scholarly journals Paretic upper extremity strength at acute rehabilitation evaluation predicts motor function outcome after stroke

2021 ◽  
Author(s):  
Mary Alice Saltão da Silva ◽  
Christine Cook ◽  
Cathy M Stinear ◽  
Steven L Wolf ◽  
Michael R Borich
Keyword(s):  
Functional Outcome ◽  
Upper Extremity ◽  
Motor Function ◽  
Clinical Decision Making ◽  
Classification And Regression Tree ◽  
Shoulder Abduction ◽  
Hospital System ◽  
Acute Hospitalization ◽  
Post Stroke ◽  
Cart Analysis

Objective: The primary objective of this study was to retrospectively assess current care practices to determine the routinely collected measures that are most predictive of paretic upper extremity (PUE) functional outcome post-stroke in patients undergoing acute inpatient rehabilitation (AR). Methods: We conducted a longitudinal chart review of patients post-stroke who received care in the Emory University Hospital system for acute hospitalization, AR, and outpatient therapy in fiscal years 2016-2018. We identified eligible patients using previously established inclusion and exclusion criteria. We extracted demographics, stroke characteristics, and longitudinal documentation of post-stroke motor function from institutional electronic medical records. Serial assessments of PUE strength were estimated using available shoulder abduction and finger extension manual muscle test documentation (E-SAFE). Estimated Action Research Arm Test (E-ARAT) was used to quantify 3-month PUE functional outcome. Metric associations were explored through correlation and cluster analyses, Kruskal-Wallis tests, classification and regression tree (CART) analysis. Results: Thirty-four patients met study eligibility criteria. E-SAFE assessments performed closest to acute hospitalization day-3 (Acute E-SAFE) and upon AR admission (AR E-SAFE) were correlated with E-ARAT. Cluster analysis produced three distinct outcome groups and aligned closely to previous outcome categories. Outcome groups significantly differed in Acute E-SAFE and AR E-SAFE. Exploratory CART analysis selected AR E-SAFE to classify patient outcome with 70.6% accuracy. Conclusions: Current study findings reveal that: PUE E-SAFE, measured both acutely and at AR admission, is associated with PUE motor recovery outcome; categorizations of outcome are consistent with previous studies; and predictive models can identify recovery outcome category in patients undergoing AR. Impact Statement: Our findings highlight the clinical utility of SAFE as an easy-to-acquire, readily implementable screening metric. Early, intentional use of SAFE in AR settings may improve clinical decision-making, enabling therapists to deliver precision-based interventions that serve to speed or enhance recovery outcome for patients post-stroke.

Abstract TMP31: Peripheral Nerve Stimulation Paired with Constraint-Induced Therapy to Enhance Post-Stroke Upper Extremity Motor Performance

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Cheryl Carrico ◽  
KC Chelette ◽  
Laurie Nichols ◽  
Lumy Sawaki
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Motor Function ◽  
Nerve Stimulation ◽  
Motor Performance ◽  
Motor Recovery ◽  
Peripheral Nerve Stimulation ◽  
Motor Deficit ◽  
Motor Training ◽  
Post Stroke

Research has shown that peripheral nerve stimulation (PNS) can enhance motor learning following cortical lesions. Studies have also shown that intensive upper extremity motor training can significantly enhance post-stroke motor performance. Constraint-induced therapy (CIT) is a form of intensive training that restricts use of the non-paretic upper extremity during repetitive, task-oriented motor training of the paretic extremity. Extensive evidence has validated the effectiveness of CIT for enhancing post-stroke upper extremity motor recovery. No studies have evaluated how PNS may modulate the effects of CIT. Therefore, we conducted a pilot study of PNS paired with CIT and hypothesized that in subjects with stroke, pairing CIT with active PNS would lead to significantly more improved motor function in the paretic upper extremity than CIT paired with sham PNS. Outcome measures included the Fugl-Meyer Assessment Scale (FMA; primary outcome measure), the Wolf Motor Function Test (WMFT), and the Action Research Arm Test (ARAT). Nineteen chronic stroke subjects with mild to moderate upper extremity motor deficit received 2 hours of either active (n=10) or sham (n=9) PNS preceding 4 hours of CIT for 10 consecutive weekdays. Changes in FMA, WMFT, and ARAT were analyzed using factorial ANOVA. Results showed significant (p<0.05) change in all measures at completion evaluation compared with baseline (FMA (p=0.005); WMFT (p=0.030); ARAT (p=0.020)) as well as 1-month follow-up compared with baseline (FMA (p=0.048); WMFT (p=0.045); ARAT (p=0.047)). These results highlight the enormous potential for PNS paired with CIT to enhance post-stroke upper extremity motor recovery more effectively than CIT alone.

Reliability and Validity of Two Tests of Upper Extremity Motor Function Post-Stroke

2001 ◽  
Vol 21 (3) ◽  
pp. 201-219 ◽  
Author(s):  
Lorie Richards ◽  
Joni Stoker-Yates ◽  
Patricia Pohl ◽  
Dennis Wallace ◽  
Pamela Duncan
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Reliability And Validity ◽  
Post Stroke

scholarly journals Fractal dimension assessment of brain white matter structural complexity post stroke in relation to upper-extremity motor function

2008 ◽  
Vol 1228 ◽  
pp. 229-240 ◽  
Author(s):  
Luduan Zhang ◽  
Andrew J. Butler ◽  
Chang-Kai Sun ◽  
Vinod Sahgal ◽  
George F. Wittenberg ◽  
...  
Keyword(s):  
Fractal Dimension ◽  
White Matter ◽  
Upper Extremity ◽  
Motor Function ◽  
Structural Complexity ◽  
Post Stroke ◽  
Brain White Matter

Choosing unwisely: Low-value care in older adults with a diagnosis of myelodysplastic syndrome.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1532-1532
Author(s):  
Sudipto Mukherjee ◽  
Weichuan Dong ◽  
Kurt C Stange ◽  
Jennifer Cullen ◽  
Sarah C. Markt ◽  
...  
Keyword(s):  
Nursing Home ◽  
Myelodysplastic Syndrome ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cost Of Care ◽  
Classification And Regression Tree ◽  
Survival Outcomes ◽  
Cart Analysis ◽  
Number Of Patients ◽  
History Of

1532 Background: In tandem with the Choosing Wisely initiative, ASCO’s Cost of Care Task Force has proposed a list of low-value (LV) procedures and therapies that may be of limited benefit to patients. Myelodysplastic syndrome (MDS) is the most common myeloid malignancy in the US. A complete diagnostic evaluation (CDE) of MDS requires a bone marrow biopsy, fluorescence in situ hybridization and chromosomal analysis. As a potential LV procedure, we evaluated receipt of CDE in MDS patients with isolated or no cytopenias and no transfusion dependence. Methods: Using national 2011-2014 Medicare data, we identified fee-for-service Medicare patients 66 years of age or older with an MDS diagnosis, one or no cytopenias, and no blood transfusions in the 16 weeks before or after an MDS diagnosis (n = 16,779). We examined the following variables that may have provided a clinical context to (or not to) pursue CDE – demographics (age, race, sex); number of Elixhauser comorbid conditions ( < 5 vs >5); nursing home status, prior history of lymphoma, myeloma, MGUS and other cancers; chronic kidney disease (CKD); colonoscopy; and therapies received including erythropoiesis stimulating agents (ESAs), hypomethylating agents (HMAs) or lenalidomide. We conducted Classification and Regression Tree (CART) analysis, a machine learning approach to identify combinations of factors in patients with little clinical justification for CDE, and Cox proportional hazards regression analysis to compare survival outcomes between those with or without CDE. Results: Over half of our study population (51%) received CDE. Of those, 46.6% were 80 years of age or older, 4.8% were nursing home residents; and 33.6% had 5 or more chronic conditions. Results from CART analysis showed that among patients with an isolated cytopenia (e.g., isolated anemia), 46.0% of patients >80 years (n = 860), and 57.7% (n = 1,156) of those in the 66-79 age group underwent CDE in the absence of CKD, colonoscopy, HMA, or ESA. Among those with no cytopenia (n = 3890), 866 patients received CDE in the absence of HMA, ESA, or history of lymphoma or progression to leukemia. In adjusted analyses, no survival benefit was associated with receipt of CDE (p = 0.24). Conclusions: A substantial number of patients with an MDS diagnosis, isolated or no cytopenias, and no transfusion dependence received a CDE in the absence of other diagnoses, procedures, or therapies that may have explained the clinical decision to perform CDE. These procedures entail costs, pain and anxiety, but do not appear to yield useful information to guide clinical management, as evidenced by the comparable survival outcomes between patients who did and did not undergo CDE. To promote patient-centered care, careful patient selection that reduces unnecessary CDE in MDS patients should be a priority in clinical decision-making.

scholarly journals Kinematic Evaluation via Inertial Measurement Unit Associated with Upper Extremity Motor Function in Subacute Stroke: A Cross-Sectional Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ze-Jian Chen ◽  
Chang He ◽  
Ming-Hui Gu ◽  
Jiang Xu ◽  
Xiao-Lin Huang
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Upper Limb ◽  
Inertial Measurement Unit ◽  
Clinical Decision Making ◽  
Motor Impairment ◽  
Measurement Unit ◽  
Inertial Measurement ◽  
Subacute Stroke ◽  
Kinematic Evaluation

Kinematic evaluation via portable sensor system has been increasingly applied in neurological sciences and clinical practice. However, conventional kinematic evaluation rarely extends the context beyond the motor impairment level. In addition, kinematic tasks with numerous items could be complex and time consuming that pose a burden to test applications and data processing. The study aimed to explore the correlation of finger-to-nose task (FNT) kinematics via Inertial Measurement Unit with upper limb motor function in subacute stroke. In this study, six FNT kinematic variables were used to measure movement time, smoothness, and velocity in 37 participants with subacute stroke. Upper limb motor function was evaluated with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and modified Barthel Index (MBI). As a result, mean velocity, peak velocity, and the number of movement units were associated with the clinical assessments. The multivariable linear regression models could estimate 55%, 51%, and 32% of variance in FMA-UE, ARAT, and MBI, respectively. In addition, age, gender, type of stroke, and paretic side had no significant effects on these associations. Results show that FNT kinematic variables measured via Inertial Measurement Unit are associated with upper extremity motor function in individuals with subacute stroke. The objective kinematic evaluation may be suitable for predicting clinical measures of motor impairment and capacity to understand upper extremity motor recovery and clinical decision making after stroke. This trial is registered with ChiCTR1900026656.

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