Development of a Comprehensive Outcome Measure for Motor Coordination, Step 2: Reliability and Construct Validity in Chronic Stroke Patients

Investigation of the reliability and validity of the Turkish version of the Comprehensive Coordination Scale in patients with Parkinson's disease

OBJECTIVE

The Comprehensive Coordination Scale (CCS) is a valid, reliable scale for evaluating motor coordination, described as the ability to produce context-dependent movements of multiple body parts in both spatial and temporal domains in patients with chronic stroke. The aim of this study was to develop a Turkish version of the CCS that can be used to evaluate coordination in Parkinson's disease patients and to test its validity and reliability.

METHODS

Thirty-four patients with Parkinson's disease (18 females, 16 males) with a mean age of 67.55± 10.93 years were included. The 9-Hole Peg Test (9 HPT), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), Functional Reach Test (FRT), and Modified Hoehn and Yahr (H&Y) were administered to the patients.

RESULTS

In the correlation analysis for convergent validity, the CCS-TR showed a moderate negative correlation with both the 9 HPT and the TUG test (r=-0.684 and -0.641, respectively). There were also moderate positive correlations observed between the CCS-TR and the FRT and BBS (r=0.607 and 0.657, respectively). The total CCS-TR had excellent intrarater reliability (ICC=0.99; 95 % CI: 0.98-0.99) and interrater reliability (ICC=0.90; 95 % CI: 0.81-0.95). The CCS-TR subscales had excellent intrarater reliability (ICC: range 0.98 from 0.99). For intrarater agreement, the ICC was 0.99, and for interrater agreement, the ICC was 0.90 (excellent agreement).

CONCLUSION

The results of the present study indicate that the Turkish version of the CCS is a reliable and valid coordination scale that can be used in patients with Parkinson's disease.

Perceptions of stroke survivors regarding factors affecting adoption of technology and exergames for rehabilitation

BACKGROUND

Task-specific motor training and repetitive practice are essential components of clinical rehabilitation. Emerging evidence suggests that incorporating gaming interfaces (also referred to as "exergames"), including virtual reality and augmented reality (VR/AR)-based interfaces for motor training, can enhance the engagement and efficacy of poststroke rehabilitation.

OBJECTIVE

To investigate perceptions of individuals with stroke regarding technology and exergames for rehabilitation.

DESIGN

This qualitative phenomenological study included a convenience sample of 11 individuals with stroke (61.7 ± 12.4 years, 6 women and 5 men, 63.5 ± 41.2 months post stroke).

SETTING

Community.

INTERVENTIONS

N/A.

OUTCOME MEASURES

Semistructured open-ended focus-group interviews to understand their perceptions on technology and exergames to improve recovery were coded using thematic content analysis.

RESULTS

Individuals with stroke were comfortable using smartphones, computers, and rehabilitation technologies but had limited experiences using exergames and VR/AR devices. Individuals with stroke were motivated to use technologies and exergames to improve their functional recovery. Participants identified facilitators (eg, enhancing functional recovery, feedback, therapist supervision) and barriers (eg, safety, inaccessibility, inadequate knowledge) to adopting exergames in their daily lives. Participants wanted the exergames to be customizable, goal oriented, and enjoyable to maintain their engagement. They were willing to use exergames to improve their functional recovery but indicated that these games could not replace the therapist's supervision.

CONCLUSIONS

Despite having limited experiences with exergames, people post stroke perceived that exergames could promote functional recovery. The perspectives gained from the present study can inform user-centered game design for neurorehabilitation.

Effects of Robot-Assisted Gait Training with Body Weight Support on Gait and Balance in Stroke Patients

This study investigated the effects of robot-assisted gait training with body weight support on gait and balance in stroke patients. The study participants comprised 24 patients diagnosed with stroke. Patients were randomly assigned to four groups of six: robot A, B, C, and non-robot. The body weight support (BWS) for the harness of the robot was set to 30% of the patient’s body weight in robot group A, 50% in robot group B, and 70% in robot group C. All experimental groups received robot-assisted gait training and general physical therapy. The non-robot group underwent gait training using a p-bar, a treadmill, and general physical therapy. The intervention was performed for 30 min a day, five times a week, for 6 weeks. All participants received the intervention after the pre-test. A post-test was performed after all of the interventions were completed. Gait was measured using a 10 m Walking test (10MWT) and the timed up and go (TUG) test. Balance was assessed using the Berg Balance Scale (BBS). Robot groups A, B, and C showed significantly better 10MWT results than did the non-robot group (p < 0.5). TUG was significantly shorter in robot groups A, B, and C than in the non-robot group (p < 0.5). The BBS scores for robot group A improved significantly more than did those for robot groups B and C and the non-robot group (p < 0.5), indicating that robot-assisted gait training with body weight support effectively improved the gait of stroke patients.

Construct Validity of the Upper-Limb Interlimb Coordination Test in Stroke

Background

Coordination impairments are under-evaluated in patients with stroke due to the lack of validated assessments resulting in an unclear relationship between coordination deficits and functional limitations.

Objective

Determine the construct validity of the new clinical upper-limb (UL) Interlimb Coordination test (ILC2) in individuals with chronic stroke.

Methods

Thirteen individuals with stroke, ≥40 years, with ≥30° isolated supination of the more-affected (MAff) arm, who could understand instructions and 13 healthy controls of similar age participated in a cross-sectional study. Participants performed synchronous bilateral anti-phase forearm rotations for 10 seconds in 4 conditions: self-paced internally-paced (IP1), fast internally-paced (IP2), slow externally-paced (EP1), and fast externally-paced (EP2). Primary (continuous relative phase-CRP, cross-correlation, lag) and secondary outcome measures (UL and trunk kinematics) were compared between groups.

Results

Participants with stroke made slower UL movements than controls in all conditions, except EP1. Cross-correlation coefficients were lower (i.e., closer to 0) in stroke in IP1, but CRP and lag were similar between groups. In IP1 and matched-speed conditions (IP1 for healthy and IP2 for stroke), stroke participants used compensatory trunk and shoulder movements. The synchronicity sub-scale and total scores of ILC2 were related to temporal coordination in IP2. Interlimb Coordination test total score was related to greater shoulder rotation of the MAff arm. Interlimb Coordination test scores were not related to clinical scores.

Conclusion

Interlimb Coordination test is a valid clinical measure that may be used to objectively assess UL interlimb coordination in individuals with chronic stroke. Further reliability testing is needed to determine the clinical utility of the scale.