1
|
Chinchai P, Pingmuang P, Chinchai K, Kaunnil A. Validity and reliability of the functional test for hemiplegic upper Extremity-Thai version. Hong Kong J Occup Ther 2024; 37:72-82. [PMID: 39539408 PMCID: PMC11556561 DOI: 10.1177/15691861241264046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/09/2024] [Indexed: 11/16/2024] Open
Abstract
Background There are very few standard instruments currently available for measuring upper extremity (UE) functions for patients with stroke in Thailand. Objectives This study aims to examine the concurrent validity, construct validity, and stability reliability of the Functional Test for Hemiplegic Upper Extremity (FTHUE)-Thai version for patients with stroke. Methods Thirty hemiplegic participants from five community rehabilitation centers in Chiang Mai province and 30 healthy subjects were recruited. The FTHUE-Thai version and the Fugl-Meyer Assessment for the Upper Extremity (FMA-UE) were the instruments used. Concurrent validity was determined by investigating the relationship between the FTHUE-Thai version and the FMA-UE. Construct validity was investigated by comparing the performance of FTHUE-Thai version between stroke participants and healthy subjects. The stability reliability of the FTHUE-Thai version, which measured the UE function of stroke participants twice in a two-week's period, was also investigated. The statistics used were Spearman's correlation coefficient and the Mann-Whitney test. Results There were significant correlations between the UE function, as measured by the FTHUE-Thai version, and the arm, and hand sub-scores, as well as the total scores of the FMA-UE (r = 0.93, r = 0.84, and r = 0.95, respectively), indicating good concurrent validity. Stability reliability was also good (r = 0.98, weighted kappa = 0.94). A known group technique test revealed significantly different scores between stroke patients and healthy subjects (p < .001), indicating good construct validity. Conclusion The FTHUE-Thai version could be a reliable measurement tool for the UE function in stroke patients in the Thai context.
Collapse
Affiliation(s)
- Pisak Chinchai
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Krongporn Chinchai
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Anuchart Kaunnil
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
2
|
Hsu HY, Koh CL, Yang KC, Lin YC, Hsu CH, Su FC, Kuo LC. Effects of an assist-as-needed equipped Tenodesis-Induced-Grip Exoskeleton Robot (TIGER) on upper limb function in patients with chronic stroke. J Neuroeng Rehabil 2024; 21:5. [PMID: 38173006 PMCID: PMC10765635 DOI: 10.1186/s12984-023-01298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The original version of the Tenodesis-Induced-Grip Exoskeleton Robot (TIGER) significantly improved the motor and functional performance of the affected upper extremity of chronic stroke patients. The assist-as-needed (AAN) technique in robot-involved therapy is widely favored for promoting patient active involvement, thereby fostering motor recovery. However, the TIGER lacked an AAN control strategy, which limited its use in different clinical applications. The present study aimed to develop and analyze the training effects of an AAN control mode to be integrated into the TIGER, to analyze the impact of baseline patient characteristics and training paradigms on outcomes for individuals with chronic stroke and to compare training effects on the upper limb function between using the AAN-equipped TIGER and using the original prototype. METHODS This was a single-arm prospective interventional study which was conducted at a university hospital. In addition to 20 min of regular task-specific motor training, each participant completed a 20-min robotic training program consisting of 10 min in the AAN control mode and 10 min in the functional mode. The training sessions took place twice a week for 9 weeks. The primary outcome was the change score of the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), and the secondary outcomes were the change score of the Box and Blocks Test (BBT), the amount of use (AOU) and quality of movement (QOM) scales of the Motor Activity Log (MAL), the Semmes-Weinstein Monofilament (SWM) test, and the Modified Ashworth Scale (MAS) for fingers and wrist joints. The Generalized Estimating Equations (GEE) and stepwise regression model were used as the statistical analysis methods. RESULTS Sixteen chronic stroke patients completed all steps of the study. The time from stroke onset to entry into the trial was 21.7 ± 18.9 months. After completing the training with the AAN-equipped TIGER, they exhibited significant improvements in movement reflected in their total score (pre/post values were 34.6 ± 11.5/38.5 ± 13.4) and all their sub-scores (pre/post values were 21.5 ± 6.0/23.3 ± 6.5, 9.5 ± 6.2/11.3 ± 7.2, and 3.6 ± 1.0/3.9 ± 1.0 for the shoulder, elbow, and forearm sub-category, the wrist and hand sub-category, and the coordination sub-category, respectively) on the FMA-UE (GEE, p < 0.05), as well as their scores on the BBT (pre/post values were 5.9 ± 6.5/9.5 ± 10.1; GEE, p = 0.004) and the AOU (pre/post values were 0.35 ± 0.50/0.48 ± 0.65; GEE, p = 0.02). However, the original TIGER exhibited greater improvements in their performance on the FMA-UE than the participants training with the AAN-equipped TIGER (GEE, p = 0.008). The baseline score for the wrist and hand sub-category of the FMA-UE was clearly the best predictor of TIGER-mediated improvements in hand function during the post-treatment assessment (adjusted R2 = 0.282, p = 0.001). CONCLUSIONS This study developed an AAN-equipped TIGER system and demonstrated its potential effects on improving both the function and activity level of the affected upper extremity of patients with stroke. Nevertheless, its training effects were not found to be advantageous to the original prototype. The baseline score for the FMA-UE sub-category of wrist and hand was the best predictor of improvements in hand function after TIGER rehabilitation. Clinical trial registration ClinicalTrials.gov, identifier NCT03713476; date of registration: October19, 2018. https://clinicaltrials.gov/ct2/show/NCT03713476.
Collapse
Affiliation(s)
- Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Kang-Chin Yang
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Hsiang Hsu
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan.
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
3
|
Shao Y, Yang Y, Sun YX, Xu AH. Different frequencies of repetitive transcranial magnetic stimulation combined with local injection of botulinum toxin type A for post-stroke lower limb spasticity: study protocol for a prospective, single-center, non-randomized, controlled clinical trial. Neural Regen Res 2022; 17:2491-2496. [PMID: 35535901 PMCID: PMC9120707 DOI: 10.4103/1673-5374.339011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
No definite consensus has currently been reached regarding the safety and efficacy of low- or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity. The latest research indicates that when combined with local injections of botulinum toxin type A, it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone. We designed a prospective, single-center, non-randomized, controlled clinical trial to investigate the safety and efficacy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen. This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hospital of China Medical University. All enrolled patients will undergo routine rehabilitation training and will be divided into five groups (n = 30 per group) according to the particular area of cerebral infarction and treatment methods. Group A: Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency (1 Hz) repetitive transcranial magnetic stimulation on the contralateral side; Group B: Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency (10–20 Hz) repetitive transcranial magnetic stimulation on the affected side; Group C: Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A; Group D: Patients with massive cerebral infarction will be given low-frequency (1 Hz) repetitive transcranial magnetic stimulation on the contralateral side; and Group E: Patients with non-massive cerebral infarction will be given high-frequency (10–20 Hz) repetitive transcranial magnetic stimulation on the affected side. The primary outcome measure of this trial is a modified Ashworth scale score from 1 day before treatment to 12 months after treatment. Secondary outcome measures include Fugl-Meyer Assessment of Lower Extremity, Visual Analogue Scale, modified Barthel index, and Berg Balance Scale scores for the same time as specified for primary outcome measures. The safety indicator is the incidence of adverse events at 3–12 months after treatment. We hope to draw a definite conclusion on whether there are differences in the safety and efficacy of low- or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation, thereby screening out the optimal therapeutic regimen. The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University (approval No. [2021] 2021-333-3) on August 19, 2021. The trial was registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2100052180) on October 21, 2021. The protocol version is 1.1.
Collapse
Affiliation(s)
- Yang Shao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yang Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yong-Xin Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ai-Hua Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| |
Collapse
|
4
|
The Prognostic Value of Domain-Specific Cognitive Abilities Assessed by Chinese Version of Oxford Cognitive Screen on Determining ADLs Recovery in Patients with Post-Stroke Cognitive Impairment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1084901. [PMID: 36110193 PMCID: PMC9470312 DOI: 10.1155/2022/1084901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
Background Poststroke cognitive impairment (PSCI) has been increasingly recognized in patients. However, it remains unclear whether ADLs recovery is more susceptible to domain-specific cognitive abilities after a stroke. Therefore, the study was designed to investigate the cognitive functions of patients with PSCI at admission by using the Chinese (Putonghua) Version of the Oxford Cognitive Screen (OCS-P) as well as to identify the prognostic value of domain-specific cognitive abilities on the recovery of ADLs when discharged. Methods A total of 153 hospitalized stroke patients were included in this prospective study. Cognitive function was assessed by OCS-P when participants were admitted to the hospital. The ADLs were measured at admission and discharge, and recovery was estimated by the improvement between admission and discharge. A diagnostic model using logistic regression was constructed to identify the prognostic value of domain-specific cognitive abilities for ADLs. The efficacy and accuracy of the diagnostic model were assessed by receiver operating characteristic (ROC) and Hosmer-Lemeshow's goodness of fit test. The diagnostic model was validated by 10-fold cross-validation and presented as a nomogram. Results The score of OCS-P was 60(49.75, 69). The most frequently impaired cognitive domain was number writing (60.8%), followed by verbal memory (52.9%). Multivariate logistic regression showed executive dysfunction was a risk prognostic factor of ADLs recovery (P < 0.001, OR = 3.176 [95% CI, 1.218∼8.278]). The ROC curve of the diagnostic model was 0.839, with a good diagnostic efficacy. Hosmer–Lemeshow test showed diagnostic model had good calibration ability (χ2 = 8.939.3, P=0.347 > 0.05). The average error rate after adjustment of 10-fold cross-validation was 20.93%, within the acceptable range. Conclusions Post-stroke patients generally suffered from multidimensional cognitive impairments. Executive dysfunction screened with OCS-P at clinical admission was a reliable and accessible predictive factor ADLs recovery in patients with PSCI. Early targeted rehabilitation programs are suggested to make them as earlier as possible, especially for those having executive dysfunction while hospitalized.
Collapse
|
5
|
Pandian S, Arya KN, Kumar V, Joshi AK. Synergy-Based Motor Therapy Inducing Favorable Changes in Motor Function Components among Poststroke Subjects: A Single-Group Study. J Neurosci Rural Pract 2022; 13:261-269. [PMID: 35694074 PMCID: PMC9187400 DOI: 10.1055/s-0042-1743458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Synergy is an outcome of multiple muscles acting in a synchronized pattern, controlled by the central nervous system. After brain insult, a set of deviated movement pattern emerges in the affected limb. The methods to train synchronization of muscles may diminish the deviated movement augmenting neuromotor control. The purpose of this investigation was to develop a synergy-based motor therapy (SBMT) protocol for the paretic upper limb in poststroke subjects. Further, the feasibility and effectiveness of the program was evaluated. .
Methods
The design was Pretest–posttest single-group assessor-blinded trial. Department of occupational therapy of a national institute for persons with physical disabilities was the study site. There were 40 study subjects (23 men, ranging from 40 to 60 years, 18 subjects with hemorrhagic cerebrovascular accident, and > 6 months after the accident) exhibiting motor paresis of half side of the body. SBMT is a stage-specific regime based on the linkage between the deviated and usual muscle action. SBMT items were selected considering the strength and magnitude of the deviated motor components. The movement linkages were utilized to dissociate strong coupled components; for instance, forearm pronation-supination with elbow 90-degree flexion. Fugl-Meyer Assessment (upper extremity) (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI) were applied to quantify the motor status, motor functional ability of the upper extremity, and self-care activities, respectively.
Results
All the enrolled subjects could perform their corresponding SBMT sessions. Posttreatment, FMA-UE improved significantly (
p
< 0.001) from mean of 26.30 (standard deviation [SD] 15.02) to 35.20 (SD 17.64). Similarly, the WMFT both time (in seconds) and quality also positively improved significantly (
p
< .001) from mean of 76.77 (SD 54.73) to 64.07 (SD 56.99) and 1.34 (SD 1.06) to 1.87 (SD 1.34), respectively. BI improved from 79.88 (SD 17.07) to 92.62 (SD 21.2) after the intervention (
p
< 0.001).
Conclusion
SBMT protocol was a feasible and effective intervention to facilitate motor function components in chronic hemiparetic subjects. The regime could be considered as a potential intervention for stroke rehabilitation. Further trials and use of sophisticated measures are recommended to authenticate the outcome of this investigation.
Clinical Trial Registration
Clinical Trial Registry of India as CTRI/2017/10/010162 on October 23, 2017 (retrospectively).
Collapse
Affiliation(s)
- Shanta Pandian
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Kamal Narayan Arya
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Vikas Kumar
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Akshay Kumar Joshi
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| |
Collapse
|
6
|
Tauchi Y, Kyougoku M, Takahashi K, Okita Y, Takebayashi T. Dimensionality and item-difficulty hierarchy of the Fugl-Meyer assessment of the upper extremity among Japanese patients who have experienced stroke. Top Stroke Rehabil 2021; 29:579-587. [PMID: 34414858 DOI: 10.1080/10749357.2021.1965797] [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: 10/20/2022]
Abstract
Background: The Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) has been used in many clinical studies and in stroke rehabilitation. In studies evaluating psychometric properties, confirmatory factor analysis (CFA) indicated that the FMA-UE is a multidimensional tool. Item Response Theory One-Parameter Logistic (IRT1PL) supports that item-difficulty hierarchy can be used as a treatment index of upper extremity function for stroke recovery. However, studies on the psychometric properties of the FMA-UE in Asian populations are lacking.Objectives: To investigate the dimensionality and item-difficulty hierarchy of the FMA-UE for stroke rehabilitation in Japanese patients. Methods: This was a cross-sectional study. The participants comprised 268 individuals admitted for de novo stroke (median age, 70.0 years; median days since stroke onset, 78.5) in 22 hospitals in Japan. The dimensionality of the FMA-UE was evaluated using CFA of selected items. The item-difficulty hierarchy of the FMA-UE using the appropriately selected model was demonstrated using IRT1PL analysis after confirming dimensionality.Results:Two reflex items were removed by utilizing the floor and ceiling effects. The 31- and 30-item FMA-UE exhibited a good model fit of the unidimensionality in the CFA. The 30-item FMA-UE was found to be a good model by model comparison (the 31-item vs. the 30-item). The item-difficulty hierarchy of the 30-item FMA-UE was found not to be consistent with the expected item order.Conclusions:This study provides evidence that the FMA-UE has multidimensionality and the 30-item FMA-UE is a valid instrument for measuring upper-extremity impairment after stroke.
Collapse
Affiliation(s)
- Yuta Tauchi
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan
| | - Makoto Kyougoku
- Department of Occupational Therapy, School of Health Sciences, Kibi International University, Okayama, Japan
| | - Kayoko Takahashi
- Department of Occupational Therapy, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Yuho Okita
- Soaring Health Sports, Wellness & Community Centre, Melbourne, Australia
| | - Takashi Takebayashi
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan.,College of Health and Human Sciences, School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan
| |
Collapse
|
7
|
Geed S, Lane CJ, Nelsen MA, Wolf SL, Winstein CJ, Dromerick AW. Inaccurate Use of the Upper Extremity Fugl-Meyer Negatively Affects Upper Extremity Rehabilitation Trial Design: Findings From the ICARE Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:270-279. [PMID: 32991872 PMCID: PMC7854957 DOI: 10.1016/j.apmr.2020.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the extent to which estimates of sample and effect size in stroke rehabilitation trials can be affected by simple summation of ordinal Upper Extremity Fugl-Meyer (UEFM) items compared with a Rasch-rescaled UEFM. DESIGN Rasch analysis of Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) phase III trial data, comparing 3 upper extremity (UE) motor treatments in stroke survivors enrolled 45.8±22.4 days poststroke. Participants underwent a structured UE motor training known as the Accelerated Skill Acquisition Program, usual and customary care, or dose-equivalent care. UEFM data from baseline, postintervention, and 6 and 12 months later were included for analysis. SETTING Outpatient stroke rehabilitation. PARTICIPANTS ICARE participants (N=361). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Item difficulties, person abilities, and sample size. RESULTS Because of their ordinality, summed raw UEFM scores measured motor impairment inconsistently across different ranges of stroke severity relative to the rescaled UEFM. In the full ICARE sample, raw UEFM understated scores relative to the rescaled UEFM by 7.4 points for the most severely impaired, but overstated scores by up to 8.4 points toward the ceiling. As a result, 50.9% of all UEFM observations showed a residual error greater than 10% of the total UEFM score. Relative to the raw scores, the rescaled UEFM improved the effect size of change in motor impairment between baseline and 1 year (d=0.35). For a hypothetical 3-arm trial resembling ICARE, UEFM rescaling reduced the required sample size by 32% (n=108) compared with raw UEFM (n=159). CONCLUSIONS In UE rehabilitation trials, a rescaled UEFM potentially decreases sample size by one-third, decreasing costs, duration, and the number of subjects exposed to experimental risks. This benefit is obtained through increased measurement efficiency. Reductions in ceiling effects are also possible. These findings apply to ICARE-like trials. Confirmatory validation in another phase III trial is needed.
Collapse
Affiliation(s)
- Shashwati Geed
- Department of Rehabilitation Medicine, Center for Brain Plasticity and Recovery, Georgetown University and MedStar National Rehabilitation Hospital, Washington, DC.
| | - Christianne J Lane
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Monica A Nelsen
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory School of Medicine, Atlanta, GA; Department of Medicine, Emory School of Medicine, Atlanta, GA; Department of Cell Biology, Emory School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Services, Decatur, GA
| | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Alexander W Dromerick
- Department of Rehabilitation Medicine, Center for Brain Plasticity and Recovery, Georgetown University and MedStar National Rehabilitation Hospital, Washington, DC; Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University and MedStar National Rehabilitation Hospital, Washington, DC
| |
Collapse
|
8
|
Hernández ED, Forero SM, Galeano CP, Barbosa NE, Sunnerhagen KS, Alt Murphy M. Intra- and interrater reliability of Fugl-Meyer Assessment of Lower Extremity early after stroke. Braz J Phys Ther 2020; 25:709-718. [PMID: 33358073 PMCID: PMC8721065 DOI: 10.1016/j.bjpt.2020.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Fugl-Meyer Assessment of Lower Extremity (FMA-LE) is a widely used and recommended scale for evaluation of post-stroke motor impairment. However, the reliability of the scale has only been established by using parametric statistical methods, which ignores the ordinal properties of the scale. OBJECTIVE To determined intra- and inter-rater reliability of the FMA-LE at item and summed score level early after stroke. METHODS Sixty patients (mean age 65.9 years, median FMA-LE 29 points) admitted to the hospital due to stroke were included. The FMA-LE was simultaneously, but independently, scored by three experienced and trained physical therapists randomly assigned into pairs, on two consecutive days, between 4 to 9 days post stroke. A rank-based statistical method for paired ordinal data was used to assess the level of agreement and systematic and random disagreements. RESULTS The item-level reliability was high (percentage of agreement [PA] ≥75%). Two items (ankle dorsiflexion during flexor synergy and normal reflex activity) showed some systematic disagreement in intrarater analysis. A satisfactory intrarater reliability (PA ≥70%) was reached for all summed scores when a 1- or 2-point difference was accepted between ratings. CONCLUSION The FMA-LE is a reliable tool for assessment of motor impairment both within and between raters early after stroke. The scale can be recommended not only for use in Spanish speaking countries, but also internationally. A unified international use of FMA-LE would allow comparison of stroke recovery outcomes worldwide and thereby potentially improve the quality of stroke rehabilitation.
Collapse
Affiliation(s)
- Edgar D Hernández
- Departamento del Movimiento Corporal Humano, Universidad Nacional de Colombia, Bogota, Colombia
| | | | | | | | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
9
|
Barbosa NE, Forero SM, Galeano CP, Hernández ED, Landinez NS, Sunnerhagen KS, Alt Murphy M. Translation and cultural validation of clinical observational scales - the Fugl-Meyer assessment for post stroke sensorimotor function in Colombian Spanish. Disabil Rehabil 2018; 41:2317-2323. [PMID: 29688080 DOI: 10.1080/09638288.2018.1464604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose: Fugl-Meyer Assessment (FMA) is the most widely used and recommended clinical scale for evaluation of sensorimotor impairment post stroke, but an official Spanish version is not available today. This study aimed to establish methodological structure for translation and cultural adaptation process and perform a transcultural validation of the upper and lower extremity FMA to Colombian Spanish. Methods: Procedures included forward and backward translation, step-wise reviewing by bilingual and professional experts to ensure conceptual and semantic equivalence. Validation included a pilot evaluation of item-level agreement on 10 individuals with stroke at the Central Military Hospital of Colombia. Results: Comprehensive step-wise procedure for transcultural validation was established. Low agreement (less than 70%) was detected for items assessing arm movements within synergies and for coordination/speed subscale. All points of disagreement were systematically reviewed and agreed upon when drafting the final version of the Spanish FMA. Conclusions: Use of FMA will allow unified description of stroke severity and motor recovery in Spanish speaking countries. This will open up possibility to compare stroke and rehabilitation outcomes with other countries and regions world-wide. Comprehensive methodological procedures provided can facilitate introduction of well-established clinical scales in other languages. Implications for Rehabilitation The Fugl-Meyer Assessment (FMA) of upper and lower extremity is the most used and recommended clinical scale for evaluation of sensorimotor impairment after stroke. The Spanish version of FMA, validated in this study, is now first time available for use in research and clinical practice. Use of FMA will allow unified description of stroke severity and motor recovery in Spanish speaking countries, which in turn opens up possibility to compare stroke and rehabilitation outcomes with other countries and regions world-wide.
Collapse
Affiliation(s)
| | | | | | - Edgar D Hernández
- b Human Movement Department , National University of Colombia , Bogota , Colombia
| | - Nancy S Landinez
- b Human Movement Department , National University of Colombia , Bogota , Colombia
| | - Katharina S Sunnerhagen
- c Institute for Neuroscience and Physiology , Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Margit Alt Murphy
- c Institute for Neuroscience and Physiology , Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| |
Collapse
|
10
|
Arya KN, Pandian S, Kumar D. Does an association exist between the hierarchical motor components of upper and lower limbs in stroke? J Bodyw Mov Ther 2016; 20:504-11. [DOI: 10.1016/j.jbmt.2015.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/06/2015] [Accepted: 11/14/2015] [Indexed: 11/24/2022]
|
11
|
Prokopenko SV, Mozheyko EY, Alekseevich GV. Methods of assessment of movement functions in the upper limb. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [DOI: 10.17116/jnevro201611671101-107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
12
|
Balasubramanian CK, Li CY, Bowden MG, Duncan PW, Kautz SA, Velozo CA. Dimensionality and Item-Difficulty Hierarchy of the Lower Extremity Fugl-Meyer Assessment in Individuals With Subacute and Chronic Stroke. Arch Phys Med Rehabil 2015; 97:582-589.e2. [PMID: 26740065 DOI: 10.1016/j.apmr.2015.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/05/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the dimensionality and item-difficulty hierarchy of the Fugl-Meyer Assessment of the lower extremity (FMA-LE). DESIGN Secondary analyses of data pooled from 4 existing datasets: a phase III randomized controlled trial investigating the effectiveness of body weight support and a treadmill for rehabilitation of walking poststroke, and 3 cross-sectional studies investigating the link between impaired motor performance poststroke and walking. SETTING University research centers and rehabilitation centers. PARTICIPANTS A pooled sample of individuals with a stroke (N=535, men=313; mean age ± SD, 61.91±12.42y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Confirmatory factor analyses (CFA) and Rasch residual principal component analysis (PCA) investigated the dimensionality of the FMA-LE. The Rasch analysis rating scale model investigated item-difficulty hierarchy of the FMA-LE. RESULTS The CFA showed adequate fit of a 3-factor model, with 2 out of 3 indices (CFA=.95; Tucker-Lewis Index=.94; root mean square error of approximation=.124) showing good model fit. Rasch PCA showed that removal of the reflex and coordination items explained 90.8% of variance in the data, suggesting that the abnormal synergy items contributed to the measurement of a unidimensional construct. However, rating scale model results revealed deviations in the item-difficulty hierarchy of the unidimensional abnormal synergy items from the originally proposed stepwise sequence of motor recovery. CONCLUSIONS Our findings suggest that the FMA-LE might represent a multidimensional construct, challenging the use of a total score of the FMA-LE to predict lower extremity motor recovery. Removal of the misfit items resulted in creation of a unidimensional scale composed of the abnormal synergy items. However, this unidimensional scale deviates from the originally proposed hierarchical ordering.
Collapse
Affiliation(s)
| | - Chih-Ying Li
- Department of Health Science and Research and Division of Physical Therapy, College of Health Profession, Medical University of South Carolina, Charleston, SC
| | - Mark G Bowden
- Department of Health Science and Research and Division of Physical Therapy, College of Health Profession, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Pamela W Duncan
- Department of Neurology, Wake Forest University, Winston-Salem, NC
| | - Steven A Kautz
- Department of Health Science and Research and Division of Physical Therapy, College of Health Profession, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Craig A Velozo
- Division of Occupational Therapy, College of Health Profession, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
13
|
Opheim A, Danielsson A, Alt Murphy M, Persson HC, Sunnerhagen KS. Early prediction of long-term upper limb spasticity after stroke: part of the SALGOT study. Neurology 2015; 85:873-80. [PMID: 26276377 PMCID: PMC4560058 DOI: 10.1212/wnl.0000000000001908] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 04/09/2015] [Indexed: 12/21/2022] Open
Abstract
Objective: To identify predictors and the optimal time point for the early prediction of the presence and severity of spasticity in the upper limb 12 months poststroke. Methods: In total, 117 patients in the Gothenburg area who had experienced a stroke for the first time and with documented arm paresis day 3 poststroke were consecutively included. Assessments were made at admission and at 3 and 10 days, 4 weeks, and 12 months poststroke. Upper limb spasticity in elbow flexion/extension and wrist flexion/extension was assessed with the modified Ashworth Scale (MAS). Any spasticity was regarded as MAS ≥1, and severe spasticity was regarded as MAS ≥2 in any of the muscles. Sensorimotor function, sensation, pain, and joint range of motion in the upper limb were assessed with the Fugl-Meyer assessment scale, and, together with demographic and diagnostic information, were included in both univariate and multivariate logistic regression analysis models. Seventy-six patients were included in the logistic regression analysis. Results: Sensorimotor function was the most important predictor both for any and severe spasticity 12 months poststroke. In addition, spasticity 4 weeks poststroke was a significant predictor for severe spasticity. The best prediction model for any spasticity was observed 10 days poststroke (85% sensitivity, 90% specificity). The best prediction model for severe spasticity was observed 4 weeks poststroke (91% sensitivity, 92% specificity). Conclusions: Reduced sensorimotor function was the most important predictor both for any and severe spasticity, and spasticity could be predicted with high sensitivity and specificity 10 days poststroke.
Collapse
Affiliation(s)
- Arve Opheim
- From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway.
| | - Anna Danielsson
- From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway
| | - Margit Alt Murphy
- From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway
| | - Hanna C Persson
- From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway
| | - Katharina Stibrant Sunnerhagen
- From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway
| |
Collapse
|
14
|
Harris-Love ML, Chan E, Dromerick AW, Cohen LG. Neural Substrates of Motor Recovery in Severely Impaired Stroke Patients With Hand Paralysis. Neurorehabil Neural Repair 2015; 30:328-38. [PMID: 26163204 DOI: 10.1177/1545968315594886] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In well-recovered stroke patients with preserved hand movement, motor dysfunction relates to interhemispheric and intracortical inhibition in affected hand muscles. In less fully recovered patients unable to move their hand, the neural substrates of recovered arm movements, crucial for performance of daily living tasks, are not well understood. Here, we evaluated interhemispheric and intracortical inhibition in paretic arm muscles of patients with no recovery of hand movement (n = 16, upper extremity Fugl-Meyer Assessment = 27.0 ± 8.6). We recorded silent periods (contralateral and ipsilateral) induced by transcranial magnetic stimulation during voluntary isometric contraction of the paretic biceps and triceps brachii muscles (correlates of intracortical and interhemispheric inhibition, respectively) and investigated links between the silent periods and motor recovery, an issue that has not been previously explored. We report that interhemispheric inhibition, stronger in the paretic triceps than biceps brachii muscles, significantly correlated with the magnitude of residual impairment (lower Fugl-Meyer scores). In contrast, intracortical inhibition in the paretic biceps brachii, but not in the triceps, correlated positively with motor recovery (Fugl-Meyer scores) and negatively with spasticity (lower Modified Ashworth scores). Our results suggest that interhemispheric inhibition and intracortical inhibition of paretic upper arm muscles relate to motor recovery in different ways. While interhemispheric inhibition may contribute to poorer recovery, muscle-specific intracortical inhibition may relate to successful motor recovery and lesser spasticity.
Collapse
Affiliation(s)
- Michelle L Harris-Love
- Georgetown University Medical Center, Washington, DC, USA MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Evan Chan
- MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Alexander W Dromerick
- Georgetown University Medical Center, Washington, DC, USA MedStar National Rehabilitation Hospital, Washington, DC, USA District of Columbia VA Medical Center, Washington, DC, USA
| | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| |
Collapse
|
15
|
Park EY, Choi YI. Psychometric Properties of the Lower Extremity Subscale of the Fugl-Myer Assessment for Community-dwelling Hemiplegic Stroke Patients. J Phys Ther Sci 2014; 26:1775-7. [PMID: 25435698 PMCID: PMC4242953 DOI: 10.1589/jpts.26.1775] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/16/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the psychometric properties of the lower extremity subscale of the Fugl-Meyer Assessment lower extremity (FMA-LE) for community-dwelling hemiplegic stroke patients. [Subjects] The participants were 140 community-dwelling hemiplegic stroke patients. [Methods] To determine the psychometric properties of the FMA-LE, we examined construct validity, response characteristics, item discrimination, and internal consistency. [Results] Factor analysis of the FMA-LE revealed that the first factor explained 61.73% of the variance and provided evidence of unidimensionality. The FMA-LE did not show ceiling or floor effects; Cronbach's α was 0.935 (95% CI: 0.919-0.950). [Conclusion] Because the FMA-LE seems to be both valid and reliable, we conclude that it is appropriate for the measurement of the lower extremity motor impairment of community-dwelling hemiplegic stroke patients.
Collapse
Affiliation(s)
- Eun Young Park
- Department of Secondary Special Education, College of Education, Jeonju University, Republic of Korea
| | - Yoo Im Choi
- Department of Occupational Therapy, School of Medicine, Wonkwang University, Republic of Korea
| |
Collapse
|