scholarly journals Self-efficacy and Reach Performance in Individuals With Mild Motor Impairment Due to Stroke

2019 ◽  
Vol 33 (4) ◽  
pp. 319-328 ◽  
Author(s):  
Jill Campbell Stewart ◽  
Rebecca Lewthwaite ◽  
Janelle Rocktashel ◽  
Carolee J. Winstein
Keyword(s):  
Upper Extremity ◽  
Self Efficacy ◽  
Movement Time ◽  
Motor Impairment ◽  
Arm Movements ◽  
Chronic Stroke ◽  
Motor Score ◽  
End Point ◽  
Arm Function ◽  
Reach Control

Background: Persistent deficits in arm function are common after stroke. An improved understanding of the factors that contribute to the performance of skilled arm movements is needed. One such factor may be self-efficacy (SE). Objective: To determine the level of SE for skilled, goal-directed reach actions in individuals with mild motor impairment after stroke and whether SE for reach performance correlated with actual reach performance. Methods: A total of 20 individuals with chronic stroke (months poststroke: mean 58.1 ± 38.8) and mild motor impairment (upper-extremity Fugl-Meyer [FM] motor score: mean 53.2, range 39 to 66) and 6 age-matched controls reached to targets presented in 2 directions (ipsilateral, contralateral). Prior to each block (24 reach trials), individuals rated their confidence on reaching to targets accurately and quickly on a scale that ranged from 0 ( not very confident) to 10 ( very confident). Results: Overall reach performance was slower and less accurate in the more-affected arm compared with both the less-affected arm and controls. SE for both reach speed and reach accuracy was lower for the more-affected arm compared with the less-affected arm. For reaches with the more-affected arm, SE for reach speed and age significantly predicted movement time to ipsilateral targets ( R2 = 0.352), whereas SE for reach accuracy and FM motor score significantly predicted end point error to contralateral targets ( R2 = 0.291). Conclusions: SE relates to measures of reach control and may serve as a target for interventions to improve proximal arm control after stroke.

scholarly journals Influence of Chronic Stroke on Functional Arm Reaching: Quantifying Deficits in the Ipsilesional Upper Extremity

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Savitha Subramaniam ◽  
Rini Varghese ◽  
Tanvi Bhatt
Keyword(s):  
Reaction Time ◽  
Upper Extremity ◽  
Movement Time ◽  
Chronic Stroke ◽  
Community Dwelling ◽  
Stroke Survivors ◽  
Initiation Time ◽  
Peak Acceleration ◽  
Movement Initiation ◽  
And Performance

Purpose. The purpose of this study was to quantify ipsilesional upper extremity (UE) stand-reaching performance (kinematics and kinetics) among chronic stroke survivors.Method. Community-dwelling chronic stroke survivors (n=13) and age-similar healthy adults (n=13) performed flexion- and abduction-reaching tasks. Surface EMG and acceleration were sampled using wireless sensors from the prime movers (anterior and middle deltoid) and provided performance-outcome (reaction time, burst duration, movement time, and movement initiation time) and performance-production (peak acceleration) measures and were then evaluated.Results. Individuals with chronic stroke demonstrated significantly reduced performance outcomes (i.e., longer reaction time, burst duration, movement time, and movement initiation time) and performance production ability (i.e., smaller peak acceleration) compared to their healthy counterparts (p< 0.05) for both flexion- and abduction-reaching movements.Conclusion. Our results are suggestive of post-stroke deficits in ipsilesional motor execution during a stand-reaching task. Based on these findings, it is essential to integrate ipsilesional UE training into rehabilitation interventions as this might aid functional reaching activities of daily living and could ultimately help community-dwelling chronic stroke survivors maintain their independent living.

scholarly journals Movement Kinematics of the Ipsilesional Upper Extremity in Persons With Moderate or Mild Stroke

2017 ◽  
Vol 31 (4) ◽  
pp. 376-386 ◽  
Author(s):  
Eva-Lena Bustrén ◽  
Katharina Stibrant Sunnerhagen ◽  
Margit Alt Murphy
Keyword(s):  
Upper Extremity ◽  
Movement Time ◽  
Motor Impairment ◽  
Stroke Severity ◽  
Movement Kinematics ◽  
Movement Performance ◽  
Severe Motor ◽  
Daily Task ◽  
Severe Motor Impairment ◽  
Mild Stroke

Background. An increasing number of studies have indicated that the ipsilesional arm may be impaired after stroke. There is, however, a lack of knowledge whether ipsilesional deficits influence movement performance during purposeful daily tasks. Objective. The aim of this study was to investigate whether, and to what extent, movement impairments are present while performing an ipsilesional upper extremity task during the first 3 months after stroke. Methods. Movement kinematics describing movement time, smoothness, velocity, strategy, and pattern were captured during a standardized drinking task in 40 persons with first-ever stroke and 20 controls. Kinematics were measured early and at 3 months poststroke, and sensorimotor impairment was assessed with Fugl-Meyer Assessment in stroke. Results. Half of the ipsilesional kinematics showed significant deficits early after stroke compared to controls, and the stroke severity had a significant impact on the kinematics. Movements of the ipsilesional arm were slower, less smooth, demonstrated prolonged relative time in deceleration, and increased arm abduction during drinking. Kinematics improved over time and reached a level comparable with controls at 3 months, except for angular velocity of the elbow and deceleration time in reaching for those with more severe motor impairment. Conclusions. This study demonstrates that movements of the ipsilesional arm, during a purposeful daily task, are impaired after stroke. These deficits are more prominent early after stroke and when the motor impairment is more severe. In clinical studies and praxis, the use of less-affected arm as a reference may underestimate the level of impairment and extent of recovery.

scholarly journals Machine Learning Methods Predict Individual Upper-Limb Motor Impairment Following Therapy in Chronic Stroke

2020 ◽  
Vol 34 (5) ◽  
pp. 428-439 ◽  
Author(s):  
Ceren Tozlu ◽  
Dylan Edwards ◽  
Aaron Boes ◽  
Douglas Labar ◽  
K. Zoe Tsagaris ◽  
...  
Keyword(s):  
Machine Learning ◽  
Upper Extremity ◽  
Upper Limb ◽  
Motor Impairment ◽  
Chronic Stroke ◽  
Response To Therapy ◽  
Stroke Patients ◽  
Learning Methods ◽  
Machine Learning Methods ◽  
The Difference

Background. Accurate prediction of clinical impairment in upper-extremity motor function following therapy in chronic stroke patients is a difficult task for clinicians but is key in prescribing appropriate therapeutic strategies. Machine learning is a highly promising avenue with which to improve prediction accuracy in clinical practice. Objectives. The objective was to evaluate the performance of 5 machine learning methods in predicting postintervention upper-extremity motor impairment in chronic stroke patients using demographic, clinical, neurophysiological, and imaging input variables. Methods. A total of 102 patients (female: 31%, age 61 ± 11 years) were included. The upper-extremity Fugl-Meyer Assessment (UE-FMA) was used to assess motor impairment of the upper limb before and after intervention. Elastic net (EN), support vector machines, artificial neural networks, classification and regression trees, and random forest were used to predict postintervention UE-FMA. The performances of methods were compared using cross-validated R2. Results. EN performed significantly better than other methods in predicting postintervention UE-FMA using demographic and baseline clinical data (median [Formula: see text] P < .05). Preintervention UE-FMA and the difference in motor threshold (MT) between the affected and unaffected hemispheres were the strongest predictors. The difference in MT had greater importance than the absence or presence of a motor-evoked potential (MEP) in the affected hemisphere. Conclusion. Machine learning methods may enable clinicians to accurately predict a chronic stroke patient’s postintervention UE-FMA. Interhemispheric difference in the MT is an important predictor of chronic stroke patients’ response to therapy and, therefore, could be included in prospective studies.

Abstract 102: NIHSS Lacks Validity and Sensitivity in Postacute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Brittani Basobas ◽  
Brittany Hand ◽  
Heather Peters ◽  
Stephen Page
Keyword(s):  
Health Status ◽  
Upper Extremity ◽  
Functional Limitation ◽  
Motor Impairment ◽  
Neurological Status ◽  
Multicenter Trial ◽  
Chronic Stroke ◽  
Motor Deficits ◽  
Ability Test ◽  
Stroke Impact Scale

Stroke remains a leading cause of disability, with those affected usually experiencing long-term motor deficits. The National Institutes of Health Stroke Scale (NIHSS) is commonly used to measure acute neurological status, but recently is being deployed in at least 29 chronic stroke trials as a secondary UE motor outcome despite a lack of evidence surrounding its validity in chronic stroke. The purpose of this secondary, retrospective analysis of randomized controlled, multicenter, trial data was to (a) determine the NIHSS’s association with the Stroke Impact Scale (SIS), a poststroke health status measurement, the upper extremity Fugl Meyer (UEFM) and the Arm Motor Ability Test (AMAT), measures of upper extremity (UE) impairment and functional limitation and (b) determine the NIHSS’s sensitivity to UE motor change over time . There was no association between total NIHSS scores and SIS physical dimension, overall perception of recovery, activity of daily living scores ( P = -.036, P = .782; P = -.039, P = .640; P = -.054, P 5.520, respectively) or functional limitation ( P; = –0.141; P; = 0.089 ). NIHSS and UE impairment associations were significant ( P; = –0.204; P; = 0.014 ) but explained less than 4% of the variance among UEFM scores. Subjects scoring a “zero” on the NIHSS exhibited discernible UE motor deficits and varied scores on the UEFM, AMAT, and SIS. A statistically significant sensitivity to change was found for the UEFM ( χ 2 (3) = 10.783, p = 0.013 ), but not for NIHSS ( X 2 (3) = 1.250, p = 0.741 ) or either AMAT functional ability or quality of movement scores ( χ 2 (3) = 3.953, p = 0.267; χ 2 (3) = 4.199, p = 0.241, respectively ). There was a significant weak, negative correlation between the NIHSS and UEFM ( r s (47) = -.325, p = .026 ), but nonsignificant weak, negative correlations between the NIHSS and either AMAT scores ( r s (47) = -.051, p = .740; r s (47) = -.103, p = .489, respectively ). While being increasingly used in postacute trials, the NIHSS’s weak correlation with measures of motor impairment, functional limitation, and health status measurements as well as its insensitivity to change suggest that its use be reserved to acute bedside status. Its utility as a predictor of real world UE motor outcomes has been purported and is currently under investigation as a next step.

scholarly journals Comparing Home Upper Extremity Activity With Clinical Evaluations of Arm Function in Chronic Stroke

2020 ◽  
Vol 2 (2) ◽  
pp. 100048
Author(s):  
Kavita Bhatnagar ◽  
Christopher T. Bever ◽  
Jing Tian ◽  
Min Zhan ◽  
Susan S. Conroy
Keyword(s):  
Upper Extremity ◽  
Chronic Stroke ◽  
Clinical Evaluations ◽  
Arm Function

scholarly journals Predictors of arm non-use in chronic stroke: a preliminary investigation

2019 ◽  
Author(s):  
Laurel J. Buxbaum ◽  
Rini Varghese ◽  
Harrison Stoll ◽  
Carolee J. Winstein
Keyword(s):  
Self Efficacy ◽  
Right Hemisphere ◽  
Preliminary Investigation ◽  
Motor Impairment ◽  
Chronic Stroke ◽  
Spatial Neglect ◽  
Stepwise Multiple Regression ◽  
Lesion Volume ◽  
Sensory Motor ◽  
Use Behavior

AbstractBackgroundThe phenomenon of non-use after stroke is characterized by failure to use the contralesional arm despite adequate capacity. It has been suggested that non-use is a consequence of the greater effort and/or attention required to use the affected limb, but such accounts have not been tested, and we have poor understanding of the characteristics of individuals who exhibit non-use.ObjectiveWe aimed to provide preliminary evidence regarding the demographic, neuropsychological, and psychological factors that may influence non-use in chronic stroke.MethodsTwenty chronic stroke survivors (10 left and 10 right hemisphere stroke) with mild-to-moderate sensory-motor impairment on the upper extremity Fugl-Meyer (UEFM) were assessed with the Actual Amount of Use Test (AAUT), which measures the disparity between amount of use and quality of movement in “spontaneous” versus “forced” conditions. Participants were als assessed with measures of limb apraxia, spatial neglect, attention/arousal, and self-efficacy (confidence in arm movement). Using stepwise multiple regression, we determined whether demographic information and/or performance on these measures predicted AAUT non-use scores.ResultsScores on the UEFM as well as attention/arousal and self-efficacy predicted the degree of non-use. Attention/arousal predicted non-use above and beyond UEFM.ConclusionsGiven the complexity of the non-use phenomenon, it follows that a combination of impairment, attention/arousal, and perceived confidence predicted non-use behavior. That a measure of attention/arousal predicted non-use behavior above and beyond sensory-motor functioning highlights the importance of motivated engagement to drive use of the paretic limb. Larger-scale studies incorporating additional measures (e.g., mental health, lesion volume and white matter connectivity, pain, motivation) will be important for future investigations.

scholarly journals Predictors of Arm Nonuse in Chronic Stroke: A Preliminary Investigation

2020 ◽  
Vol 34 (6) ◽  
pp. 512-522 ◽  
Author(s):  
Laurel J. Buxbaum ◽  
Rini Varghese ◽  
Harrison Stoll ◽  
Carolee J. Winstein
Keyword(s):  
Self Efficacy ◽  
Preliminary Investigation ◽  
Motor Impairment ◽  
Preliminary Evidence ◽  
Chronic Stroke ◽  
Spatial Neglect ◽  
Stepwise Multiple Regression ◽  
Lesion Volume ◽  
Paretic Limb ◽  
White Matter Connectivity

Background. Nonuse (NU) after stroke is characterized by failure to use the contralesional arm despite adequate capacity. It has been suggested that NU is a consequence of the greater effort and/or attention required to use the affected limb, but such accounts have not been directly tested, and we have poor understanding of the predictors of NU. Objective. We aimed to provide preliminary evidence regarding demographic, neuropsychological (ie, apraxia, attention/arousal, neglect), and psychological (ie, self-efficacy) factors that may influence NU in chronic stroke. Methods. Twenty chronic stroke survivors with mild to moderate sensory-motor impairment characterized by the Upper-Extremity Fugl-Meyer (UEFM) were assessed for NU with a modified version of the Actual Amount of Use Test (AAUT), which measures the disparity between amount of use in spontaneous versus forced conditions. Participants were also assessed with measures of limb apraxia, spatial neglect, attention/arousal, and self-efficacy. Using stepwise multiple regression, we determined which variables predicted AAUT NU scores. Results. Scores on the UEFM as well as attention/arousal predicted the degree of NU ( P < .05). Attention/arousal predicted NU above and beyond UEFM ( P < .05). Conclusions. The results are consistent with the importance of attention and engagement necessary to fully incorporate the paretic limb into daily activities. Larger-scale studies that include additional behavioral (eg, sensation, proprioception, spasticity, pain, mental health, motivation) and neuroanatomical measures (eg, lesion volume and white matter connectivity) will be important for future investigations.

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