Establishing Criterion Validity for the Functional Upper-Extremity Levels (FUEL) in Comparison to the Fugl-Meyer To Classify Functional Motor Recovery in the Acute Stroke Population

2019 ◽  
Vol 73 (4_Supplement_1) ◽  
pp. 7311500012p1
Author(s):  
Rachel Feld-Glazman ◽  
Lisa Spinelli ◽  
Ashley Foley ◽  
Daniel Geller ◽  
Steve Van Lew ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Criterion Validity ◽  
Motor Recovery ◽  
Stroke Population

Abstract 13: Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David J Lin ◽  
Alison M Cloutier ◽  
Kimberly S Erler ◽  
Jessica M Cassidy ◽  
Samuel B Snider ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Corticospinal Tract ◽  
Standard Of Care ◽  
Major Effect ◽  
Motor Recovery ◽  
Post Stroke ◽  
Stroke Imaging ◽  
Recovery Potential ◽  
Structural Injury

Introduction: Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods: Patients (N = 48) with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer (FM) during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using four different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict delta FM. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results: 48 patients were enrolled 4.2 ± 2.7 days post-stroke and completed this study. CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with AUC values ranging from 0.75 to 0.8. In addition, CST injury explained ~20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing four different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions: Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in post-stroke upper extremity motor recovery.

scholarly journals Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3569-3577 ◽  
Author(s):  
David J. Lin ◽  
Alison M. Cloutier ◽  
Kimberly S. Erler ◽  
Jessica M. Cassidy ◽  
Samuel B. Snider ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Corticospinal Tract ◽  
Area Under The Curve ◽  
Standard Of Care ◽  
Major Effect ◽  
Motor Recovery ◽  
Stroke Imaging ◽  
Recovery Potential

Background and Purpose— Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods— Patients with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using 4 different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict ΔFugl-Meyer. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results— N=48 patients were enrolled 4.2±2.7 days poststroke and completed 3-month follow-up (median 90-day modified Rankin Scale score, 3; interquartile range, 1.5). CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with area under the curve values ranging from 0.70 to 0.8. In addition, CST injury explained ≈20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing 4 different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions— Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in poststroke upper extremity motor recovery.

The Effectiveness of Mirror Therapy to Upper Extremity Rehabilitation in Acute Stroke Patients

2021 ◽  
Author(s):  
Phassakorn Klinkwan ◽  
Chalunda Kongmaroeng ◽  
Sombat Muengtaweepongsa ◽  
Wiroj Limtrakarn
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Home Exercise ◽  
Control Group ◽  
Mirror Therapy ◽  
Stroke Patients

Rehabilitation is a crucial part of stroke recovery to help them regain use of their limb. The aim of this article was to compare the effectiveness of long-term training of mirror therapy with conventional rehabilitation therapy on neurological and recovery of upper limb in acute stroke patients. In this randomized and assessor-blinded control study, 20 acute stroke patients were analyzed in this study and allocated to a case (n = 10, 50.6 ± 17.90 years) and control group (n = 10, 55.9 ± 11.25 years). All the participants performed daily home exercise during 12 weeks. The patients in the control group were treated with conventional therapy (CT) and a group of cases were treated with mirror therapy (MT) alone program. The outcome measurements were assessed by a therapist blinded assessor using Fugl-Meyer Assessment (FMA) upper extremity score, Brunnstrom recovery stages (BRS), Modified Ashworth Scale (MAS) and Muscle Strength to evaluate upper limb motor function and motor recovery. Data were analyzed using Wilcoxon and Mann-Whitney U tests to compare within-groups and between-group differences. The results revealed that, after 12 weeks of treatment, patients of both groups presented statistically significant improvements in all the variables measured (p < 0.05). Compared with the control group, the patients of the MT group had greater improvement in the proximal movement portion of the FMA upper extremity mean score change (15.8 ± 3.2 versus 10.0 ± 2.7, p = 0.002) while there were no differences in other variables (p > 0.05). There were also no adverse events. It suggests that 12 weeks training of mirror therapy alone was likely to improve the motor recovery of the upper limb and activity of daily living in acute stroke patients than conventional therapy, if treated early.

EFFECTS OF EARLY PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION EXERCISES ON SENSORY- MOTOR RECOVERY OF UPPER EXTREMITY AND NEUROPLASTICITY IN THE PATIENTS WITH ACUTE STROKE

2018 ◽  
Vol 5 (5) ◽  
pp. 378
Author(s):  
Poonam Chaturvedi ◽  
Ajai Kumar Singh ◽  
Dinkar Kulshreshtha ◽  
Vandana Tiwari ◽  
Pradeep Kumar Maurya ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Motor Recovery ◽  
Proprioceptive Neuromuscular Facilitation ◽  
Sensory Motor

scholarly journals Effectiveness of self-administered mirror therapy on upper extremity impairments and function of acute stroke patients: study protocol

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Venkadesan Rajendran ◽  
Deepa Jeevanantham ◽  
Céline Larivière ◽  
Ravinder-Jeet Singh ◽  
Lisa Zeman ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Outcome Measure ◽  
Outcome Evaluation ◽  
Secondary Outcome ◽  
Mirror Therapy ◽  
Stroke Patients ◽  
Extremity Function ◽  
Upper Extremity Function ◽  
Experimental Group

Abstract Background Many therapeutic interventions are performed by physiotherapists to improve upper extremity function and/or activities of daily living (ADL) in stroke patients. Mirror therapy (MT) is a simple technique that can be self-administered by the patients with intact cognition following patient education by a skilled physiotherapist. However, the effectiveness of self-administered MT in post-stroke patients in upper extremity function remains unclear. Therefore, the objective of this study is to examine the effectiveness of MT in improving upper extremity function and recovery in acute stroke patients. Methods This study is a single-center, prospective, randomized, open-label, controlled trial with blinded outcome evaluation (PROBE design), in which a total of 36 eligible acute stroke patients will be randomly assigned to control (n=18) and experimental group (n=18). Participants in the control group will receive regular rehabilitation interventions whereas participants in the experimental group will receive MT education in addition to their regular interventions for 4 weeks. Study outcome The primary outcome measure will be upper extremity function that will be measured using the Fugl-Meyer Assessment scale and the Wolf Motor Function Test. The secondary outcome measure will be behaviors related to ADL as estimated using the Modified Barthel Index. Outcome measures will be assessed at baseline and at 4 weeks post-rehabilitation intervention/MT. Results A two-way repeated analysis of variance (ANOVA) with time and group effects will be used to analyze between-group differences. The level of significance will be set at P < 0.05. Conclusion The results of the study will provide critical information to include self-administered MT as an adjuvant to regular interventions and may facilitate recovery of the upper extremity function of stroke patients. Trial registration ClinicalTrials.gov NCT04542772. Registered on 9 September 2020. Protocol version: Final 1.0.

Cognitive Demands Influence Upper Extremity Motor Performance During Recovery From Acute Stroke

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011992
Author(s):  
David J Lin ◽  
Kimberly S Erler ◽  
Samuel B Snider ◽  
Anna K Bonkhoff ◽  
Julie A DiCarlo ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Grip Strength ◽  
Upper Extremity ◽  
Cognitive Dysfunction ◽  
Motor Performance ◽  
Motor Task ◽  
Upper Extremities ◽  
Cognitive Demands ◽  
Strength Performance ◽  
Lesion Symptom Mapping

Objective:To test the hypothesis that cognitive demands influence motor performance during recovery from acute stroke, we tested acute stroke patients on two motor tasks with different cognitive demands and related task performance to cognitive impairment and neuroanatomic injury.Methods:We assessed the contralesional and ipsilesional upper extremities of a cohort of 50 patients with weakness after unilateral acute ischemic stroke at three timepoints with two tasks: the Box & Blocks Test, a task with greater cognitive demand, and Grip Strength, a simple and ballistic motor task. We compared performance on the two tasks, related motor performance to cognitive dysfunction, and used voxel-based lesion symptom mapping to determine neuroanatomical sites associated with motor performance.Results:Consistent across contralesional and ipsilesional upper extremities and most pronounced immediately post-stroke, Box & Blocks scores were significantly more impaired than Grip Strength scores. The presence of cognitive dysfunction significantly explained up to 33% of variance in Box & Blocks performance but was not associated with Grip Strength performance. While Grip Strength performance was associated with injury largely restricted to sensorimotor regions, Box & Blocks performance was associated with broad injury outside sensorimotor structures, particularly the dorsal anterior insula, a region known to be important for complex cognitive function.Conclusions:Altogether, these results suggest that cognitive demands influence upper extremity motor performance during recovery from acute stroke. Our findings emphasize the integrated nature of motor and cognitive systems and suggest that it is critical to consider cognitive demands during motor testing and neurorehabilitation after stroke.

Abstract 2173: Abbreviated 7-Item NIHSS for Inpatient Acute Stroke Management

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jennifer Parreira ◽  
Julie Nauser
Keyword(s):  
Acute Stroke ◽  
Internal Consistency ◽  
Recurrent Stroke ◽  
Reliability And Validity ◽  
Internal Consistency Reliability ◽  
Neurological Status ◽  
Criterion Validity ◽  
Suitable Alternative ◽  
Motor Movement ◽  
Left And Right

Background: Each year, nearly 800,000 people experience a new or recurrent stroke. To assess changes in neurological status during hospitalization, nurses are required to complete the 15-item National Institute of Health Stroke Scale (NIHSS), which is time consuming and therefore, may not be completed as thoroughly as it should. To ensure these patients are being effectively and adequately assessed, there is a need for an abbreviated NIHSS, which can be completed in a shorter time frame. Purpose: The purpose of this study was to determine the merits of an abbreviated NIHSS using seven items considered to be key to determining changes in neurological status. Methods: Over a six month period, 100 scores from the 15-item NIHSS were collected on a sample of 92 acute care stroke patients who had a mean age of 64.2; 52% were female. Seven items were calculated, which included level of consciousness, left and right arm motor movement, left and right leg motor movement, speech fluency, and speech clarity. To assess internal consistency reliability of the 7-item NIHSS, Cronbach's α was computed. To assess criterion validity, the 7-item NIHSS and 15-item NIHSS were correlated using Pearson's r . Results: The 15-item NIHSS ranged from 1 to 37, with a mean of 8.6. The 7-item NIHSS ranged from 0 to 24, with a mean of 4.9. For the 7-item NIHSS, Cronbach's α was .82 and Pearson's r was .96 (p<.001), when correlated with the 15-item NIHSS. Conclusions: Assessment of the acute stroke patient using the 15-item NIHSS is time-consuming, and therefore, may be underutilized. An abbreviated 7-item NIHSS demonstrated satisfactory evidence of internal consistency reliability and criterion validity, when correlated with the 15-item NIHSS, suggesting the 7-item version may be a suitable alternative to the longer version. More psychometric testing is warranted to fully evaluate reliability and validity of the 7-item NIHSS.

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