. PLoS One 2024; 19:e0295101. [PMID: 38781257 PMCID: PMC11115294 DOI: 10.1371/journal.pone.0295101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
The reaching motion to the back of the head with the hand is an important movement for daily living. The scores of upper limb function tests used in clinical practice alone are difficult to use as a reference when planning exercises for movement improvements. This cross-sectional study aimed to clarify in patients with mild hemiplegia the kinematic characteristics of paralyzed and non-paralyzed upper limbs reaching the occiput. Ten patients with post-stroke hemiplegia who attended the Department of Rehabilitation Medicine of the Jikei University Hospital and met the eligibility criteria were included. Reaching motion to the back of the head by the participants' paralyzed and non-paralyzed upper limbs was measured using three-dimensional motion analysis, and the motor time, joint angles, and angular velocities were calculated. Repeated measures multivariate analysis of covariance was performed on these data. After confirming the fit to the binomial logistic regression model, the cutoff values were calculated using receiver operating characteristic curves. Pattern identification using random forest clustering was performed to analyze the pattern of motor time and joint angles. The cutoff values for the movement until the hand reached the back of the head were 1.6 s for the motor time, 55° for the maximum shoulder joint flexion angle, and 145° for the maximum elbow joint flexion angle. The cutoff values for the movement from the back of the head to the hand being returned to its original position were 1.6 s for the motor time, 145° for the maximum elbow joint flexion angle, 53°/s for the maximum angular velocity of shoulder joint abduction, and 62°/s for the maximum angular velocity of elbow joint flexion. The numbers of clusters were three, four, and four for the outward non-paralyzed side, outward and return paralyzed side, and return non-paralyzed side, respectively. The findings obtained by this study can be used for practice planning in patients with mild hemiplegia who aim to improve the reaching motion to the occiput.
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Affiliation(s)
- Daigo Sakamoto
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo, Japan
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Toyohiro Hamaguchi
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Takashi Yasojima
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Keisuke Kubota
- Research Development Center, Saitama Prefectural University, Saitama, Japan
| | - Ryota Suwabe
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo, Japan
| | - Yasuhide Nakayama
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Wunderle V, Kuzu TD, Tscherpel C, Fink GR, Grefkes C, Weiss PH. Age- and sex-related changes in motor functions: a comprehensive assessment and component analysis. Front Aging Neurosci 2024; 16:1368052. [PMID: 38813530 PMCID: PMC11133706 DOI: 10.3389/fnagi.2024.1368052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
Age-related motor impairments often cause caregiver dependency or even hospitalization. However, comprehensive investigations of the different motor abilities and the changes thereof across the adult lifespan remain sparse. We, therefore, extensively assessed essential basic and complex motor functions in 444 healthy adults covering a wide age range (range 21 to 88 years). Basic motor functions, here defined as simple isolated single or repetitive movements in one direction, were assessed by means of maximum grip strength (GS) and maximum finger-tapping frequency (FTF). Complex motor functions, comprising composite sequential movements involving both proximal and distal joints/muscle groups, were evaluated with the Action Research Arm Test (ARAT), the Jebsen-Taylor Hand Function Test (JTT), and the Purdue Pegboard Test. Men achieved higher scores than women concerning GS and FTF, whereas women stacked more pins per time than men during the Purdue Pegboard Test. There was no significant sex effect regarding JTT. We observed a significant but task-specific reduction of basic and complex motor performance scores across the adult lifespan. Linear regression analyses significantly predicted the participants' ages based on motor performance scores (R2 = 0.502). Of note, the ratio between the left- and right-hand performance remained stable across ages for all tests. Principal Component Analysis (PCA) revealed three motor components across all tests that represented dexterity, force, and speed. These components were consistently present in young (21-40 years), middle-aged (41-60 years), and older (61-88 years) adults, as well as in women and men. Based on the three motor components, K-means clustering analysis differentiated high- and low-performing participants across the adult life span. The rich motor data set of 444 healthy participants revealed age- and sex-dependent changes in essential basic and complex motor functions. Notably, the comprehensive assessment allowed for generating robust motor components across the adult lifespan. Our data may serve as a reference for future studies of healthy subjects and patients with motor deficits. Moreover, these findings emphasize the importance of comprehensively assessing different motor functions, including dexterity, force, and speed, to characterize human motor abilities and their age-related decline.
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Affiliation(s)
- Veronika Wunderle
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Taylan D. Kuzu
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Caroline Tscherpel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gereon R. Fink
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Peter H. Weiss
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
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Fujimoto K, Ueno M, Etoh S, Shimodozono M. Combined repetitive facilitative exercise under continuous neuromuscular electrical stimulation and task-oriented training for hemiplegic upper extremity during convalescent phase after stroke: before-and-after feasibility trial. Front Neurol 2024; 15:1356732. [PMID: 38456153 PMCID: PMC10919145 DOI: 10.3389/fneur.2024.1356732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Whereas repetitive facilitative exercise (RFE) affects primarily recovery of motor impairment after stroke, task-oriented training (TOT) focuses on facilitating daily use of the affected upper extremity. However, feasibility of combined RFE and TOT has not been reported. We originated "task-oriented RFE," as a new combination therapy for patients with hemiplegic upper extremity after subacute stroke, to examine its feasibility in convalescent rehabilitation wards. Methods This is a before-and-after pilot study. Eight patients with hemiplegic upper extremity after subacute stroke received the task-oriented RFE program for 6 weeks at 80 min per day (20-60 min of TOT applied after 60-20 min of RFE under continuous neuromuscular electrical stimulation) in a convalescent rehabilitation ward. In the current program, we introduced the Aid for Decision-making in Occupation Choice (ADOC) iPad application as a goal-setting method for determining tasks. Feasibility was assessed with adherence to the protocol, adverse events in response to the intervention, and preliminary efficacy. Motor functions, amount of use and quality of movement in the hemiparetic upper extremity, and satisfaction of the patients were evaluated with Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the motor activity log (MAL) for the amount of use (AOU) and quality of movement (QOM) of the paralyzed hand, and ADOC. Results All participants accomplished the program, which was implemented as originally planned; neither nonattendance nor an adverse event occurred during the study. Favorable outcomes were obtained with all measures; mean changes in FMA, ARAT in the dominant hand, MAL-AOU, and MAL-QOM were greater than minimal clinically important differences. Mean changes in ADOC were greater than the minimal detectable change. Discussion The task-oriented RFE program was safe, well-tolerated, beneficial, and feasible within 80 min a day of occupational therapy, which means also within the procedural constraints of the Japanese health insurance system during the convalescent phase. Future studies are warranted to examine whether combined RFE and TOT enhances the efficacies of each program alone.
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Affiliation(s)
- Koya Fujimoto
- Department of Rehabilitation, Kirishima Sugiyasu Hospital, Kirishima, Kagoshima, Japan
| | - Makoto Ueno
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Amano S, Umeji A, Takahashi K, Takebayashi T, Uchiyama Y, Domen K. Psychometric properties of the Action Research Arm Test using decision rules for skipping items in hemiparetic patients after stroke: a retrospective study. Disabil Rehabil 2023; 45:4471-4477. [PMID: 36476063 DOI: 10.1080/09638288.2022.2153177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Important properties have been studied using the Action Research Arm Test (ARAT) in patients with stroke. However, whether the ARAT subtests constitute a Guttman scale (i.e., items hierarchically ordered according to difficulty) remains unclear. Guttman scales can define decision rules for skipping items in patients with low endurance. This study investigated the psychometric properties of the ARAT when applying decision rules for post-stroke hemiparetic patients. METHODS A retrospective, single-institution study was conducted between 2020 and 2021. Datasets of 30 patients with stroke-induced hemiparesis were collected from a previous study which employed the ARAT without decision rules, Fugl-Meyer assessment (FMA), Box and Block Test (BBT), and Motor Activity Log (MAL). The ARAT was rescored with decision rules for this study, and inter-rater reliability/agreement, parallel forms reliability, and construct validity were assessed. RESULTS Parallel forms reliability (Spearman's rho) was 0.99 (95% CI, 0.99-0.99) for both raters. The lower 95% CI limits of the sum and individual item scores in the reliability analysis exceeded the planned value (0.8). Construct validity values exceeded the planned value (0.8) for FMA, BBT, and MAL. CONCLUSION Decision rules can be used to skip ARAT items when assessing upper extremity motor function in stroke patients.IMPLICATIONS FOR REHABILITATIONThe Action Research Arm Test with decision rules for skipping items was valid and reliable for measuring upper extremity motor function in hemiparetic patients after stroke.The decision rules may reduce the burden of both patients and evaluators by decreasing the number of Action Research Arm Test items to be administrated.
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Affiliation(s)
- Satoru Amano
- Occupational Therapy Course, Department of Rehabilitation, Kitasato University, Kanagawa, Japan
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Atsushi Umeji
- Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine College Hospital, Nishinomiya, Japan
| | - Kayoko Takahashi
- Occupational Therapy Course, Department of Rehabilitation, Kitasato University, Kanagawa, Japan
| | - Takashi Takebayashi
- Department of Occupational Therapy, School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
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Selves C, Lejeune T, Detrembleur C, Haustrate MA, Stoquart G. Validity and reliability of the assessment of hand flexors stiffness using a new electromechanical oscillatory device in people with stroke. Int J Rehabil Res 2023; 46:170-177. [PMID: 36916037 DOI: 10.1097/mrr.0000000000000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Hyper-resistance after a central nervous system injury has been largely referred to as spasticity, which is but one of its neural components. Assessment largely relies on clinical scales (Modified Ashworth scale - MAS and Modified Tardieu scale, MTS) which are unable to distinguish between the non-neural (tissue-related) and the neural (central nervous system-related) components. This study assessed criterion validity and reliability (reproducibility) of muscle stiffness measures, namely, maximum elastic stiffness (ELmax), viscous stiffness (VI), and path length (L-path) in the hand flexor muscles among people with stroke. Measurements were obtained with a wrist-electromechanical oscillatory device (w-EOD). Twenty-four people with arm impairment after stroke were evaluated with the w-EOD and clinical assessment (MAS and MTS), twice on the same day (short-term reliability) and once 10 days later (long-term reliability). For criterion validity, a Spearman coefficient ( r ) was calculated between stiffness values and the clinical scales. For reliability, intraclass correlation coefficients (ICCs), SEM, and MDC95 were calculated. Moderate correlations were observed between EL max and MAS ( r = 0.49) and MTS (V2, r = 0.43; V3, r = 0.49) of the wrist flexors, and finger flexors (MAS, r = 0.60; MTS V2, r = 0.56; MTS V3, r = 0.55). There was a poor correlation between the clinical scales and VI and L-path. Reliability was excellent for all stiffness measurements at short term (EL max : 0.95, VI: 0.94, L-path: 0.92) and good at long term (EL max : 0.87, VI: 0.76, L-path: 0.82). In conclusion, stiffness measurements are valid and reliable to evaluate hyper-resistance in people with stroke.
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Affiliation(s)
- Clara Selves
- Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate
- Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Avenue Mounier, Brussels
| | - Thierry Lejeune
- Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate
- Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Avenue Mounier, Brussels
| | - Christine Detrembleur
- Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Avenue Mounier, Brussels
| | - Marie-Adeline Haustrate
- Department of Physical Medicine and Rehabilitation, Cliniques Saint Pierre, Avenue Reine Fabiola, Ottignies, Belgium
| | - Gaëtant Stoquart
- Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate
- Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Avenue Mounier, Brussels
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Hamer O, Hill JE, Zafar M, Morgan N. Effectiveness of mental practice for limb dysfunction in patients who have experienced a stroke: a systematic review and meta-analysis. BRITISH JOURNAL OF NEUROSCIENCE NURSING 2023; 19:S23-S26. [PMID: 38807859 PMCID: PMC7616017 DOI: 10.12968/bjnn.2023.19.sup2.s23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Stroke is the second largest cause of death in adults and the principal cause of long-term severe adult disability worldwide. Approximately 70% of patients present with upper limb weakness following stroke. One intervention for the treatment of upper limb impairment post-stroke is mental practice. This article critically appraises a systematic review which assesses the effectiveness of mental practice for limb dysfunction in patients who have experienced stroke.
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Juckett LA, Wengerd LR, Banhos M, Darragh AR. Conducting Implementation Research in Stroke Rehabilitation: A Case Example and Considerations for Study Design. Neurorehabil Neural Repair 2022; 36:770-776. [PMID: 36398961 DOI: 10.1177/15459683221138747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As neurorehabilitation research continues to grow, the field must ensure its scientific discoveries are implemented into routine clinical care. Without targeted efforts to increase the implementation of evidence into practice, patients may never see the benefits of interventions, assessments, and technologies developed in the confines of empirical studies. This article serves as a response to Lynch et al's 2018 Point of View piece in Neurorehabilitation and Neural Repair that underscored the urgent need for implementation studies to expedite the application of neurorehabilitation evidence in practice. To address this need, we provide the following 4 considerations investigators should contemplate when designing their own studies at the intersection of implementation and neurorehabilitation research: (a) consideration of guiding theories, models, and frameworks, (b) consideration of implementation strategies, (c) considerations of target outcomes, and (d) consideration of hybrid effectiveness-implementation designs. To conclude, we also provide a study exemplar to depict how these considerations can be integrated into the neurorehabilitation research field to narrow the evidence-to-practice gap.
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Affiliation(s)
- Lisa A Juckett
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
| | - Lauren R Wengerd
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
| | - Meredith Banhos
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Amy R Darragh
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
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Santamaría-Peláez M, Pardo-Hernández R, González-Bernal JJ, Soto-Cámara R, González-Santos J, Fernández-Solana J. Reliability and Validity of the Motor Activity Log (MAL-30) Scale for Post-Stroke Patients in a Spanish Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14964. [PMID: 36429681 PMCID: PMC9690477 DOI: 10.3390/ijerph192214964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The validation of assessment instruments is of great importance when they are applied in clinical and healthcare settings, since their safe and reliable use is essential for the application of appropriate and high-quality treatments. The motor activity log (MAL-30) is an instrument widely used by professionals in the clinic, which has been validated in different countries, languages and populations. The aim of this study was to determine the reliability and validity of the MAL-30 scale for post-stroke patients in a Spanish sample. METHODS For this purpose, internal consistency tests were carried out using Cronbach's alpha, item-item and item-total correlations, and a half-and-half test for reliability. For the validation, criterion validity tests were performed using the Fugl-Meyer assessment scale as the gold standard, and the convergent validity tests were carried out by correlation with the action research arm test (ARAT), box and block test (BBT), functional independence measure (FIM)-functional assessment measure (FAM), Lawton and Brody index and stroke quality of life scale (ECVI-38). RESULTS The results showed good internal consistency, as well as a good criterion and convergent validity. CONCLUSIONS The MAL-30 instrument can be considered a valid and reliable tool for assessing the quantity and quality of the use of the affected upper limb in the performance of the activities of daily living and the instrumental activities of daily living after stroke in a Spanish sample.
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Fernández-Solana J, Pardo-Hernández R, González-Bernal JJ, Sánchez-González E, González-Santos J, Soto-Cámara R, Santamaría-Pelaez M. Psychometric Properties of the Action Research Arm Test (ARAT) Scale in Post-Stroke Patients-Spanish Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14918. [PMID: 36429637 PMCID: PMC9690867 DOI: 10.3390/ijerph192214918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
The validation of measuring instruments in the field of health is a requirement before they can be used safely and reliably. The action research arm test (ARAT) tool is an instrument validated in numerous countries and languages and for different populations, and its use is widespread. The objective of this research was to determine the psychometric properties of ARAT for a sample composed of post-stroke patients. To achieve this, a psychometric analysis was performed, where internal consistency tests were carried out using Cronbach's alpha, correlations between items and item-total and half-level tests to verify their reliability. Regarding validity, criteria validity tests were performed, taking the motor function dimension of the Fugl-Meyer scale as gold standard, and convergent validity tests were performed by correlation with the FIM-FAM, ECVI-38 and Lawton and Brody scales. The results showed very good internal consistency as well as good criterion and convergent validity. In conclusion, the ARAT can be considered a valid and reliable instrument for the evaluation of upper limb function in post-stroke patients.
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Affiliation(s)
| | | | | | | | | | - Raúl Soto-Cámara
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain
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Wu X, Zhang Q, Qiao J, Chen N, Wu X. Calligraphy-based rehabilitation exercise for improving the upper limb function of stroke patients: protocol for an evaluator-blinded randomised controlled trial. BMJ Open 2022; 12:e052046. [PMID: 35568494 PMCID: PMC9109027 DOI: 10.1136/bmjopen-2021-052046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/29/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A common complication of stroke is upper limb dysfunction. Chinese calligraphy handwriting (CCH) is an aesthetical exercise developed from the traditional way of writing in China and holds potential to become a rehabilitation method to improve upper limb functions in patients with stroke. This study aims to design a randomised controlled trial to assess the effect of a customised CCH-based exercise for poststroke rehabilitation of upper limb dysfunction. METHODS AND ANALYSIS A single-blinded randomised controlled trial will be conducted on 60 stroke patients. The patients will be randomly allocated into three groups: (1) conventional occupational therapy (COT) group, (2) COT+CCH group, (3) COT+Graded Repetitive Arm Supplementary Program (GRASP) group. For the COT group, patients will receive COT treatment of 1 hour/day. For the COT+CCH group, patients will receive 30 mins COT treatment and 30 mins CCH training. For the COT+GRASP group, patients will receive 30 mins COT treatment and 30 mins GRASP training. All the interventions will be performed 5 days per week for a total of 3 weeks. The upper limb functions will be assessed before and after the interventions using a series of rating scales. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Committees of the Second Rehabilitation Hospital of Shanghai (study ID: 2020-32-01) and the Shanghai University of Sport (study ID: 102772021RT043). Results will be directly disseminated to the patients at the end of the study and to the public via publications in peer-reviewed journals and presentations in conferences. TRIAL REGISTRATION NUMBER ChiCTR 2100043036; Chinese Clinical Trials Registry.
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Affiliation(s)
- Xiaodi Wu
- School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Qiang Zhang
- Institute for Biomechanics, ETH Zürich, Zurich, Switzerland
| | - Jun Qiao
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, People's Republic of China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Afliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People's Republic of China
| | - Xie Wu
- School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
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Werner C, Schönhammer JG, Steitz MK, Lambercy O, Luft AR, Demkó L, Easthope CA. Using Wearable Inertial Sensors to Estimate Clinical Scores of Upper Limb Movement Quality in Stroke. Front Physiol 2022; 13:877563. [PMID: 35592035 PMCID: PMC9110656 DOI: 10.3389/fphys.2022.877563] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Neurorehabilitation is progressively shifting from purely in-clinic treatment to therapy that is provided in both clinical and home-based settings. This transition generates a pressing need for assessments that can be performed across the entire continuum of care, a need that might be accommodated by application of wearable sensors. A first step toward ubiquitous assessments is to augment validated and well-understood standard clinical tests. This route has been pursued for the assessment of motor functioning, which in clinical research and practice is observation-based and requires specially trained personnel. In our study, 21 patients performed movement tasks of the Action Research Arm Test (ARAT), one of the most widely used clinical tests of upper limb motor functioning, while trained evaluators scored each task on pre-defined criteria. We collected data with just two wrist-worn inertial sensors to guarantee applicability across the continuum of care and used machine learning algorithms to estimate the ARAT task scores from sensor-derived features. Tasks scores were classified with approximately 80% accuracy. Linear regression between summed clinical task scores (across all tasks per patient) and estimates of sum task scores yielded a good fit (R 2 = 0.93; range reported in previous studies: 0.61-0.97). Estimates of the sum scores showed a mean absolute error of 2.9 points, 5.1% of the total score, which is smaller than the minimally detectable change and minimally clinically important difference of the ARAT when rated by a trained evaluator. We conclude that it is feasible to obtain accurate estimates of ARAT scores with just two wrist worn sensors. The approach enables administration of the ARAT in an objective, minimally supervised or remote fashion and provides the basis for a widespread use of wearable sensors in neurorehabilitation.
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Affiliation(s)
- Charlotte Werner
- Spinal Cord Injury Research Center, University Hospital Balgrist, Zurich, Switzerland
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Josef G. Schönhammer
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), Vitznau, Switzerland
| | - Marianne K. Steitz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Zurich, Singapore
| | - Andreas R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - László Demkó
- Spinal Cord Injury Research Center, University Hospital Balgrist, Zurich, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), Vitznau, Switzerland
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Zonjee VJ, Selles RW, Roorda LD, Nijland RH, van der Oest MJW, Bosomworth HJ, van Wijck F, Meskers CGM, van Schaik SM, Van den Berg-Vos RM, Kwakkel G. Reducing the number of test items of the Action Research Arm Test post stroke: A decision tree analysis. Arch Phys Med Rehabil 2022; 103:1582-1591. [PMID: 34998711 DOI: 10.1016/j.apmr.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
Objective - The present study aimed to create a shorter version of the Action Research Arm Test (ARAT) without compromising its measurement properties. Design - Secondary analysis of stroke recovery cohorts that used the ARAT to measure upper-limb impairment. Setting - Rehabilitation centers. Participants - Patients with stroke from five different stroke recovery cohorts. Interventions - Not applicable. Main Outcome Measures - A decision tree version of the ARAT (ARAT-DT) was developed using Chi-squared Automated Interaction Detection (CHAID). In an independent validation subset, criterion validity, agreement of ARAT-DT with original ARAT scores and score categories, and construct validity with the Fugl-Meyer upper extremity (FM-UE) score were determined. Results - In total, 3738 ARAT measurements were available involving 1,425 subjects. CHAID analysis in the development subset (n=2803) revealed an optimized decision tree with a maximum of four consecutive items. In the validation dataset (n=935), the ARAT-DT differed by a mean of 0.19 points (0.3% of the total scale) from the original ARAT scores (limits of agreement: -5.67 to 6.05). The ARAT-DT demonstrated excellent criterion validity with the original ARAT scores (ICC=0.99 and ρ=0.99) and scoring categories (κw=0.97). The ARAT-DT showed very good construct validity with the FM-UE motor scale (ρ=0.92). Conclusion - A decision tree version of the ARAT was developed, reducing the maximum number of items necessary for ARAT administration from 19 to 4. The scores produced by the decision tree had excellent criterion validity with original ARAT scores.
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Affiliation(s)
- V J Zonjee
- Department of Neurology, OLVG, Amsterdam, the Netherlands.
| | - R W Selles
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic and Reconstructive Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - L D Roorda
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - R H Nijland
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre Reade, Amsterdam, the Netherlands
| | - M J W van der Oest
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic and Reconstructive Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - H J Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - F van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - C G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - S M van Schaik
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - R M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, the Netherlands; Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - G Kwakkel
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre Reade, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Neuromuscular electrical stimulation restores upper limb sensory-motor functions and body representations in chronic stroke survivors. MED 2022; 3:58-74.e10. [DOI: 10.1016/j.medj.2021.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/08/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
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14
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Egger M, Steinböck M, Müller F, Bergmann J. The German version of the Stroke Upper Limb Capacity Scale: Translation, cross-cultural adaption and evaluation of its psychometric properties. Clin Rehabil 2021; 36:272-282. [PMID: 34789042 DOI: 10.1177/02692155211043502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the psychometric properties of a newly developed German version of the Stroke Upper Limb Capacity Scale (SULCS). DESIGN Prospective cohort study. SETTING Neurorehabilitation clinic. SUBJECTS Patients after stroke (n = 50) with moderate to severe upper limb hemiparesis undergoing inpatient rehabilitation. INTERVENTION Not applicable. MAIN MEASURES The SULCS was administered twice by two different raters on the first day of assessments and another time the day after. Additionally the Fugl-Meyer-Assessment, Action Research Arm Test and the Box and Block Test were conducted. Three and six weeks later, the SULCS, Fugl-Meyer-Assessment and Box and Block Test were repeated. Floor and ceiling effects were analyzed. RESULTS Reliability was demonstrated to be excellent as displayed by weighted kappa of 0.960 (95%-confidence interval: CIκw = 0.808-1.112) for the intra-rater reliability and 0.936 (CIκw = 0.749-1.123) for the inter-rater reliability. High correlations of the SULCS with the Fugl-Meyer-Assessment (ρ = 0.889), Action Research Arm Test (ρ = 0.872), and Box and Block Test (ρ = 0.845; all P < 0.001) confirmed a high convergent validity. The longitudinal validity was determined by a moderate to high correlation of the SULCS and Box and Block Test changes (ρ ⩾ 0.695, P ⩽ 0.001). Although floor effects were observed for the SULCS (16%), they were more substantial for the Action Research Arm Test and the Box and Block Test (>38%). CONCLUSION Due to the good to excellent psychometric properties and the low level of floor effects of the German version of the SULCS, the usage for clinical and scientific purposes can be recommended.
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Affiliation(s)
| | | | | | - Jeannine Bergmann
- Schoen Clinic Bad Aibling, Bad Aibling, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Munich, Germany
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15
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Zbytniewska M, Kanzler CM, Jordan L, Salzmann C, Liepert J, Lambercy O, Gassert R. Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke. J Neuroeng Rehabil 2021; 18:115. [PMID: 34271954 PMCID: PMC8283922 DOI: 10.1186/s12984-021-00904-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations \documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations (\documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ=0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other (\documentclass[12pt]{minimal}
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\begin{document}$$\rho \le$$\end{document}ρ≤0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile. Conclusions The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00904-5.
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Affiliation(s)
- Monika Zbytniewska
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Lisa Jordan
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christian Salzmann
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Joachim Liepert
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
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16
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Wilson N, Howel D, Bosomworth H, Shaw L, Rodgers H. Analysing the Action Research Arm Test (ARAT): a cautionary tale from the RATULS trial. Int J Rehabil Res 2021; 44:166-169. [PMID: 33741815 PMCID: PMC8104013 DOI: 10.1097/mrr.0000000000000466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
Many studies of stroke rehabilitation use the Action Research Arm Test (ARAT) as an outcome, which measures upper limb function by scoring the ability to complete functional tasks. This report describes an issue encountered when analysing the ARAT subscales in a trial of upper limb therapies after stroke. The subscales of the ARAT at three months followed a 'U-shaped' distribution, and therefore, comparing means or medians was not appropriate. A simple alternative approach was chosen that dichotomised the subscales. When analysing the ARAT, the shape of the distributions must be checked in order to choose the most appropriate descriptive and inferential statistical techniques. In particular, if the data follows a 'U-shaped' distribution, a simple dichotomising or a more sophisticated approach is needed. These should also be considered for heavily skewed distributions, often arising from substantial floor or ceiling effects. Inappropriate analyses can lead to misleading conclusions.
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Affiliation(s)
| | | | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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17
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Subramanian SK, Baniña MC, Turolla A, Levin MF. Reaching performance scale for stroke - Test-retest reliability, measurement error, concurrent and discriminant validity. PM R 2021; 14:337-347. [PMID: 33675151 DOI: 10.1002/pmrj.12584] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Post-stroke upper limb motor improvement can be better quantified by describing movement patterns characterizing movement quality and use of compensations. Movement patterns can be described using both kinematic and clinical outcomes. One clinical outcome that assesses movement quality and compensations used for reaching a Close (18 points) and Far target (18 points) is the Reaching Performance Scale for Stroke (RPSS). OBJECTIVE To estimate the pilot test-retest reliability and validity (concurrent, discriminant) of the RPSS in individuals with chronic stroke. DESIGN Retrospective data analysis. SETTING Research laboratory. PARTICIPANTS Seventy-two individuals with upper limb hemiparesis ≥6 months prior to participation. INTERVENTION Not applicable. MAIN OUTCOME MEASURE RPSS Close and Far Target scores. Intraclass correlation coefficients (ICCs) helped assess pilot test-retest reliability on a subset of 14 participants. Concurrent validity was assessed for individual RPSS items with corresponding kinematic outcomes (trunk displacement, shoulder flexion, shoulder horizontal adduction, elbow extension, trajectory straightness) using Pearson correlations. We also ran multiple regression analyses with the RPSS total scores and used kinematic outcomes as the criterion standard. Logistic regression analyses estimated discriminant validity. We divided participants into two groups based on the Fugl-Meyer Assessment (FMA) scores (mild: ≥50/66; moderate-to-severe: ≤49/66). RESULTS Test-retest reliability was excellent for Close (ICC = 0.98, 95% confidence interval [CI] 0.94-0.99) and Far targets (ICC = 0.98, 95% CI 0.95-0.99). Individual RPSS items for both targets were mildly to moderately correlated with corresponding kinematic values. A combination of trajectory straightness, elbow extension, and trunk displacement explained the majority of the variance in RPSS scores (47%) for both targets. The RPSS scores discriminated between individuals with mild and moderate-to-severe motor impairment for both Close (ExpB = 3.33, P < .001; 95% CI 1.70-6.52) and Far targets (ExpB = 2.59, P < .001, 95% CI 1.65-4.07). Cutoff points for transition between groups were 15.5 (Close target) and 14 (Far target). CONCLUSION The RPSS is a valid clinical measure with excellent pilot results of test-retest reliability for assessing movement patterns and compensations used for reaching.
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Affiliation(s)
- Sandeep K Subramanian
- Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada.,Feil-Oberfeld JRH CRIR Research Centre, Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Melanie C Baniña
- Feil-Oberfeld JRH CRIR Research Centre, Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, Ospedale San Camillo IRCCS, Venice, Italy
| | - Mindy F Levin
- Feil-Oberfeld JRH CRIR Research Centre, Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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18
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Selles RW, Andrinopoulou ER, Nijland RH, van der Vliet R, Slaman J, van Wegen EE, Rizopoulos D, Ribbers GM, Meskers CG, Kwakkel G. Computerised patient-specific prediction of the recovery profile of upper limb capacity within stroke services: the next step. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-324637. [PMID: 33479046 PMCID: PMC8142441 DOI: 10.1136/jnnp-2020-324637] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/16/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Predicting upper limb capacity recovery is important to set treatment goals, select therapies and plan discharge. We introduce a prediction model of the patient-specific profile of upper limb capacity recovery up to 6 months poststroke by incorporating all serially assessed clinical information from patients. METHODS Model input was recovery profile of 450 patients with a first-ever ischaemic hemispheric stroke measured using the Action Research Arm Test (ARAT). Subjects received at least three assessment sessions, starting within the first week until 6 months poststroke. We developed mixed-effects models that are able to deal with one or multiple measurements per subject, measured at non-fixed time points. The prediction accuracy of the different models was established by a fivefold cross-validation procedure. RESULTS A model with only ARAT time course, finger extension and shoulder abduction performed as good as models with more covariates. For the final model, cross-validation prediction errors at 6 months poststroke decreased as the number of measurements per subject increased, from a median error of 8.4 points on the ARAT (Q1-Q3:1.7-28.1) when one measurement early poststroke was used, to 2.3 (Q1-Q3:1-7.2) for seven measurements. An online version of the recovery model was developed that can be linked to data acquisition environments. CONCLUSION Our innovative dynamic model can predict real-time, patient-specific upper limb capacity recovery profiles up to 6 months poststroke. The model can use all available serially assessed data in a flexible way, creating a prediction at any desired moment poststroke, stand-alone or linked with an electronic health record system.
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Affiliation(s)
- Ruud W Selles
- Rehabilitation Medicine & Plastic and Reconstructive Surgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | | | - Rick van der Vliet
- Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
- Neuroscience - University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands
| | - Jorrit Slaman
- Rijndam Rehabilitation Center, Rotterdam, Netherlands
| | - Erwin Eh van Wegen
- Rehabilitation Medicine, Amsterdam UMC - Location VUMC, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Dimitris Rizopoulos
- Biostatistics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Gerard M Ribbers
- Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
- Rijndam Rehabilitation Center, Rotterdam, Netherlands
| | - Carel Gm Meskers
- Rehabilitation Medicine, Amsterdam UMC - Location VUMC, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Gert Kwakkel
- Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
- Rehabilitation Medicine, Amsterdam UMC - Location VUMC, Amsterdam Movement Sciences, Amsterdam, Netherlands
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19
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Hordacre B, Lotze M, Jenkinson M, Lazari A, Barras CD, Boyd L, Hillier S. Fronto-parietal involvement in chronic stroke motor performance when corticospinal tract integrity is compromised. NEUROIMAGE-CLINICAL 2021; 29:102558. [PMID: 33513561 PMCID: PMC7841401 DOI: 10.1016/j.nicl.2021.102558] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preserved integrity of the corticospinal tract (CST) is a marker of good upper-limb behavior and recovery following stroke. However, there is less understanding of neural mechanisms that might help facilitate upper-limb motor recovery in stroke survivors with extensive CST damage. OBJECTIVE The purpose of this study was to investigate resting state functional connectivity in chronic stroke survivors with different levels of CST damage and to explore neural correlates of greater upper-limb motor performance in stroke survivors with compromised ipsilesional CST integrity. METHODS Thirty chronic stroke survivors (24 males, aged 64.7 ± 10.8 years) participated in this study. Three experimental sessions were conducted to: 1) obtain anatomical (T1, T2) structural (diffusion) and functional (resting state) MRI sequences, 2) determine CST integrity with transcranial magnetic stimulation (TMS) and conduct assessments of upper-limb behavior, and 3) reconfirm CST integrity status. Participants were divided into groups according to the extent of CST damage. Those in the extensive CST damage group did not show TMS evoked responses and had significantly lower ipsilesional fractional anisotropy. RESULTS Of the 30 chronic stroke survivors, 12 were categorized as having extensive CST damage. Stroke survivors with extensive CST damage had weaker functional connectivity in the ipsilesional sensorimotor network and greater functional connectivity in the ipsilesional fronto-parietal network compared to those with preserved CST integrity. For participants with extensive CST damage, improved motor performance was associated with greater functional connectivity of the ipsilesional fronto-parietal network and higher fractional anisotropy of the ipsilesional rostral superior longitudinal fasciculus. CONCLUSIONS Stroke survivors with extensive CST damage have greater resting state functional connectivity of an ipsilesional fronto-parietal network that appears to be a behaviorally relevant neural mechanism that improves upper-limb motor performance.
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Affiliation(s)
- Brenton Hordacre
- University of South Australia, IIMPACT in Health, Adelaide, Australia.
| | - Martín Lotze
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Alberto Lazari
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Christen D Barras
- South Australian Health and Medical Research Institute, Adelaide, Australia; The University of Adelaide, Adelaide, Australia
| | - Lara Boyd
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Susan Hillier
- University of South Australia, IIMPACT in Health, Adelaide, Australia
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20
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Edwards JD, Black SE, Boe S, Boyd L, Chaves A, Chen R, Dukelow S, Fung J, Kirton A, Meltzer J, Moussavi Z, Neva J, Paquette C, Ploughman M, Pooyania S, Rajji TK, Roig M, Tremblay F, Thiel A. Canadian Platform for Trials in Noninvasive Brain Stimulation (CanStim) Consensus Recommendations for Repetitive Transcranial Magnetic Stimulation in Upper Extremity Motor Stroke Rehabilitation Trials. Neurorehabil Neural Repair 2021; 35:103-116. [PMID: 33410386 DOI: 10.1177/1545968320981960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective. To develop consensus recommendations for the use of repetitive transcranial magnetic stimulation (rTMS) as an adjunct intervention for upper extremity motor recovery in stroke rehabilitation clinical trials. Participants. The Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim) convened a multidisciplinary team of clinicians and researchers from institutions across Canada to form the CanStim Consensus Expert Working Group. Consensus Process. Four consensus themes were identified: (1) patient population, (2) rehabilitation interventions, (3) outcome measures, and (4) stimulation parameters. Theme leaders conducted comprehensive evidence reviews for each theme, and during a 2-day Consensus Meeting, the Expert Working Group used a weighted dot-voting consensus procedure to achieve consensus on recommendations for the use of rTMS as an adjunct intervention in motor stroke recovery rehabilitation clinical trials. Results. Based on best available evidence, consensus was achieved for recommendations identifying the target poststroke population, rehabilitation intervention, objective and subjective outcomes, and specific rTMS parameters for rehabilitation trials evaluating the efficacy of rTMS as an adjunct therapy for upper extremity motor stroke recovery. Conclusions. The establishment of the CanStim platform and development of these consensus recommendations is a first step toward the translation of noninvasive brain stimulation technologies from the laboratory to clinic to enhance stroke recovery.
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Affiliation(s)
- Jodi D Edwards
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Sandra E Black
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Shaun Boe
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lara Boyd
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Arthur Chaves
- Memorial University, St John's, Newfoundland, Canada
| | - Robert Chen
- Toronto Western Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Joyce Fung
- McGill University, Montreal, Quebec, Canada
| | - Adam Kirton
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Jason Neva
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Tarek K Rajji
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marc Roig
- McGill University, Montreal, Quebec, Canada
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21
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O’Brien J, Bracewell RM, Castillo JA. The effects of kinesthetic and visual motor imagery on interjoint coordination in the hemiplegic index finger: an experimental study using the index of temporal coordination. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2021. [DOI: 10.1590/2526-8910.ctoao2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Upper limb hemiparesis is a common impairment following stroke and can affect interjoint coordination. Motor imagery training is one treatment strategy. However, motor imagery can use visual or kinesthetic modalities and there has been a lack of research comparing the effectiveness of these modalities when treating the upper limb. The aim of this study was to compare visual and kinesthetic motor imagery in improving interjoint coordination in the hemiparetic index finger. Fifteen stroke survivors with upper limb hemiparesis were allocated to groups using kinesthetic or visual motor imagery, or a control group using guided relaxation. Reaching and grasping movements of the upper limb were captured using optoelectronic motion capture. Interjoint coordination of the hemiparetic index finger was analysed using the index of temporal coordination. No significant differences were found for interjoint coordination following treatment in either condition. Future work should focus on comparing kinesthetic and visual motor imagery in the rehabilitation of more proximal upper limb joints.
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22
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Hordacre B, Goldsworthy MR, Welsby E, Graetz L, Ballinger S, Hillier S. Resting State Functional Connectivity Is Associated With Motor Pathway Integrity and Upper-Limb Behavior in Chronic Stroke. Neurorehabil Neural Repair 2020; 34:547-557. [PMID: 32436426 DOI: 10.1177/1545968320921824] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background. Resting state functional connectivity (RSFC) is a developmental priority for stroke recovery. Objective. To determine whether (1) RSFC differs between stroke survivors based on integrity of descending motor pathways; (2) RSFC is associated with upper-limb behavior in chronic stroke; and (3) the relationship between interhemispheric RSFC and upper-limb behavior differs based on descending motor pathway integrity. Methods. A total of 36 people with stroke (aged 64.4 ± 11.1 years, time since stroke 4.0 ± 2.8 years) and 25 healthy adults (aged 67.3 ± 6.7 years) participated in this study. RSFC was estimated from electroencephalography (EEG) recordings. Integrity of descending motor pathways was ascertained using transcranial magnetic stimulation to determine motor-evoked potential (MEP) status and magnetic resonance imaging to determine lesion overlap and fractional anisotropy of the corticospinal tract (CST). For stroke participants, upper-limb motor behavior was assessed using the Fugl-Meyer test, Action Research Arm Test and grip strength. Results. β-Frequency interhemispheric sensorimotor RSFC was greater for MEP+ stroke participants compared with MEP- (P = .020). There was a significant positive correlation between β RSFC and upper-limb behavior (P = .004) that appeared to be primarily driven by the MEP+ group. A hierarchical regression identified that the addition of β RSFC to measures of CST integrity explained greater variance in upper-limb behavior (R2 change = 0.13; P = .01). Conclusions. This study provides insight to understand the role of EEG-based measures of interhemispheric network activity in chronic stroke. Resting state interhemispheric connectivity was positively associated with upper-limb behavior for stroke survivors where residual integrity of descending motor pathways was maintained.
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Affiliation(s)
- Brenton Hordacre
- University of South Australia, IIMPACT in Health, Adelaide, Australia
| | - Mitchell R Goldsworthy
- Lifespan Human Neurophysiology group, Adelaide Medical School, The University of Adelaide, Australia
| | - Ellana Welsby
- University of South Australia, IIMPACT in Health, Adelaide, Australia
| | - Lynton Graetz
- Lifespan Human Neurophysiology group, Adelaide Medical School, The University of Adelaide, Australia
| | - Sophie Ballinger
- Lifespan Human Neurophysiology group, Adelaide Medical School, The University of Adelaide, Australia
| | - Susan Hillier
- University of South Australia, IIMPACT in Health, Adelaide, Australia
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24
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Bourke-Taylor HM, Brown T, Cordier R. Special Issue: Innovations in occupational therapy measurement. Aust Occup Ther J 2019; 65:343-345. [PMID: 30306606 DOI: 10.1111/1440-1630.12521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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