Revisiting Poststroke Upper Limb Stratification: Resilience in a Larger Cohort

2021 ◽  
pp. 154596832199204
Author(s):  
Benjamin J. Varley ◽  
Christine T. Shiner ◽  
Liam Johnson ◽  
Penelope A. McNulty ◽  
Angelica G. Thompson-Butel
Keyword(s):  
Clinical Practice ◽  
Motor Function ◽  
Upper Limb ◽  
Hierarchical Cluster ◽  
Community Dwelling ◽  
Stratification Method ◽  
Wolf Motor Function Test ◽  
Block Test ◽  
Time Restriction ◽  
Post Hoc

Background Upper limb (UL) impairment in stroke survivors is both multifactorial and heterogeneous. Stratification of motor function helps identify the most sensitive and appropriate assessments, which in turn aids the design of effective and individualized rehabilitation strategies. We previously developed a stratification method combining the Grooved Pegboard Test (GPT) and Box and Block Test (BBT) to stratify poststroke UL motor function. Objective To investigate the resilience of the stratification method in a larger cohort and establish its appropriateness for clinical practice by investigating limitations of the GPT completion time. Methods Post hoc analysis of motor function for 96 community-dwelling participants with stroke (n = 68 male, 28 female, age 60.8 ± 14 years, 24.4 ± 36.6 months poststroke) was performed using the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (F-M), BBT, and GPT. Hypothesis-free and hypothesis-based hierarchical cluster analyses were conducted to determine the resilience of the stratification method. Results The hypothesis-based analysis identified the same functional groupings as the hypothesis-free analysis: low (n = 32), moderate (n = 26), and high motor function (n = 38), with 3 exceptions. Thirty-three of the 38 participants with fine manual dexterity completed the GPT in ≤5 minutes. The remaining 5 participants took 6 to 25 minutes to place all 25 pegs but used alternative movement strategies to complete the test. The GPT time restriction changed the functional profile of the moderate and high motor function groups leading to more misclassifications. Conclusion The stratification method unambiguously classifies participants by UL motor function. While the inclusion of a 5-minute cutoff time for the GPT is preferred for clinical practice, it is not recommended for stratification purposes.

scholarly journals Assist-as-needed control strategy for upper-limb rehabilitation based on subject’s functional ability

2019 ◽  
Vol 52 (9-10) ◽  
pp. 1354-1361 ◽  
Author(s):  
Shawgi Younis Ahmed Mounis ◽  
Norsinnira Zainul Azlan ◽  
Fatai Sado
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Functional Ability ◽  
Measurement Unit ◽  
Robotic Assistance ◽  
Clinical Procedure ◽  
Function Test ◽  
Wolf Motor Function Test ◽  
Movement Ability ◽  
Ability Index

The assist-as-needed technique in robotic rehabilitation is a popular technique that encourages patients’ active participation to promote motor recovery. It has been proven beneficial for patients with functional motor disability. However, its application in robotic therapy has been hindered by a poor estimation method of subjects’ functional or movement ability which is required for setting the appropriate robotic assistance. Moreover, there is also the need for consistency and repeatability of the functional ability estimation in line with the clinical procedure to facilitate a wider clinical adoption. In this study, we propose a new technique of estimation of subject’s functional ability based on the Wolf Motor Function Test. We called this estimation the functional ability index. The functional ability index enables the modulation of robotic assistance and gives a more consistent indication of subjects’ upper-limb movement ability during therapy session. Our baseline controller is an adaptive inertia-related controller, which is integrated with the functional ability index algorithm to provide movement assistance as when needed. Experimental studies are conducted on three hemiplegic patients with different levels of upper-limb impairments. Each patient is requested to perform reaching task of lifting a can from table-to-mouth according to the guidelines stipulated in the Wolf Motor Function Test. Data were collected using two inertial measurement unit sensors installed at the flexion/extension joints, and the functional ability score of each patient was rated by an experienced therapist. Results showed that the proposed functional ability index algorithm can estimate patients’ functional ability level consistently with clinical procedure and can modify generated robotic assistance in accordance with patients’ functional movement ability.

scholarly journals Application of the Fugl-Meyer Assessment (FMA) and the Wolf Motor Function Test (WMFT) in the recovery of upper limb function in patients after chronic stroke: a literature review

2013 ◽  
Vol 20 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Cauê Padovani ◽  
Cristhiane Valério Garabello Pires ◽  
Fernanda Pretti Chalet Ferreira ◽  
Gabriela Borin ◽  
Thais Raquel Martins Filippo ◽  
...  
Keyword(s):  
Literature Review ◽  
Motor Function ◽  
Upper Limb ◽  
Chronic Stroke ◽  
Limb Function ◽  
Upper Limb Function ◽  
Function Test ◽  
Wolf Motor Function Test

scholarly journals The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits

2019 ◽  
Vol 26 (10) ◽  
pp. 1-12
Author(s):  
Thanchanok Pumprasart ◽  
Noppol Pramodhyakul ◽  
Pagamas Piriyaprasarth
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Upper Limb ◽  
Muscle Tone ◽  
Chronic Stroke ◽  
Rank Test ◽  
Limb Function ◽  
Function Test ◽  
Wolf Motor Function Test ◽  
Therapy Programme

Background/Aims The Bobath concept has long been used to improve postural control and limb function post-stroke, yet its effect in patients with deficits have not been clearly demonstrated. This study aimed to investigate the effect of the latest Bobath therapy programme on upper limb functions, muscle tone and sensation in chronic stroke individuals with moderate to severe deficits. Methods A pre–post test design was implemented. The participants were chronic stroke individuals (n=26). Home-based intervention based on the Bobath concept was administered 3 days per week for 6 weeks (20 repetitions × 3 sets per task each session). Outcome measures consisted of the Wolf Motor Function Test, Fugl-Meyer Assessment for the upper extremity, Modified Ashworth Scale, and the Revised Nottingham Sensory Assessment. Data were analysed using the Wilcoxon Signed rank test. Results Almost all items of the Wolf Motor Function Test and the Fugl-Meyer Assessment for the upper extremity demonstrated statistically significant differences post-intervention. Finger flexor muscle tone and stereognosis were also significantly improved. Conclusions The 6-week Bobath therapy programme could improve upper limb function and impairments in chronic stroke individuals with moderate to severe deficits. Its effects were also demonstrated in improving muscle tone and cortical sensation.

scholarly journals Análise da consolidação da funcionalidade manual de hemiparéticos crônicos após terapia de movimento induzido pela restrição.

2016 ◽  
Vol 27 (3) ◽  
pp. 297
Author(s):  
Akeline Santos de Almeida ◽  
Juliana De Santana Santos ◽  
Diogo Costa Garção
Keyword(s):  
Action Research ◽  
Motor Activity ◽  
Motor Function ◽  
Function Test ◽  
Wolf Motor Function Test ◽  
Post Hoc

Diversos métodos de intervenção são utilizados para a reabilitação da função manual de hemiparéticos, dentre os quais está a Terapia de Movimento Induzido pela Restrição (TMIR). O objetivo deste estudo foi investigar a possível consolidação da funcionalidade manual após três meses do término da TMIR em hemiparéticos crônicos pós-AVE. Participaram deste estudo 16 sujeitos, distribuídos em Grupo Intervenção (GI) e Grupo Controle (GC). Os integrantes do GI foram submetidos à TMIR, enquanto o GC realizou o mesmo treino funcional sem a contensão. Os sujeitos foram avaliados pré, pós e após três meses da intervenção com os instrumentos de avaliação padronizados: Motor Activity Log (MAL), Wolf Motor Function Test (WMFT) e o Action Research Arm Test (ARAT). Os dados foram analisados através do teste ANOVA seguido pelo post hoc Student – Newman – Keuls. O GI apresentou aumento significativo do desempenho nos testes MAL (p=0,001), WMFT (p=0,05) e ARAT (p=0,03) e não se constatou diferença significativa (p=1) da AV2 para AV3 no GI em todos os testes, indicando aumento do uso espontâneo, função motora e destreza manual/digital que se mantiveram após três meses do término do protocolo. A TMIR aumentou a funcionalidade manual de hemiparéticos crônicos e os ganhos funcionais permaneceram três meses após o término da terapia.

scholarly journals Effectiveness of combined modified constraint-induced movement therapy for upper and lower limb in stroke rehabilitation: a study protocol for randomized controlled trial (Preprint)

2018 ◽  
Author(s):  
Lawan Umar
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Gait Speed ◽  
Stride Length ◽  
Controlled Trial ◽  
Stroke Survivors ◽  
Hrqol Score ◽  
Randomized Controlled ◽  
Post Hoc

BACKGROUND Background: The translation of neuroscientific research into care has led to new approaches and renewed promise. Stroke survivors with hemiparesis often exhibit impaired balance, ambulation dysfunction and asymmetrical weight distribution leading to physical dysfunction and decreased Health-Related Quality of Life (HRQoL).Constraint-induced movement therapy (CIMT) approach could be translated into a clinical protocol for gait rehabilitation. Modified CIMT for upper limb and lower limb when applied singly improve lower limb motor function, balance, gait and HRQoL of stroke survivors OBJECTIVE However, effects of combined modified CIMT for upper and lower limbs (CoMCIMTULL) have not been investigated. Therefore, the effects of four-week CoMCIMTULL was compared with Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) among hemiparetic stroke survivors in this study. METHODS This single-blind randomized controlled trial involved random assignment of 56 consecutive stroke survivors to three groups: CoMCIMTULL (n=19), MCIMTLL (n=20), and MCIMTUL (n=17). The CoMCIMTULL group received both upper and lower limb CIMT for the reduced use of the upper limb and maladaptive use of the lower limb. The MCIMTLL group used the affected lower limb to lead weight bearing activities and exercises while the MCIMTUL group used the affected upper limbs for motor task practice following the unaffected hand’s restraining in a special splint. These treatments were administared in the clinic for two hours daily, five times per week for four consecutive weeks. Lower Limb Motor Function (LLMF) and balance were assessed using Fugyl Meyer Motor Assessement Scale, Lower Limb Use (LLU) with Lower Extremity Motor Activity Log, balance confidence using Activities-specific Balance Confidence Scale, Weight Asymmetry Ratio (WAR) using two weighing scales, spatiotemporal gait parameters [gait speed (m/s) and stride length (m)] using foot print method and HRQoL using the Stroke Impact Scale. These assessments were done at baseline, ends of weeks two and four. Data were analysed using descriptive statistics, ANOVA with post-hoc, Kruskal-Wallis with post-hoc and Wilcoxon Signed Rank at ᾳ0.05. RESULTS MBetween-group comparisons showed that the differences were significant in CoMCIMTULL (HRQoL score=70.00(10.00) ; LLMF = 29.00(5.00); gait speed=0.650(0.70)m/s ; Stride length=0.60(0.30)m ; and WAR=0.90(0.80) ) compared to MCIMTLL (HRQoL score=80.00(17.50); LLMF =29.50(2.50) ; gait speed=0.80(0.28)m/s; Stride length=0.65(0.40)m; and WAR=0.85(0.40) and MCIMTUL (HRQoL score= 60.00(10.00; LLMF =26.00(4.00) ; gait speed= 0.60(0.20)m/s;Stride length= 0.40(0.40)m; and WAR= 0.80(0.40) CONCLUSIONS It is expected, the outcome of this study will clarify whether the effect of combined modified CIMT upper and lower limb (CoMCIMTULL), Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) will leads to better recovery of motor function in stroke survivors. CLINICALTRIAL This study has been approved by both Health Research Ethics Committee of Universty of Ibadan/University College Hospital (UI/EC/14/0101) and the Murtala Muhammad Specialist Hospital, Kano (HMB/GEN/488/VOL.I)(Nigeria). Additionaly, the study employed a randomized controlled clinical trial design, registered with Pan Africa Clinical Trial Registry PACTR 201611001646207, available on www.pactr.org.

scholarly journals Safety, Feasibility, and Acceptability of a New Virtual Rehabilitation Platform: A Supervised Pilot Study

2021 ◽  
Vol 10 ◽  
pp. 117957272110332
Author(s):  
Ana María Escalante-Gonzalbo ◽  
Yoás Saimon Ramírez-Graullera ◽  
Herminia Pasantes ◽  
José Jonathan Aguilar-Chalé ◽  
Gloria Ixchel Sánchez-Castillo ◽  
...  
Keyword(s):  
Pilot Study ◽  
Motor Function ◽  
Upper Limb ◽  
Virtual Rehabilitation ◽  
Function Test ◽  
Wolf Motor Function Test ◽  
Significant Impairment ◽  
Task Oriented ◽  
Movement Sensors ◽  
Significant Motor

Purpose: Stroke is the leading cause of disability in adults worldwide, with hemiparesis being the most prevalent consequence. The use of video games and movement sensors could contribute to improving patients’ chances of recovery. We performed a supervised pilot study to validate the safety, feasibility, and acceptability of a new virtual rehabilitation platform in patients with chronic post-stroke upper limb hemiparesis. Methods: The participants (n = 9) participated in 40 rehabilitation sessions, twice a week, for a period of 20 weeks. Their experiences with the platform were documented using a Likert-scale survey. Changes in motor function were evaluated using the Chedoke Arm and Hand Activity Inventory (CAHAI) and the Wolf Motor Function Test (WMFT). Results and conclusions: All participants expressed that they enjoyed the experience and felt comfortable using the platform. Preliminary results showed significant motor recovery ( P = .0039) according to the WMFT scores. Patients with significant impairment showed no improvement in upper limb task-oriented motor function after therapy. The new platform is safe and well-accepted by patients. The improvement in motor function observed in some of the participants should be attributed to the therapy since spontaneous functional recovery is not expected in chronic stroke patients.

A SYSTEM FOR UPPER LIMB REHABILITATION AND MOTOR FUNCTION EVALUATION

2015 ◽  
Vol 15 (01) ◽  
pp. 1550010 ◽  
Author(s):  
HAILONG YU ◽  
LE XIE ◽  
CHAO LV ◽  
WEI SHAO ◽  
YUAN WANG ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Upper Limb ◽  
Degrees Of Freedom ◽  
Function Evaluation ◽  
Upper Limb Rehabilitation ◽  
Paretic Limb ◽  
Wolf Motor Function Test ◽  
Passive Exoskeleton ◽  
Limb Rehabilitation

In the conventional upper-limb rehabilitation process, patients have to be relying on therapists to do the exercise and assessments. Using robotic rehabilitation devices, patients can practice independently and intensively with their upper paretic limb. In this study, we hypothesized that a multi-DOF passive mechanism coupled with multi-DOF 3D sensory feedback could provide: (1) safe and nature active exercise; (2) various combinations of degrees of freedom (DOF) for the training of different specific joints; (3) the possibility to realize ideal trajectory. In order to test the hypothesis, we designed a seven-DOF passive exoskeleton-based system for the upper extremity, integrated with virtual reality (VR) technology based 3D feedback. An experiment was done on six healthy subjects and three subjects with upper-limb impairment. All subjects did not experience any problems when handling the device during the intervention. Moreover, Fugl–Meyer Score of the upper extremity Assessment (FMA) scale showed that the three patients have increased the score by 19, 23 and 14, respectively. Wolf Motor Function Test (WMFT) scale showed that the three patients have increased their scores by 22, 22 and 14, respectively.

Efeitos da terapia por contensão induzida nas lesões encefálicas adquiridas

2016 ◽  
Vol 17 (1) ◽  
pp. 30
Author(s):  
Gabriela Da Silva Matuti ◽  
Rafaela Do Nascimento Borges Marques ◽  
Amanda Conte Magesto ◽  
Rafael Eras Garcia ◽  
Clarissa Barros De Oliveira
Keyword(s):  
Motor Activity ◽  
Motor Function ◽  
Function Test ◽  
Wolf Motor Function Test

Introdução: A Terapia por Contensão Induzida (TCI) é uma técnica de reabilitação que tem como objetivo melhora da função do membro superior.acometido. Objetivos: Determinar se o protocolo da TCI é adequado para a reabilitação do membro superior em adultos com Lesões Encefálicas Adquiridas (LEA), analisar a manutenção dos resultados e identificar possíveis preditores de eficácia da técnica. Método: Estudo retrospectivo, 40 pacientes. As escalas utilizadas foram Motor Activity Log (MAL), Quantidade (QT) e Qualidade (QL) de movimento do membro superior acometido e Wolf Motor Function Test (WMFT). Resultados e discussão: As médias de QT e QL do membro superior acometido no pré e pós-tratamento tiveram um aumento significativo (p < 0,001), enquanto as do WMFT apresentaram uma redução significativa do tempo (p < 0,001), o que representa uma melhora na habilidade motora e maior uso fora do ambiente terapêutico. Os ganhos foram mantidos após 12 meses do término do protocolo, e não foi evidenciado nenhum preditor de evolução. Conclusão: A TCI demonstrou eficácia na melhora da habilidade motora e reversão do não uso aprendido do membro superior acometido, estes resultados foram mantidos após um ano da intervenção. Não foi evidenciado no estudo nenhum fator preditor de eficácia da técnica.Palavras-chave: lesões encefálicas adquiridas, hemiplegia, terapia por contensão induzida, reabilitação.

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