Development and Validation of Neuro-Cognitive Assessment Battery for Stroke Patients (NCABS) in Pakistan

Urdu Receptive Language Scale (URLS): Modification & development of protocol for administration in Urdu

Objective

To conduct pretesting of Urdu Receptive Language Scale (URLS) for scale modification and development of protocol for administration on children.

Methods

This exploratory research was conducted from December 2021 to June 2022 in Lahore, Pakistan. Objective was achieved by pretesting in three steps including literature review, expert review and pilot testing on infants, toddlers and children aged 0-6 years utilizing purposive sampling technique. For expert review five experts' speech language pathologists with minimum five years of experience and for pilot study 48 normal developing children age range birth to six years were recruited. The analysis was done using content validity ratio, content validity index and Cronbach alpha. Protocol for administration of test items and stimulus with minimum three correct responses among four children's responses were finalized.

Results

Of the 59 items, 57 with CVR = 0.99 were retained. Item number 3 (age 6-11 months) and item 5 (age 3.6-3.11 years) were eliminated as CVR was <0.99. CVI was one for retained items indicating acceptable validity. Cronbach's alpha was 0.95 indicating high level of internal consistency for the scale. Task groups of protocol of administration directions included: Selection of scale items, testing environment, seating arrangements, rapport building and involving the caregiver, handling the scale material and scoring the task responses.

Conclusion

The modified 57 items has high validity and internal consistency with suitable protocol of administration. It is linguistically appropriate for the application on larger scale with children of different cultural backgrounds in Pakistan.

Motor relearning program along with electrical stimulation for improving upper limb function in stroke patients: A quasi experimental study

Objective:

To determine the effectiveness of motor relearning program along with electrical stimulation for improving upper limb function in patients with sub-acute stroke.

Methods:

A quasi experimental study was conducted at Physiotherapy Department of SAIDU Group of Teaching Hospitals Swat Khyber Pakhtunkhwa from January to June 2019. Forty four subjects with post stroke duration of 3-9 months (sub-acute) participated in the study. Subjects received electrical stimulations for the effected arm for 15 minutes along with motor relearning programme for an hour five days a week for six weeks. The upper limb sub scales of motor assessment scale were used to collect pre and post treatment data. SPSS version 20 was used to analyze the data.

Results:

The mean age of the participants was 54.95±13.2 years. Out of 44 participants 31(70.5%) were male and 13 (29.5%) were female. Pretreatment upper arm function, hand movement and advance hand activities scores were 1.36 ± 0.49, 1.18 ± 0.39 and 1.04 ± 0.21 respectively while their post treatment scores were 5.18 ± 0.96, 4.77 ± 1.02 and 3.95 ± 1.21 respectively. There was significant differences (P<0.05) between pre and post treatment scores of upper arm function, hand movement and advance hand activities.

Conclusion:

Motor relearning program along with electrical stimulation significantly improves upper limb function in patients with sub-acute stroke.

A hemispheric comparison of cognitive dysfunction and sleep quality impairment in Middle Cerebral Artery infarction

Objectives:

To investigate the severity of cognitive dysfunction and sleep quality impairment in patients with middle cerebral artery (MCA) strokes across the left and right hemisphere. Moreover, it also study gender differences with respect to MCA strokes.

Methods:

The study was conducted from February 2019 - May 2019 at COMSATS University, Islamabad. A total sample size of N=55 middle cerebral artery ischemic infarct patients was selected with N=29 left middle cerebral artery ischemic infarct patients and N=26 right middle cerebral artery ischemic infarct patients. The sample was assessed on The Neurocognitive Assessment Battery for stroke patients (N-CABS) & The Pittsburgh Sleep Quality Index-Urdu (PSQI-U).

Results:

The mean age of the sample was 50.96 years. There was a significant difference among scores of cognitive dysfunction between Left MCA (M=47.28, SD=12.87) and Right MCA stroke patients (M=29.7, S=21.41), t (53) =-6.80, p<0.001. Similarly, there was significant difference among scores of sleep disturbance between Left MCA (M=6.90, SD=2.93) and Right MCA (M=10.35, SD=3.97), t (53) =-3.68, p<0.001. Gender comparisons reveal that there is no significant difference between males and females for both, cognitive dysfunction and sleep quality impairment.

Conclusions:

Cognitive dysfunction and sleep quality impairment due to MCA strokes is significant between left and right hemispheres respectively, regardless of gender, assessed with N-CABS and PSQI-U. Further studies are required to analyse other demographic correlates related to MCA strokes.