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Gular K, Sivasubramanian V, Reddy RS, Tedla JS, Dixit S. The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15644. [PMID: 36497718 PMCID: PMC9738511 DOI: 10.3390/ijerph192315644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The trunk acts as proximal support with which limbs execute smooth and purposeful movement. Furthermore, as upper extremity functions are an integral component of daily living activities, exploring the association between trunk and upper extremity recovery will guide therapists in developing appropriate rehabilitation goals and interventions. The objectives of this study were to (1) assess the association between trunk and upper extremity recovery in the subacute stroke population and (2) assess the effect of trunk control on upper extremity impairment and function with age, gender, and duration of stroke as mediators using mediation analysis in subacute stroke individuals. METHODS This cross-sectional study included 54 subacute stroke participants with a mean age of 58.37 ± 6.11 years. The trunk impairment scale (TIS) assessed the trunk's stability, mobility, and coordination. The level of upper extremity impairment was evaluated using the Fugl-Meyer Assessment scale (FMA). The quality and quantity of upper limb motor functions were measured using the Wolf motor function test (WMFT). RESULTS The TIS exhibited moderate positive correlations with the FMA-UE, WMFT-time scale (TS), and WMFT-functional ability scale (FAS) at p < 0.001. The mediation analysis reported a profound mediation effect of post-stroke duration on the association of trunk and upper limb recovery. CONCLUSIONS The study results substantiated that trunk control significantly correlates with upper limb impairment and the quality and quantity of its use in the subacute stroke population. Post-stroke duration proved to mediate the association between trunk and upper limb recovery. Therefore, the assessment and intervention of trunk and upper extremity motor control considering the post-stroke duration is vital and should be incorporated in stroke rehabilitation aiming at functional independence.
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Affiliation(s)
- Kumar Gular
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Viswanathan Sivasubramanian
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
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2
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Kim H, Shin JH. Assessment of Upper Extremity Function in People With Stroke Based on the Framework of the ICF: A Narrative Review. BRAIN & NEUROREHABILITATION 2022; 15:e16. [PMID: 36743205 PMCID: PMC9833478 DOI: 10.12786/bn.2022.15.e16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/20/2022] [Indexed: 11/08/2022] Open
Abstract
Although there are many assessment tools for upper extremity (UE) function, it is still difficult to select an appropriate outcome measurement for the rehabilitation process of individuals with stroke. This review aims to classify each tool within the International Classification of Functioning, Disability and Health (ICF) framework and provide an overview of UE assessments. Through a comprehensive understanding of assessments based on ICF, health care professionals will be able to choose suitable measurement tools for individuals, facilitating their rehabilitation.
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Affiliation(s)
- Hanna Kim
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
| | - Joon-Ho Shin
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
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3
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Ingram LA, Butler AA, Brodie MA, Lord SR, Gandevia SC. Quantifying upper limb motor impairment in chronic stroke: a physiological profiling approach. J Appl Physiol (1985) 2021; 131:949-965. [PMID: 34264125 DOI: 10.1152/japplphysiol.00078.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Upper limb motor impairments, such as muscle weakness, loss of dexterous movement, and reduced sensation, are common after a stroke. The extent and severity of these impairments differ among individuals, depending on the anatomical location and size of lesions. Identifying impairments specific to the individual is critical to optimize their functional recovery. The upper limb Physiological Profile Assessment (PPA) provides quantitative measures of key physiological domains required for adequate function in the upper limbs. The present study investigates the use of the upper limb PPA in a chronic stroke population. Fifty participants with chronic stroke completed all tests of the upper limb PPA with both their affected and less affected upper limbs. Performance in each test was compared to that of 50 age- and sex-matched control subjects with no history of a stroke. Correlations between test performance and validated measures of stroke, sensorimotor function, and disability were examined. Compared with control subjects, people with stroke demonstrated substantially impaired upper limb PPA performance for both their affected and less affected limbs. Performance in the upper limb PPA was associated with validated measures of sensorimotor function specific to the stroke population (Fugl-Meyer Assessment) and stroke-related disability (Stroke Impact Scale). The upper limb PPA shows good concurrent validity as a means to quantify upper limb function in a chronic stroke population. These tests identify domain-specific deficits and could be further tailored to an individual patient by the clinician to inform rehabilitation and track recovery.NEW & NOTEWORTHY Upper limb motor impairment is a common manifestation after stroke, compromising independence in fundamental daily activities involving the ability to reach, grasp, and manipulate objects. The upper limb Physiological Profile Assessment (PPA) offers a means of quantifying performance of the individual sensorimotor domains that are essential for upper limb function. Establishing individual performance profiles based on age- and sex-based normative scores may facilitate individualized treatment decisions by identifying the stroke patient's specific strengths and limitations.
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Affiliation(s)
- Lewis A Ingram
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Annie A Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew A Brodie
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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4
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Kumar P, Bradley M, Gray S, Swinkels A. Association between ultrasound assessment of glenohumeral subluxation and shoulder pain, muscle strength, active range of movement and upper limb function in people with stroke. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2018.1549273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Praveen Kumar
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Michael Bradley
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Selena Gray
- Department of Public Health, University of the West of England, Bristol, UK
| | - Annette Swinkels
- Department of Allied Health Professions, University of the West of England, Bristol, UK
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5
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Martino Cinnera A, Bonnì S, Pellicciari MC, Giorgi F, Caltagirone C, Koch G. Health-related quality of life (HRQoL) after stroke: Positive relationship between lower extremity and balance recovery. Top Stroke Rehabil 2020; 27:534-540. [PMID: 32041495 DOI: 10.1080/10749357.2020.1726070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Stroke survivors have poor long-term quality of life (QoL), especially in the dimensions of mobility and daily activities. Objectives: We aimed to investigate how clinical variables influence QoL during subacute stroke rehabilitation. Methods: We assessed the evolution of the health-related QoL (HRQoL), the balance skills, the sensory-motor functions, and the ability in the activity of daily living in 25 hospitalized patients (60.6 ± 11.14 years old; 32% female) during a period of 2 months of stroke rehabilitation. We used the Stroke-Specific Quality of Life scale (SSQoL) to assess the HRQoL; the Berg Balance Scale to assess gait and balance functions; the Fugl-Meyer Assessment scale for sensory-motor functions of upper (UE) and lower limb (LE); and the Barthel Index for activity of daily living. All data have been investigated with the repeated-measures analysis of variance before and after normalization. Multiple Regression Analysis (MRA) has been performed on the normalized data and between the normalized data and the demographic characteristics (Gender; Age; Lesion side). Results: A significant improvement was found in all the assessed scales during the time of observation. MRA shows a positive regression between HRQoL and the motor recovery of LE and between HRQoL and the balance skills in 60 days from the stroke (MR = 0.88; respectively: p = 0.004 and p = 0.02). Conclusions: Our result shows that LE motor recovery impacts the QoL more than motor recovery of UE after 60 days of neurorehabilitation. This finding is strengthened by a positive regression between balance skills and QoL.
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Affiliation(s)
- Alex Martino Cinnera
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | - Sonia Bonnì
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | | | - Francesco Giorgi
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | - Carlo Caltagirone
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy.,Department of Psychology, "eCampus" University , Novedrate, Italy
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Ghaziani E, Couppé C, Siersma V, Christensen H, Magnusson SP, Sunnerhagen KS, Persson HC, Alt Murphy M. Easily Conducted Tests During the First Week Post-stroke Can Aid the Prediction of Arm Functioning at 6 Months. Front Neurol 2020; 10:1371. [PMID: 31993016 PMCID: PMC6962352 DOI: 10.3389/fneur.2019.01371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/11/2019] [Indexed: 12/23/2022] Open
Abstract
Background: Prognostic models can estimate the recovery of arm functioning after stroke, guide the selection of individual training strategies, and inform patient selection in clinical trials. Several models for early prediction of arm recovery have been proposed, but their implementation has been hindered by insufficient external validation, limited evidence of their impact on patient outcomes, and reliance on predictors that are not feasible in regular clinical practice. Objectives: To determine the predictive value of new and previously reported tests that can be easily conducted in regular clinical settings for early prognosis of two levels of favorable arm recovery at 6 months post-stroke. Methods: We performed a secondary analysis of merged data (n = 223) from two Scandinavian prospective longitudinal cohorts. The candidate predictors were seven individual tests of motor function and the sensory function measured by the Fugl-Meyer Assessment of Upper Extremity within 7 days post-stroke, and the whole motor section of this assessment. For each candidate predictor, we calculated the adjusted odds ratio (OR) of two levels of residual motor impairment in the affected arm at 6 months post-stroke: moderate-to-mild (≥32 points on the motor section of the Fugl-Meyer Assessment of Upper Extremity, FMA-UE) and mild (FMA-UE ≥ 58 points). Results: Patients with partial shoulder abduction (OR 14.6), elbow extension (OR 15.9), and finger extension (OR 9.5) were more likely to reach FMA-UE ≥ 32. Patients with full function on all individual motor tests (OR 5.5–35.3) or partial elbow extension, pronation/supination, wrist dorsiflexion and grasping ability (OR 2.1–18.3) were more likely to achieve FMA-UE ≥ 58 compared with those with absent function. Intact sensory function (OR 2.0–2.2) and moderate motor impairment on the FMA-UE (OR 7.5) were also associated with favorable outcome. Conclusions: Easily conducted motor tests can be useful for early prediction of arm recovery. The added value of this study is the prediction of two levels of a favorable functional outcome from simple motor tests. This knowledge can be used in the development of prognostic models feasible in regular clinical settings, inform patient selection and stratification in future trials, and guide clinicians in the selection of individualized training strategies for improving arm functioning after stroke. Clinical Trial Registration:ClinicalTrials.gov: NCT02250365, NCT01115348.
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Affiliation(s)
- Emma Ghaziani
- Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - Christian Couppé
- Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Centre for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Centre for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Katharina S Sunnerhagen
- Research Unit for Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Hanna C Persson
- Research Unit for Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Margit Alt Murphy
- Research Unit for Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
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7
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Marque P, Denis A, Gasq D, Chaleat-Valayer E, Yelnik A, Colin C, Pérennou D. Botuloscope: 1-year follow-up of upper limb post-stroke spasticity treated with botulinum toxin. Ann Phys Rehabil Med 2019; 62:207-213. [DOI: 10.1016/j.rehab.2019.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/31/2019] [Accepted: 06/13/2019] [Indexed: 11/16/2022]
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8
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Ghaziani E, Couppé C, Siersma V, Søndergaard M, Christensen H, Magnusson SP. Electrical Somatosensory Stimulation in Early Rehabilitation of Arm Paresis After Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2018; 32:899-912. [PMID: 30251591 DOI: 10.1177/1545968318799496] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Arm paresis is present in 48% to 77% of acute stroke patients. Complete functional recovery is reported in only 12% to 34%. Although the arm recovery is most pronounced during the first 4 weeks poststroke, few studies examined the effect of upper extremity interventions during this period. OBJECTIVE To investigate the effect of electrical somatosensory stimulation (ESS) delivered during early stroke rehabilitation on the recovery of arm functioning. METHODS A total of 102 patients with arm paresis were randomized to a high-dose or a low-dose ESS group within 7 days poststroke according to our sample size estimation. The high-dose group received 1-hour ESS to the paretic arm daily during hospitalization immediately followed by minimum 15-minute task-oriented arm training that was considered a component of the usual rehabilitation. The low-dose group received a placebo ESS followed by identical training. Primary outcome-Box and Block Test (BBT); secondary outcomes-Fugl-Meyer Assessment (FMA), grip strength, pinch strength, perceptual threshold of touch, pain, and modified Rankin Scale (mRS); all recorded at baseline, postintervention and at 6 months poststroke. RESULTS There were no differences between the high-dose and the low-dose groups for any outcome measures at any time points. Improvements ⩾ minimal clinically important difference were observed for FMA, hand grip strength, and mRS in both groups. CONCLUSIONS Providing the present ESS protocol prior to arm training was equally beneficial as arm training alone. These results are valid for patients with mild-to-moderate stroke and moderate arm impairments. We cannot exclude benefits in patients with other characteristics, in other time intervals poststroke or using a different ESS protocol. TRIAL REGISTRATION ClinicalTrials.gov (NCT02250365).
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Affiliation(s)
- Emma Ghaziani
- 1 Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,2 University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppé
- 1 Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,2 University of Copenhagen, Copenhagen, Denmark
| | | | | | - Hanne Christensen
- 1 Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,2 University of Copenhagen, Copenhagen, Denmark
| | - S Peter Magnusson
- 1 Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,2 University of Copenhagen, Copenhagen, Denmark
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9
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Vratsistas-Curto A, Sherrington C, McCluskey A. Responsiveness of five measures of arm function in acute stroke rehabilitation. Clin Rehabil 2018; 32:1098-1107. [PMID: 29843521 DOI: 10.1177/0269215518778316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the responsiveness of five arm function measures in people receiving acute inpatient stroke rehabilitation. DESIGN Inception cohort study. SETTING Comprehensive stroke unit providing early rehabilitation. SUBJECTS A total of 64 consecutively admitted stroke survivors with moderately severe disability (Modified Rankin Scale score median (interquartile range (IQR)): 4.0 (1.0)). MAIN MEASURES Responsiveness was analyzed by calculating effect size, standardized response mean and median-based effect size. Floor/ceiling effects were calculated as the percentage of participants scoring the lowest/highest possible scores. RESULTS Average length of stay and number of therapy days were 34 (SD = 27.9) and 12 (SD = 13.1), respectively. Box and Block Test and Functional Independence Measure-Self-Care showed the highest responsiveness with values in the moderate-large range (effect size = 1.09, standardized response mean = 1.07 and median-based effect size = 0.76; effect size = 0.94, standardized response mean = 1.04 and median-based effect size = 1.0). Responsiveness of Action Research Arm Test and Upper Limb-Motor Assessment Scale were moderate (effect size = 0.58, standardized response mean = 0.69 and median-based effect size = 0.59; effect size = 0.62, standardized response mean = 0.75 and median-based effect size = 0.67). For Manual Muscle Test, responsiveness was in the small-moderate range (effect size = 0.42, standardized response mean = 0.59 and median-based effect size = 0.5). Box and Block Test showed the largest floor effect on admission (28%), and Action Research Arm Test and Manual Muscle Test showed the largest ceiling effect on discharge (31%). CONCLUSION These five measures varied in their ability to detect change with responsiveness ranging from the small to large range. Box and Block Test and Functional Independence Measure-Self-Care showed a greater ability to detect change; both demonstrated moderate-large responsiveness.
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Affiliation(s)
- Angela Vratsistas-Curto
- 1 Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Sherrington
- 1 Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Annie McCluskey
- 2 Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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10
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Branco JP, Oliveira S, Sargento-Freitas J, Laíns J, Pinheiro J. Assessing functional recovery in the first six months after acute ischemic stroke: a prospective, observational study. Eur J Phys Rehabil Med 2018; 55:1-7. [PMID: 29764094 DOI: 10.23736/s1973-9087.18.05161-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stroke is a major cause of short-term functional impairment, but the recovery timeframes are not well-established. AIM This study aims to evaluate the progression of functional recovery during the first 24 weeks after acute ischemic stroke, to determine the timeframes for motor, cognitive, and overall recovery. DESIGN Prospective observational study. SETTING Tertiary care center; 12-week inpatient period, followed by 12-week outpatient period. POPULATION A group of 131 patients with acute stroke in the territory of the middle cerebral artery with age 18-85 years-old. METHODS Patients received treatment according to routine clinical practice and underwent a closely-controlled rehabilitation program for 24 weeks. Functionality assessments were conducted at 48 hours, 3 weeks, 12 weeks, and 24 weeks after acute stroke and included the modified Rankin Scale (mRS), the Functional Independence Measure (FIM), and the Stroke Upper Limb Capacity Scale (SULCS). RESULTS Over the study period, patient functionality improved significantly (P<0.001) as measured by all scales. Assessment scores improved significantly from 48 hours to 3 weeks for all scales; the same occurred from 3 weeks to 12 weeks, except for C-FIM. From 12 weeks to 24 weeks, there were no statistically significant functional improvements for any scale. In comparative terms, cognitive impairment was less severe than motor disability in the acute phase. C-FIM scores at 48 hours were significantly higher than M-FIM and mRS scores. Upper limb functioning measured by SULCS, showed a intermediate degree of disability compared to the C-FIM, M-FIM, and mRS. CONCLUSIONS Functional recovery occurs at least until 24 weeks after acute stroke, but most of the functional gains tend to be achieved during the first 12 weeks. Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks. From 12 to 24 weeks there are observable numerical gains in patient functionality, highlighting the need to maintain an adequate rehabilitation program. CLINICAL REHABILITATION IMPACT This study provides insight into the recovery timeframe for stroke patients, which can support the development of more effective rehabilitation programs.
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Affiliation(s)
- João P Branco
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal - .,Department of Physical and Rehabilitation Medicine, University Hospital Center of Coimbra, Coimbra, Portugal - .,Department of Physical and Rehabilitation Medicine, Centro de Medicina de Reabilitação da Região Centro, Rovisco Pais, Tocha, Portugal -
| | - Sandra Oliveira
- Department of Physical and Rehabilitation Medicine, Centro de Medicina de Reabilitação da Região Centro, Rovisco Pais, Tocha, Portugal
| | - João Sargento-Freitas
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Department of Neurology, University Hospital Center of Coimbra, Coimbra, Portugal
| | - Jorge Laíns
- Department of Physical and Rehabilitation Medicine, Centro de Medicina de Reabilitação da Região Centro, Rovisco Pais, Tocha, Portugal
| | - João Pinheiro
- Department of Physical and Rehabilitation Medicine, University Hospital Center of Coimbra, Coimbra, Portugal.,Department of Neurology, University Hospital Center of Coimbra, Coimbra, Portugal
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11
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Kuzgun H, Denat Y. The manual dexterity of nursing students and factors that affect it. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2018. [PMID: 29521574 DOI: 10.1080/10803548.2018.1442909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aim. The purpose of this study was to define the manual dexterity of nursing students and factors that affect it. Methodology. The sample for this descriptive and analytical study was composed of 196 nursing students. The data collection tools were a survey and the Purdue pegboard test. Results. The mean dominant hand dexterity score of the students was determined to be 19.16 ± 1.36; non-dominant hand dexterity score, 17.04 ± 1.43; mean both hands dexterity score, 14.58 ± 1.35; mean right hand + left hand + both hands dexterity score, 50.70 ± 4.20; and mean assembly skill score, 38.55 ± 6.02. As a result, manual dexterity of the nursing students is relatively high in the 4th year of their education. Also, the students who have a normal body type, a hobby or have chosen the profession voluntarily have better manual dexterity scores. Conclusion. The results of the present study demonstrate that students should be guided to a hobby and adapted to the profession during nursing education. This study may constitute normative data for future study related to this issue, and may be guiding in the achievement of the objectives of nursing training and provision of a higher quality education.
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Affiliation(s)
- Hürmüs Kuzgun
- Mersin University Health, Research and Training Hospital, Turkey
| | - Yıldız Denat
- Adnan Menderes University Faculty of Nursing, Turkey
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12
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Cheong YS, Kim AR, Park E, Yang WJ, Huh JW, Oh HM, Min YS, Kim CH, Jung TD, Lee YS. Validity of the Buttoning Test in Hand Disability Evaluation of Patients With Stroke. Ann Rehabil Med 2018; 42:18-25. [PMID: 29560320 PMCID: PMC5852222 DOI: 10.5535/arm.2018.42.1.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/28/2017] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate the relationship between the buttoning test and Jebsen-Taylor Hand Function Test (JTHFT), and to determine the validity of using the buttoning test as a tool to evaluate hand disability in patients with stroke. Methods This was a retrospective study of the medical records of 151 ischemic stroke patients affecting the dominant hand. Patients underwent the buttoning test and JTHFT for their affected hand. All patients were divided into three groups depending on how quickly they fastened a button (group A, not completed; group B, slowly completed over 18 seconds; and group C, completed within 18 seconds). Results The button fastening time was negatively correlated with the total score and subtest scores of the JTHFT. Patients who experienced difficulty during the buttoning test had lower mean scores in the JTHFT (group A, 28.0±23.9; group B, 62.9±21.7; group C, 75.4±13.3; p<0.0001, Jonckheere-Terpstra test). We observed significant differences in JTHFT scores among the three groups (p<0.017, Mann-Whitney U-test), although there were considerable overlaps in JTHFT scores between the groups. Significant differences were also found in the subtest scores of the JTHFT, which include fine hand motor function (writing letters, p=0.009; moving small objects, p=0.003; stacking checkers, p=0.001 between groups B and C), among the three groups. Conclusion Considering its relationship with the JTHFT and validity, the buttoning test can be considered appropriate for evaluation of hand disability in patients with stroke.
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Affiliation(s)
- Youn-Soo Cheong
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eunhee Park
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Won-Jong Yang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jae-Won Huh
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hyun-Min Oh
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea.,Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chul-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea.,Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea.,Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea.,Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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13
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Tomita Y, Rodrigues MRM, Levin MF. Upper Limb Coordination in Individuals With Stroke: Poorly Defined and Poorly Quantified. Neurorehabil Neural Repair 2017; 31:885-897. [DOI: 10.1177/1545968317739998] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background. The identification of deficits in interjoint coordination is important in order to better focus upper limb rehabilitative treatment after stroke. The majority of standardized clinical measures characterize endpoint performance, such as accuracy, speed, and smoothness, based on the assumption that endpoint performance reflects interjoint coordination, without measuring the underlying temporal and spatial sequences of joint recruitment directly. However, this assumption is questioned since improvements of endpoint performance can be achieved through different degrees of restitution or compensation of upper limb motor impairments based on the available kinematic redundancy of the system. Confusion about adequate measurement may stem from a lack a definition of interjoint coordination during reaching. Methods and Results. We suggest an operational definition of interjoint coordination during reaching as a goal-oriented process in which joint degrees of freedom are organized in both spatial and temporal domains such that the endpoint reaches a desired location in a context-dependent manner. Conclusions. In this point-of-view article, we consider how current approaches to laboratory and clinical measures of coordination comply with our definition. We propose future study directions and specific research strategies to develop clinical measures of interjoint coordination with better construct and content validity than those currently in use.
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Affiliation(s)
- Yosuke Tomita
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Marcos R. M. Rodrigues
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Mindy F. Levin
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
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Yetisgin A. Clinical characteristics affecting motor recovery and ambulation in stroke patients. J Phys Ther Sci 2017; 29:216-220. [PMID: 28265142 PMCID: PMC5332973 DOI: 10.1589/jpts.29.216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/27/2016] [Indexed: 12/02/2022] Open
Abstract
[Purpose] To describe the clinical characteristics affecting motor recovery and
ambulation in stroke patients. [Subjects and Methods] Demographic and clinical
characteristics of 53 stroke patients (31 M, 22 F), such as age, gender, etiology,
hemiplegic side, Brunnstrom stage, functional ambulation scale scores, history of
rehabilitation, and presence of shoulder pain and complex regional pain syndrome were
evaluated. [Results] The etiology was ischemic in 79.2% of patients and hemorrhagic in
20.8%. Brunnstrom hand and upper extremity values in females were lower than in males.
Complex regional pain syndrome was observed at a level of 18.9% in all patients (more
common in females). Brunnstrom hand stage was lower in complex regional pain syndrome
patients than in those without the syndrome. Shoulder pain was present in 44.4% of
patients. Brunnstrom lower extremity values and functional ambulation scale scores were
higher in rehabilitated than in non-rehabilitated cases. [Conclusion] Brunnstrom stages of
hand and upper extremity were lower and complex regional pain syndrome was more common in
female stroke patients. Shoulder pain and lower Brunnstrom hand stages were related to the
presence of complex regional pain syndrome.
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Affiliation(s)
- Alparslan Yetisgin
- Department of Physical Medicine and Rehabilitation, Harran University Medical School, Turkey
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Higgins J, Salbach NM, Wood-Dauphinee S, Richards CL, Côté R, Mayo NE. The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial. Clin Rehabil 2016; 20:296-310. [PMID: 16719028 DOI: 10.1191/0269215505cr943oa] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: To evaluate the efficacy of a task-oriented intervention in enhancing arm function in people with stroke. Design: Two-centre, observer-blinded, stratified, block-randomized controlled trial. Setting: General community. Patients: Ninety-one individuals within one year of a first or recurrent stroke consented to participate between May 2000 and February 2003. Interventions: The experimental intervention involved practice of functional, unilateral and bilateral tasks that were designed to improve gross and fine manual dexterity whereas the control intervention was composed of walking tasks. Members in both groups participated in three sessions a week for six weeks. Main outcome measure(s): The primary test of arm function was the Box and Block Test. Secondary tests included the Nine-Hole Peg Test, maximal grip strength, the Test d'Evaluation des Membres supé rieurs des Personnes Agées (TEMPA) and the Stroke Rehabilitation Assessment of Movement. Results: Results are for the more affected arm. Baseline performance on the Box and Block Test was an average of 26 blocks (standard deviation (SD=16) in the experimental group (n=47) and 26 blocks (Sd=18) in the control group (n=44). These values represent approximately 40% of age-predicted values. Values for the postintervention evaluation were an average of 28 (SD=17) and 28 (SD=19) blocks for the experimental and control group respectively. No meaningful change on other measures of arm function was observed. Conclusions: A task-oriented intervention did not improve voluntary movement or manual dexterity of the affected arm in people with chronic stroke.
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Affiliation(s)
- Johanne Higgins
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Differences in motor recovery between upper and lower limbs: does stroke subtype make the difference? Int J Rehabil Res 2016; 39:185-7. [DOI: 10.1097/mrr.0000000000000172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ferrarello F, Deluca G, Pizzi A, Baldini C, Iori F, Marchionni N, Di Bari M. Passive standing as an adjunct rehabilitation intervention after stroke: a randomized controlled trial. Arch Physiother 2015; 5:2. [PMID: 29340171 PMCID: PMC5721723 DOI: 10.1186/s40945-015-0002-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background Early physical rehabilitation enhances functional recovery in stroke survivors. Supported standing is a common adjunctive therapeutic practice in subjects with several central nervous diseases who are unable to stand actively. Data on the effect of supported positioning on standing frames in individuals with recent stroke are scarce and contradictory. Objectives To verify if the addition of supported standing practice (SSP), delivered by means of a standing frame in two durations, to conventional physical therapy (CPT), may improve motor function, autonomy, and mobility in individuals with disability due to recent stroke. Methods After baseline assessment, 75 participants with severe disability due to stroke, all receiving CPT, were randomly assigned to adjunctive 20 or 40 min of SSP, or CPT only (control). Motor function, autonomy, and mobility were assessed before and after training, and three months later. Results All participants assessed received the planned dose of intervention. No adverse events of SSP were detected. Most outcome measures improved from baseline through the end of treatment and in the follow-up in all groups; the extent of change was comparable across the three randomization groups. Conclusions In this randomized trial, SSP was unable to provide any sizeable adjunctive benefit, above and beyond CPT, in subjects with recent stroke.
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Affiliation(s)
- Francesco Ferrarello
- Functional Rehabilitation Unit, Azienda USL 4, Via Cavour 118/120, 59100 Prato, Italy
| | | | - Assunta Pizzi
- Fondazione Don Carlo Gnocchi ONLUS-IRCCS, Florence, Italy
| | - Carlo Baldini
- Fondazione Don Carlo Gnocchi ONLUS-IRCCS, Florence, Italy
| | - Francesca Iori
- Fondazione Don Carlo Gnocchi ONLUS-IRCCS, Florence, Italy
| | - Niccolò Marchionni
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Silva FPDP, Freitas SMSFD, Silva PV, Banjai RM, Alouche SR. Ipsilesional Arm Motor Sequence Performance After Right and Left Hemisphere Damage. J Mot Behav 2014; 46:407-14. [DOI: 10.1080/00222895.2014.924473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Samuelkamaleshkumar S, Reethajanetsureka S, Pauljebaraj P, Benshamir B, Padankatti SM, David JA. Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial. Arch Phys Med Rehabil 2014; 95:2000-5. [PMID: 25064777 DOI: 10.1016/j.apmr.2014.06.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/29/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the effectiveness of mirror therapy (MT) combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb after stroke. DESIGN Randomized, controlled, assessor-blinded study. SETTING Inpatient stroke rehabilitation center of a tertiary care teaching hospital. PARTICIPANTS Patients with first-time ischemic or hemorrhagic stroke (N=20), confined to the territory of the middle cerebral artery, occurring <6 months before the commencement of the study. INTERVENTION The MT and control group participants underwent a patient-specific multidisciplinary rehabilitation program including conventional occupational therapy, physical therapy, and speech therapy for 5 d/wk, 6 h/d, over 3 weeks. The participants in the MT group received 1 hour of MT in addition to the conventional stroke rehabilitation. MAIN OUTCOME MEASURES The Upper Extremity Fugl-Meyer Assessment for motor recovery, Brunnstrom stages of motor recovery for the arm and hand, Box and Block Test for gross manual hand dexterity, and modified Ashworth scale to assess the spasticity. RESULTS After 3 weeks of MT, mean change scores were significantly greater in the MT group than in the control group for the Fugl-Meyer Assessment (P=.008), Brunnstrom stages of motor recovery for the arm (P=.003) and hand (P=.003), and the Box and Block Test (P=.022). No significant difference was found between the groups for modified Ashworth scale (P=.647). CONCLUSIONS MT when combined with bilateral arm training and graded activities was effective in improving motor performance of the paretic upper limb after stroke compared with conventional therapy without MT.
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Affiliation(s)
| | | | | | | | | | - Judy Ann David
- Christian Medical College Vellore, Vellore, Tamil Nadu, India
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22
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Abstract
Objective: Submissions on recovery of post-stroke motor performance vary, especially in relation to increasing time after stroke. This study examined the trajectory of motor performance over the first 12 months after stroke.Methods: Consecutive first-incidence stroke survivors (N = 83) were recruited within 1 month of onset from a tertiary health institution in Nigeria. Simplified Fugl Meyer scale (S-FM) was used to assess motor performance at monthly intervals. Changes in overall motor performance, and differences between the affected upper and lower extremities, were examined using Friedman's ANOVA and paired t-tests, respectively.Results: Significant improvement in motor performance was observed across 12 months (p < .001), with the proportion of stroke survivors with severe impairment at onset (53.3%) decreasing to 20% by 12 months. Lower extremity motor performance scores were significantly higher than for the upper extremity from 1 to 12 months (p <.01 at 3, 4, 5, 6 and 12 months; and p < .05 at the remaining months).Conclusions: The potential for long-term improvement in motor performance after stroke was observed, suggesting that this can be harnessed by long-term rehabilitation efforts. The comparatively poorer outcome in the upper extremity indicates the need for extra rehabilitation strategies to enhance upper-extremity motor recovery in the first year of stroke.
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23
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Pedlow K, Lennon S, Wilson C. Application of Constraint-Induced Movement Therapy in Clinical Practice: An Online Survey. Arch Phys Med Rehabil 2014; 95:276-82. [DOI: 10.1016/j.apmr.2013.08.240] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/12/2013] [Accepted: 08/23/2013] [Indexed: 11/15/2022]
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Kumar P, Swinkels A. A critical review of shoulder subluxation and its association with other post-stroke complications. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x405883] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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25
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Simpson LA, Eng JJ. Functional recovery following stroke: capturing changes in upper-extremity function. Neurorehabil Neural Repair 2012; 27:240-50. [PMID: 23077144 DOI: 10.1177/1545968312461719] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Augmenting changes in recovery is core to the rehabilitation process following a stroke. Hence it is essential that outcome measures are able to detect change as it occurs, a property known as responsiveness. This article critically reviewed the responsiveness of functional outcome measures following stroke, specifically examining tools that captured upper-extremity (UE) functional recovery. METHODS A systematic search of the literature was undertaken to identify articles providing responsiveness data for 3 types of change (observed, detectable, and important). RESULTS Data from 68 articles for 14 UE functional outcome measures were retrieved. Larger percentage changes were required to be considered important when obtained through anchor-based methods (eg, based on patient opinion or comparative measure) compared with distribution methods (eg, statistical estimates). Larger percentage changes were required to surpass the measurement error for patient-perceived functional measures (eg, Motor Activity Log) compared with laboratory-based performance measures (eg, Action Research Arm Test). The majority of rehabilitation interventions have similar effect sizes on patient-perceived UE function and laboratory-based UE function. CONCLUSIONS The magnitude of important change or change that surpasses measurement error can vary substantially depending on the method of calculation. Rehabilitation treatments can affect patient perceptions of functional change as effectively as laboratory-based functional measures; however, larger sample sizes may be required to account for the larger measurement error associated with patient-perceived functional measures.
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26
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An S, Lee G, Kim S. A Study of the Clinical Utility of the BPI-12 and 23 in Predicting Shoulder Pain in Stroke Patients. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- SeongHun An
- Department of Physical Therapy, National Rehabilitation Center
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University
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Coupar F, Pollock A, Rowe P, Weir C, Langhorne P. Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil 2011; 26:291-313. [PMID: 22023891 DOI: 10.1177/0269215511420305] [Citation(s) in RCA: 243] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review and summarize the current available literature on prognostic variables relating to upper limb recovery following stroke. To identify which, if any variables predict upper limb recovery following stroke. DATA SOURCES We completed searches in MEDLINE, EMBASE, AMED, CINAHL and Cochrane CENTRAL databases. Searches were completed in November 2010. REVIEW METHODS Studies were included if predictor variables were measured at baseline and linked to an outcome of upper limb recovery at a future time point. Exclusion criteria included predictor variables relating to response to treatment and outcome measurements of very specific upper limb impairments such as spasticity or pain. Two independent reviewers completed data extraction and assessed study quality. RESULTS Fifty-eight studies met the inclusion criteria. Predictor variables which have been considered within these studies include; age, sex, lesion site, initial motor impairment, motor-evoked potentials and somatosensory-evoked potentials. Initial measures of upper limb impairment and function were found to be the most significant predictors of upper limb recovery; odds ratio 14.84 (95% confidence intervals (CI) 9.08-24.25) and 38.62 (95% CI 8.40-177.53), respectively. CONCLUSIONS Interpretation of these results is complicated by methodological factors including variations in study populations, upper limb motor outcome scales, timing of baseline and outcome assessments and predictors selected. The most important predictive factors for upper limb recovery following stroke appears to the initial severity of motor impairment or function.
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Affiliation(s)
- Fiona Coupar
- Glasgow University, Academic Section of Geriatric Medicine, Glasgow, UK.
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Rowland TJ, Turpin M, Gustafsson L, Henderson RD, Read SJ. Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9): perceived clinical utility within 14 days of stroke. Top Stroke Rehabil 2011; 18:382-93. [PMID: 21914604 DOI: 10.1310/tsr1804-382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9) is an activity-based assessment developed to include relevant functional tasks and to be sensitive to clinically important changes in upper limb function. The aim of this study was to explore both therapists' and clients' views on the clinical utility of CAHAI-9 within 14 days of stroke. METHOD Twenty-one occupational therapists actively working in stroke settings were recruited by convenience sampling from 8 hospitals and participated in semistructured focus groups. Five clients within 14 days of stroke were recruited by consecutive sampling from 1 metropolitan hospital and participated in structured individual interviews. The transcripts were analyzed thematically. RESULTS Six themes emerged from the focus groups and interviews: collecting information, decisions regarding client suitability, administration and scoring, organizational demands, raising awareness, and clients' perceptions of CAHAI-9 utility. All therapists agreed CAHAI-9 was suited for the stroke population and assisted identification of client abilities or difficulties within functional contexts. Opinions varied as to whether CAHAI-9 should be routinely administered with clients who had mild and severe upper limb deficits, but therapists agreed it was appropriate for clients with moderate deficits. Therapists made suggestions regarding refinement of the scoring and training to increase utility. All clients with stroke felt that the assessment provided reassurance regarding their recovery. CONCLUSION The findings indicate that CAHAI-9 shows promise as an upper limb ability assessment for clients within 14 days of stroke.
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Affiliation(s)
- Tennille Jane Rowland
- Neurology Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia
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Bouffioulx É, Arnould C, Thonnard JL. Satisfaction With Activity and Participation and Its Relationships With Body Functions, Activities, or Environmental Factors in Stroke Patients. Arch Phys Med Rehabil 2011; 92:1404-10. [DOI: 10.1016/j.apmr.2011.03.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/27/2011] [Accepted: 03/28/2011] [Indexed: 10/17/2022]
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Higgins J, Finch LE, Kopec J, Mayo NE. Development and initial psychometric evaluation of the Stroke Arm Ladder – a measure of upper extremity function post stroke*. Clin Rehabil 2011; 25:740-59. [DOI: 10.1177/0269215510389496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To develop an adaptive measure, the Stroke Arm Ladder, to parsimoniously quantify upper extremity function post stroke. Setting: Various studies conducted in Montreal and elsewhere in Canada. Subjects: A total of 4058 persons with stroke who participated in various studies were assessed on different occasions post stroke. Assessments spanned from 3 days to 1 year post stroke. Main measures: A calibrated bank containing 49 items from tests and indices designed to assess global motor recovery of the upper extremity, upper extremity function and activities involving the upper extremity was used. Data including all testing occasions were analysed to test whether they adhered to the expectations of the Rasch partial credit model and whether item hierarchy remained stable across testing occasions. Results: Fifteen items did not meet the requirements of the Rasch model and were deleted. An adaptive measure of upper extremity function, the Stroke Arm Ladder, containing 34 items was created. The easiest item was partially executing the bilateral task of tying a scarf around one’s neck, while the hardest item was being able to transfer more than 60 blocks on the Box and Block Test. The items’ difficulty thresholds cover a wide range of difficulty levels from −7.4 to 6.2 and the global fit statistics (χ2: 331; probability: 0.18), confirmed content validity. Conclusion: The Stroke Arm Ladder demonstrates adequate initial psychometric properties. Further testing of the measure in its adaptive format is necessary before it can be used clinically.
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Affiliation(s)
- Johanne Higgins
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Quebec, Canada
| | - Lois E Finch
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Quebec, Canada
| | - Jacek Kopec
- Department of Health Care and Epidemiology Faculty of Medicine, Mather Building University of British Columbia, Vancouver, Canada
| | - Nancy E Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Quebec, Canada, Department of Epidemiology and Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Quebec, Canada
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Fliess-Douer O, Vanlandewijck YC, Lubel Manor G, Van Der Woude LHV. A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure. Clin Rehabil 2010; 24:867-86. [PMID: 20554638 DOI: 10.1177/0269215510367981] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review, analyse, evaluate and critically appraise available wheelchair skill tests in the international literature and to determine the need for a standardized measurement tool of manual wheeled mobility in those with spinal cord injury. DATA SOURCES A systematic review of literature (databases PubMed, Web of Science and Cochrane Library (1970-December 2009). SUBJECTS Hand rim wheelchair users, mainly those with spinal cord injury. REVIEW METHODS Studies' content and methodology were analysed qualitatively. Study quality was assessed using the scale of Gardner and Altman. RESULTS Thirteen studies fell within the inclusion criteria and were critically reviewed. The 13 studies covered 11 tests, which involved 14 different skills. These 14 skills were categorized into: wheelchair manoeuvring and basic daily living skills; obstacle-negotiating skills; wheelie tasks; and transfers. The Wheelchair Skills Test version 2.4 (WST-2.4) and Wheelchair Circuit tests scored best on the Gardner and Altman scale, the Obstacle Course Assessment of Wheelchair User Performances (OCAWUP) test was found to be the most relevant for daily needs in a wheelchair. The different tests used different measurement scales, varying from binary to ordinal and continuous. Comparison of outcomes between tests was not possible because of differences in skills assessed, measurement scales, environment and equipment selected for each test. A lack of information regarding protocols as well as differences in terminology was also detected. CONCLUSION This systematic review revealed large inconsistencies among the current available wheelchair skill tests. This makes it difficult to compare study results and to create norms and standards for wheelchair skill performance.
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Affiliation(s)
- Osnat Fliess-Douer
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium.
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Rowland TJ, Gustafsson L, Henderson RD, Turpin M, Read SJ. Review of upper limb ability assessments in acute stroke care, from a practice perspective. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.12.45434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tennille J Rowland
- Royal Brisbane and Women's Hospital, Occupational Therapy Department, Queensland, Australia
| | - Louise Gustafsson
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | | | - Merrill Turpin
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Stephen J Read
- Royal Brisbane and Women's Hospital, Queensland, Australia
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Rensink M, Schuurmans M, Lindeman E, Hafsteinsdóttir T. Task-oriented training in rehabilitation after stroke: systematic review. J Adv Nurs 2009; 65:737-54. [PMID: 19228241 DOI: 10.1111/j.1365-2648.2008.04925.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper is a report of a review conducted to provide an overview of the evidence in the literature on task-oriented training of stroke survivors and its relevance in daily nursing practice. BACKGROUND Stroke is the second leading cause of death and one of the leading causes of adult disability in the Western world. The use of neurodevelopmental treatment in the daily nursing care of stroke survivors does not improve clinical outcomes. Nurses are therefore exploring other forms of rehabilitation intervention, including task-oriented rehabilitation. Despite the growing number of studies showing evidence on task-oriented interventions, recommendations for daily nursing practice are lacking. DATA SOURCES A range of databases was searched to identify papers addressing task-oriented training in stroke rehabilitation, including Medline, CINAHL, Embase and the Cochrane Library of systematic reviews. Papers published in English between January 1996 and September 2007 were included. There were 42 papers in the final dataset, including nine systematic reviews. REVIEW METHODS The selected randomized controlled trials and systematic reviews were assessed for quality. Important characteristics and outcomes were extracted and summarized. RESULTS Studies of task-related training showed benefits for functional outcome compared with traditional therapies. Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life. CONCLUSION Generally, task-oriented rehabilitation proved to be more effective. Many interventions are feasible for nurses and can be performed in a ward or at home. Nurses can and should play an important role in creating opportunities to practise meaningful functional tasks outside of regular therapy sessions.
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Affiliation(s)
- Marijke Rensink
- Care for elderly and chronically ill, University of Applied Sciences, Utrecht, The Netherlands.
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Rowland TJ, Gustafsson L, Henderson RD, Turpin M, Read SJ. Review of upper limb ability assessments in acute stroke care, from a practice perspective. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.12.45424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: The purpose of this study was to compare three upper limb ability assessments - the Action Research Arm Test (ARAT), Arm Motor Ability Test (AMAT), and Chedoke Arm and Hand Activity Inventory (CAHAI) - in acute stroke occupational therapy practice during a 6-month period, to identify whether any or all were appropriate for use in acute stroke care. Methods: Medical records of clients with stroke admitted to an acute stroke unit were reviewed retrospectively. Inclusion criteria were: (a) admission between March and August 2006, (b) new diagnosis of stroke, (c) upper limb involvement, and (d) assessed by an occupational therapist with ARAT, AMAT or CAHAI. Included records were reviewed and the following noted: diagnosis, upper limb weakness, gender, age, assessment score, when assessed, time to administer, test items completed, and qualitative notations. Findings: Thirty three records satisfied the inclusion criteria. A range of stroke subtypes were assessed. The mean ARAT score was 21.4/45, CAHAI was 66.5/91 and AMAT was 3.0/5. The median number of days post-stroke when assessed was 9 days. Conclusions: Overall, ARAT, CAHAI and AMAT were useful for assessment of upper limb ability. The results cannot specifically identify which assessment is most suited to the acute stroke setting. The findings do support the inclusion of ARAT, CAHAI and AMAT in standard clinical care.
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Affiliation(s)
- Tennille J Rowland
- Royal Brisbane and Women's Hospital, Occupational Therapy Department, Queensland, Australia
| | - Louise Gustafsson
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | | | - Merrill Turpin
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Stephen J Read
- Royal Brisbane and Women's Hospital, Queensland, Australia
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Rajaratnam BS, Venketasubramanian N, Kumar PV, Goh JC, Chan YH. Predictability of Simple Clinical Tests to Identify Shoulder Pain After Stroke. Arch Phys Med Rehabil 2007; 88:1016-21. [PMID: 17678664 DOI: 10.1016/j.apmr.2007.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify simple diagnostic musculoskeletal tests that can be performed early after stroke to predict patients' likelihood of reporting early signs of hemiplegic shoulder pain. DESIGN Case control. SETTING Multicenter acute care hospitals. PARTICIPANTS A total of 152 adults after a first episode of stroke, of whom 135 met the inclusion criteria. Thirty patients were assigned to the experimental group because they reported moderate intensity of hemiplegic shoulder pain at rest. The remaining 105 patients made up the control group. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Therapists measured the performance of combined upper-limb movement including the hand-behind-neck (HBN) maneuver, passive pain-free ranges of shoulder motion, 3 musculoskeletal tests, and the strength of deltoid muscles during each patient's hospital stay. The numeric rating scale (NRS) identified those who reported moderate or greater intensities of hemiplegic shoulder pain during rest and during assessment. RESULTS In our study, 22.2% (95% confidence interval, 15.5-30.2) of the patients reported hemiplegic shoulder pain, on average 1 week after the onset of stroke. Positive Neer test (NRS score >or=5) during the HBN maneuver and a difference of more than 10 degrees of passive range of external rotation between shoulders had a 98% probability of predicting the presence of hemiplegic shoulder pain (receiver operating characteristic, .994; sensitivity, 96.7%; specificity, 99.0%; positive predictive value, 96.7%; negative predictive value, 99.0%; P<.001). CONCLUSIONS Three diagnostic clinical tests that can be performed during a bedside evaluation increase the likelihood of determining those who complain of hemiplegic shoulder pain after an acute episode of stroke.
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Sezer N, Yavuzer G, Sivrioglu K, Basaran P, Koseoglu BF. Clinimetric Properties of the Duruoz Hand Index in Patients With Stroke. Arch Phys Med Rehabil 2007; 88:309-14. [PMID: 17321822 DOI: 10.1016/j.apmr.2006.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the reliability, validity, and responsiveness of the Duruoz Hand Index (DHI) in assessing activity limitation related to hand function in patients with stroke. DESIGN Prospective validation study. A consecutive sample of stroke patients was evaluated on 3 occasions: 2 baseline measurements with a 24-hour interval in between, and again 1 month later immediately after a 4-week inpatient rehabilitation program. SETTING Three different inpatient rehabilitation centers. PARTICIPANTS A consecutive sample of 56 patients with stroke (33 men, 23 women) with a mean age 62 years and a mean time since stroke 84 days. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Brunnstrom stages, Modified Ashworth Scale, sensory status, FIM instrument, and DHI. Test-retest reliability was tested using the intraclass correlation coefficient (ICC) and internal consistency was tested using the Cronbach alpha coefficient. Indexes of measurement error were calculated by standard error of measurement and minimal detectable change (MDC). Construct validity was assessed by association with the FIM instrument (Spearman rho correlation coefficient). Responsiveness was assessed by calculation of the effect size and paired t test. RESULTS The test-retest reliability and internal consistency of the DHI were excellent, with an ICC of .99 (95% confidence interval, .93-.99) and alpha of .97. The MDC was 1.4 DHI points. The correlation between the DHI and the FIM self-care items was high (rho=-.73). The DHI significantly discriminated the patients with dominant side paresis versus nondominant side paresis (P<.01). The DHI score improved significantly after a 4-week inpatient rehabilitation program (P<.05). CONCLUSIONS The DHI is a time and labor efficient, practical instrument that can be used to assess the hand-related activity level for clinical and research purposes in patients with stroke.
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Affiliation(s)
- Nebahat Sezer
- IVth Physical Medicine & Rehabilitation Clinic, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, and Department of Physical Medicine & Rehabilitation, Ankara University, Faculty of Medicine, Turkey.
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Ang JHY, Man DWK. The discriminative power of the Wolf motor function test in assessing upper extremity functions in persons with stroke. Int J Rehabil Res 2006; 29:357-61. [PMID: 17106357 DOI: 10.1097/mrr.0b013e3280118e65] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Wolf motor function test is a new time-based method to evaluate upper extremity function both on a joint-specific level and on total limb movements, while performing some functional tasks. The purpose of this paper is to investigate the discriminating power of the Wolf motor function test in classifying individuals with stroke into different levels according to Brunnstrom's stages of recovery. Discriminant analysis was used and the results showed that the Wolf motor function test can classify 86.7% of original grouped cases into the correct groupings. A high correlation was found between the Wolf motor function test, the Brunnstrom stages of recovery and the Fugl-Meyer Assessment. The Wolf motor function test is found to be an instrument capable of discriminating the upper extremity motor function of the individuals with stroke into different functional groups.
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Affiliation(s)
- Josephine Hui Yung Ang
- Occupational Therapy Department, MacLehose Medical Rehabilitation Centre, Hospital Authority, Hong Kong, China
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