Arm and hand skills: Training preferences after stroke

Purpose. An increasing demand for training after stroke has brought about the need to develop rehabilitation technology. This article reports an inquiry into skill preferences of persons after stroke regarding arm–hand training and examines the relationship between the use of the affected arm and the patient's training preference.

Method. Data collection involved a semi-structured interview of 20 persons in the subacute and 20 persons in the chronic stage after stroke, based on an adaptation of the motor activity log.

Results. Subacute and chronic patients after stroke agreed on seven out of 10 most preferred training skills. Patient preferences related mostly to ‘manipulation in combination with positioning’ and ‘manipulation’. Eight motivation aspects for skill training were identified as being important. A positive correlation was found between skill preference scores and use of the impaired arm (r = 0.64) (p < 0.001).

Conclusions. This study has resulted in an inventory of skills that persons after stroke prefer to train on. This list can be used for implementation of exercises in rehabilitation technology. Motivation for skill training pertains to optimising participation level, rather than function or activity level. This study suggests that client-centred assessment is advocated to set therapy goals that match patient training preferences.     

Test position and hip strength in healthy adults and people with chronic stroke

Barbic S, Brouwer B. Test position and hip strength in healthy adults and people with chronic stroke.

Objective

To determine if peak torques generated by the hip flexors and extensors are dependent on test position in healthy adults and in people with chronic stroke.

Design

Cross-sectional study.

Setting

Motor performance laboratory.

Participants

Volunteers were 10 young (20.7±1.5y), 10 older adults (62.1±7y), and 10 stroke survivors (60.6±10y) who were an average of 5 years poststroke.

Interventions

Not applicable.

Main Outcome Measures

Isokinetic (60°/s) peak concentric hip flexor and extensor torques (in Nm/kg) generated in supine and standing positions.

Results

Peak flexor torques measured in standing were generally higher than in supine (P=.018); a pattern evident in all groups, but significant only in stroke. An interaction between test position and group for hip extensor strength (P=.016) reflected 2 distinct patterns in which torques were highest in standing among the young subjects and highest in supine after stroke.

Conclusions

Isokinetic hip flexor and extensor strength measured in standing and supine are comparable in young and older healthy people. In chronic stroke, the test position may over or underestimate maximum peak torque depending on the muscle group tested, particularly on the side ipsilateral to the lesion. These findings may have implications for predicting functional ability from strength measurements.     

Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study

Purpose: The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated.

Methods: This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl–Meyer examination score?=?25/66, Wrist and Hand items?=?2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation.

Results: Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing.

Conclusion: This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes.

• Implications for rehabilitation

• Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke.

• Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis.

• Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning.

• Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke.

     

强制性使用运动疗法塑形技术对恢复期脑卒中上肢运动功能的康复作用

摘要 目的：探讨强制性使用运动疗法塑形技术对恢复期脑卒中偏瘫上肢运动功能的影响。 方法：恢复期脑卒中上肢运动功能障碍患者30例,随机分为3组：强制性使用运动疗法组（CIMT组）10例,塑形组10例,作业疗法组（OT组）10例。CIMT组采用塑形技术+行为技术+限制技术;塑形组采用塑形技术+限制技术;OT组采用作业疗法+限制技术。所有组连续康复治疗3h/d,5d/周,共2周。采用运动功能活动指数（MAL）评定患侧上肢在日常生活中的使用能力;采用Wolf运动功能评定法（WMFT）评定患侧上肢运动功能。所有组治疗前、治疗后1天、治疗后6个月及12个月进行MAL评定,治疗前后分别进行WMFT评定。 结果：与治疗前比较,所有组治疗后1d MAL指数提高明显（P＜0.01）;CIMT组治疗后6个月和12个月MAL指数提高明显（P＜0.01）,塑形组和OT组则无明显提高（P＞0.05）。治疗后组间MAL比较,CIMT组MAL指数提高最明显,与塑形组和OT组比较有显著性差异（P＜0.01）;而塑形组与OT组组间MAL比较无显著性差异（P＞0.05）。所有组治疗前后WMFT指数无明显变化（P＞0.05）。 结论：单纯塑形技术和强化作业疗法对运动功能具有同样的康复疗效;CIMT通过塑形技术和行为技术协同应用,显著提高康复疗效,并使康复疗效继续维持到治疗后1年;康复治疗中应重视行为因素的康复作用。     

The evaluation of non-use of the upper limb in chronic hemiparesis is influenced by the level of motor impairment and difficulty of the activities–proposal of a new version of the Motor Activity Log

ABSTRACT

This study aims to evaluate the influence of the degree of difficulty of the activities in Motor Activity Log (MAL) scores for patients with mild, moderate, and severe hemiparesis, and to estimate the correlation between motor impairment levels of hemiparesis and MAL scores in post-stroke patients. Sixty-six patients with chronic hemiparesis (49 with mild–moderate hemiparesis, and 17 with severe hemiparesis) were evaluated by the Fugl–Meyer upper-limb section and versions of MAL for different degrees of motor impairment. The Rasch model was used to analyze the level of difficulty of the activities of the different versions of MAL. The Spearman’s correlation tested the relationship between the Fugl–Meyer Assessment upper-limb section and MAL. The MAL version, developed to evaluate patients with severe hemiparesis, does not contain the easier activities as employed by the Rasch analysis. There was positive correlation between the Fugl–Meyer Assessment upper-limb section scores and Amount of Use of the three versions of the MAL (r = 0.76, 0.78, and 0.77). The difficulty of the activities seems to influence the quantity and quality of use of the affected upper limb in individuals with chronic hemiparesis. A new version of MAL is proposed for individuals with severe motor impairment.     

Kinematic upper extremity performance in people with near or fully recovered sensorimotor function after stroke

Background: Clinical scales for upper extremity motor function may not capture improvement among higher functioning people with stroke. Objective: To describe upper extremity kinematics in people with stroke who score within the upper 10% of the Fugl-Meyer Assessment (FMA-UE) and explore the ceiling effects of the FMA-UE. Design: A cross-sectional study design was used. Participants: People with stroke were included from the Stroke Arm Longitudinal Study at University of Gothenburg together with 30 healthy controls. The first analysis included participants who achieved FMA-UE score > 60 within the first year of stroke (assessed at 3 days, 2 weeks, 4 weeks, 3 months, or 12 months post stroke). The second analysis included participants with submaximal FMA-UE (60–65 points, n = 24) or maximal FMA-UE score (66 points, n = 21) at 3 months post stroke. Measurements: The kinematic analysis of a standardized drinking task included movement time, velocity and strategy, joint angles of the elbow, and shoulder and trunk displacement. Results: The high FMA-UE stroke group showed deficits in seven of eight kinematic variables. The submaximal FMA-UE stroke group was slower, had lower tangential and angular peak velocity, and used more trunk displacement than the controls. In addition, the maximal FMA-UE stroke group showed larger trunk displacement and arm abduction during drinking and lower peak angular velocity of the elbow. Conclusions: Participants with near or fully recovered sensorimotor function after stroke still show deficits in movement kinematics; however, the FMA-UE may not be able to detect these impairments.     

偏瘫上肢的运动障碍

偏瘫上肢运动障碍是脑中风常见的症状和体征之一,临床检查肌力分为6级,为精细观察肌力减弱程度提出一种补充分级法。其他尚可应用握力针、量角器、磁刺激反应和经皮氧张力检测等方法。中风偏瘫上肢运动障碍早期为弛缓性瘫,在恢复期中逐渐转变为痉挛性瘫。可伴有瘫侧上肢疼痛和反射性交感神经营养不良现象,并伴有各型病理性联合运动。肌电图表现为主动肌拮抗肌3相型电活动。脑内不同部位病变的上肢运动障碍各具不同特点,一些征象可预测中风瘫痪上肢的功能预后。     

Low frequency repetitive transcranial magnetic stimulation to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance after chronic stroke

Purpose: To investigate the effect of inhibitory low frequency repetitive Transcranial Magnetic Stimulation (rTMS) applied to the non-lesioned hemisphere on kinematics and coordination of paretic arm reach-to-grasp (RTG) actions in individuals with stroke. Relevance: This study is designed as a phase I trial to determine the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The results have important implications for the use of rTMS in parallel with complex paretic arm skill practice. Participants: Nine adults, anterior circulation unilateral stroke. Their average age was 59 years, the average time since stroke was 4.8 years. Method and analysis: Two TMS treatments were performed on two separate days: active rTMS and sham rTMS. Cortico-motor excitability (CE) of the non-lesioned hemisphere as well as RTG kinematics of the paretic hand as participants reached for a dowel of 1.2?cm in diameter was assessed before and after the rTMS treatments. In the active condition, rTMS was applied over the “hot spot” of the extensor digitorum communis muscle (EDC) in primary motor cortex (M1) of the non-lesioned hemisphere at 90% resting motor threshold. TMS pulses were delivered at 1 Hz for 20?min. In the sham condition, a sham coil was positioned similar to the active condition; TMS clicking noise was produced but no TMS pulse was delivered. Dependent measures: CE was measured as peak-to-peak amplitude of the motor evoked potential at 120% of resting motor threshold. RTG kinematics included movement time, peak transport velocity, peak aperture, time of peak transport velocity and time of peak aperture. RTG coordination was captured by cross correlation coefficient between transport velocity and grasp aperture size. Results: While 1 Hz rTMS applied over non-lesioned M1 significantly decreased the MEP amplitude of non-paretic EDC, sham TMS did not have a significant effect on MEP amplitude. Active rTMS significantly decreased total movement time and increased peak grasp aperture. There were no changes in peak transport velocity or the time of peak transport velocity or the time of peak aperture after application of active rTMS. Additionally, the participants completed RTG actions with a more coordinated pattern after undergoing active rTMS. Following sham TMS, there were no changes in CE, RTG kinematics or coordination. While there were no significant correlation between changes in cortico-motor excitability and RTG kinematics, the decrease in cortico-motor excitability of the non-lesioned hemisphere showed a strong correlation with an increase in cross-correlation coefficient. Conclusions and implications: The findings demonstrate the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The inhibitory effect of low frequency rTMS resulted in improved paretic hand reach-to-grasp performance with faster movement time and more coordinated reach-to-grasp pattern. These results have important implications for the use of rTMS for stroke rehabilitation.

Implications for Rehabilitation

• Low frequency repetitive transcranial magnetic stimulation (LF-rTMS) to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance.

• The preliminary results have important implications for the use of LF-rTMS as conjunctive intervention for stroke rehabilitation.

     

Feasibility of incorporating functionally relevant virtual rehabilitation in sub-acute stroke care: perception of patients and clinicians

Purpose: To determine user satisfaction and safety of incorporating a low-cost virtual rehabilitation intervention as an adjunctive therapeutic option for cognitive-motor upper limb rehabilitation in individuals with sub-acute stroke.

Methods: A low-cost upper limb virtual rehabilitation application incorporating realistic functionally-relevant unimanual and bimanual tasks, specifically designed for cognitive-motor rehabilitation was developed for patients with sub-acute stroke. Clinicians and individuals with stroke interacted with the intervention for 15–20 or 20–45 minutes, respectively. The study had a mixed-methods convergent parallel design that included a focus group interview with clinicians working in a stroke program and semi-structured interviews and standardized assessments (Borg Perceived Exertion Scale, Short Feedback Questionnaire) for participants with sub-acute stroke undergoing rehabilitation. The occurrence of adverse events was also noted.

Results: Three main themes emerged from the clinician focus group and patient interviews: Perceived usefulness in rehabilitation, satisfaction with the virtual reality intervention and aspects to improve. All clinicians and the majority of participants with stroke were highly satisfied with the intervention and perceived its usefulness to decrease arm motor impairment during functional tasks. No participants experienced major adverse events.

Conclusions: Incorporation of this type of functional activity game-based virtual reality intervention in the sub-acute phase of rehabilitation represents a way to transfer skills learned early in the clinical setting to real world situations. This type of intervention may lead to better integration of the upper limb into everyday activities.

• Implications for Rehabilitation

• ??Use of a cognitive-motor low-cost virtual reality intervention designed to remediate arm motor impairments in sub-acute stroke is feasible, safe and perceived as useful by therapists and patients for stroke rehabilitation.

• ??Input from end-users (therapists and individuals with stroke) is critical for the development and implementation of a virtual reality intervention.

     

中风后的健侧上肢问题

大量证据表明 ,成年人中风后大脑损伤的同侧上肢感觉运动控制也出现异常。一些感觉运动缺损因脑损伤侧的功能不同而异 ,需要精确时序性的快速运动在左半球损伤的患者中对同侧上肢的影响大 ,相反在右半球损伤的患者中对有空间运动需要的同侧上肢影响较大 ,左侧中风的成年人同侧上肢的分离协调动作是正常的 ,但是连续协调动作则异常。中风后同侧上肢的感觉不受影响或仅受轻微影响 ,损伤同侧上肢有肌力缺陷 ,主要表现在右侧半球损伤患者 ,在要求一定时间完成的床功能检查中 ,见损伤同侧操作不能按时完成 ,这种操作缺陷可以反映损伤同侧的运动控制缺陷 ,这种缺陷往往被对侧偏瘫和偏身感觉丧失掩盖 ,集中于特殊运动控制缺陷的干预措施有助于双上肢的功能改善。     

脑卒中偏瘫患者健侧上肢运动控制障碍的研究

目的 :研究脑卒中偏瘫患者健侧上肢运动控制障碍对功能恢复的影响。方法 :62例脑卒中偏瘫患者分别在治疗前和治疗 3个月后对健侧上肢进行上肢功能检查 (manualfunctiontest ,MFT) ,用巴塞尔指数 (BarthelIndex ,BI)评测患者的ADL。结果 :①治疗前MFT异常者 49例 (79% ) ;②MFT变化差值上早期康复组高于恢复期康复组 (P <0 .0 0 1 ) ;③MFT正常组 3个月治疗训练后BI值 1 0 0分 ,BI变化差值正常组高于异常组 (P <0 .0 0 1 )。结论 :脑卒中偏瘫患者健侧上肢存在运动控制障碍 ,并影响功能恢复 ,因此脑卒中后早期积极对健侧上肢运动控制障碍评测和治疗是十分重要的     

3种疗法对脑卒中后偏瘫患者上肢运动速度的临床比较

目的比较改良强制性使用运动疗法（modified constraint-induced movement therapy, mCIMT）、强制性使用运动疗法（constraint-induced movement therapy, CIMT）和常规神经发育技术（neurodevelopment treatment,NDT）对脑卒中偏瘫患者上肢运动功能的康复疗效。方法选取符合入选标准的脑卒中偏瘫患者45例,随机分为改良组（15例）、强制组（15例）和常规组（15例）。在治疗前和治疗后的第2周、第3周、第5周和第8周的随访后,分别进行简易上肢功能检查法（simple test for evaluating hand function,STEF）的功能评定。结果在治疗前3组患者上肢的STEF评分差异无统计学意义（P〉0．05）。随着治疗时间的延长,3组的STEF评分均有上升趋势,组间、不同时点以及组间和不同时点的交互作用差异均有统计学意义（P〈0．05）,但是3组的上升趋势有所不同,CIMT组上升很快,治疗后2周在3组中评分最高,由治疗前的（42．3±9．6）分提高到（72．3±5．7）分,随访时提高到到（75．2±8．4）分;mCMT组治疗后3～5周近乎直线上升,由治疗前的（42．1±9．7）分提高到（73．6±4．7）分,随访时仍继续提高到到（79．8±5．1）分,并在治疗后8周维持在3组的最高水平;Bobath组作用缓慢,由治疗前的（41．2±9．8）分提高到（56．6±4．7）分,在治疗3周后呈逐渐下降趋势降低到（50．3±5．3）分,为3组中评分最低。结论对于脑卒中患者上肢运动功能的恢复,强制性使用运动疗法和改良强制性使用运动疗法比常规神经发育技术治疗更为有效。对于偏瘫患者上肢运动速度的提高和效果的持续时间,改良强制性使用运动疗法显示出更大的优势。     

早期康复对脑卒中后肩-手综合征患者上肢功能的影响

目的探讨早期综合康复治疗对脑卒中后肩 手综合征患者患侧上肢临床症状、关节活动度和运动功能的影响。方法将 47例脑卒中后肩 手综合征患者分为早期康复组和非早期康复组 ,两组患者均给予综合康复治疗 ,观察其临床表现 ,并采用Fugl-Meyer评定法评定康复治疗前后偏瘫侧上肢的关节活动范围、疼痛程度和运动功能。结果①对脑卒中患者予早期预防性康复措施 ,在并发肩 手综合征时 ,其患侧上肢关节活动范围减小程度和疼痛程度均较非早期康复组轻。②经综合康复治疗后 ,脑卒中后肩 手综合征患者患侧上肢的临床症状、关节活动度和运动功能均有改善 (P <0 .0 5 ) ,早期康复治疗效果更佳。结论早期康复干预可以预防和减轻脑卒中患者肩 手综合征的发生 ;发病后更易为综合康复治疗所逆转     

Athletic Shoulder Test Differences Exist Bilaterally in Healthy Pitchers

BackgroundThere is a lack of valid and reliable tests that assess upper extremity strength and function for rehabilitation and injury prevention purposes in throwing athletes. The Athletic Shoulder (ASH) test has been proposed as a reliable measure of shoulder strength, but has not yet been studied in baseball pitchers.Hypothesis/PurposeThe purpose of this study was to establish values for healthy baseball pitchers performing the ASH test, compare those values with other common tests of shoulder strength and function, and compare ASH test performance bilaterally. It was hypothesized that the dominant arm would perform significantly better on the ASH test compared to the non-dominant arm. A secondary purpose of the study was to evaluate if ASH test performance was related to fastball velocity in baseball pitchers. It was hypothesized that ASH test performance would positively correlate with fastball velocity.Study DesignCross-Sectional StudyMethodsCollege and high school baseball pitchers were recruited to complete shoulder range of motion (ROM), isokinetic shoulder strength, and isometric shoulder strength testing using the ASH test. The ASH test was used to assess force production as a proxy for strength bilaterally at four levels of shoulder abduction (0°, 90°, 135°, and 180°), using a force plate. Approximately one-week later subjects returned for a bullpen session where fastball velocity was recorded with a radar gun. Bilateral differences in passive ROM, isokinetic, and isometric shoulder strength were examined using paired t-tests while linear relationships between isometric shoulder strength and fastball velocity were assessed using Pearson correlations.ResultsThirty-five healthy pitchers participated in the study (19.7 ± 1.8 years). Pitchers demonstrated significantly greater isometric shoulder strength at the 90° and 135° abduction positions with the throwing arm compared to the non-throwing arm. Pitchers also demonstrated commonly observed musculoskeletal adaptations in the throwing arm such as increased passive external rotation, decreased passive internal rotation, and greater internal and external rotator strength during isokinetic testing. Peak force production during the ASH test was not related to fastball velocity.ConclusionThe ASH test is capable of detecting bilateral shoulder strength adaptations commonly observed in other clinical tests in healthy pitchers. Pitchers demonstrated greater isometric peak force during the ASH test at levels of shoulder abduction similar to those observed in pitching. While these results may be intriguing for clinical use, peak force from the ASH test was not correlated to fastball velocity in pitchers, and therefore should be used with caution for predictions in this realm.Level of Evidence2Clinical RelevanceA need exists for objective measures of shoulder strength for rehabilitation and injury risk monitoring in throwing athletes that are easy to administer, have high reliability and validity, and provide minimal re-injury risk to athletes recovering from injury.What is known about the subjectData from the ASH test has been published previously in non-throwing athletes and was shown to be valid and reliable in that group. However, the test has not been explored widely in throwing athletes who are known to have significant musculoskeletal adaptations to the throwing shoulder.What this study adds to existing knowledgeThe results from this study confirm that the ASH test is sensitive enough to detect the adaptations that are present in the healthy throwing athlete’s shoulder. Due to the prior proven validity and reliability and these results, the test can be used to monitor throwing arm strength and function during rehabilitation or as a pre/intra-season screening tool to help describe arm health.     

Elbow kinematics during overground manual wheelchair propulsion in individuals with tetraplegia

Purpose.?The purpose of this study was to describe horizontal and vertical translation of the elbow and elbow angle in two planes and three speeds during manual wheelchair overground propulsion in individuals with tetraplegia.

Methods.?Seven individuals with tetraplegia who used manual wheelchairs wheeled overground at three different speeds were recruited for the study. Video motion capture methods quantified their movements. Video data were tracked and used to calculate variables describing three-dimensional elbow translation and angular orientation. Repeated measures ANOVA were used to determine effects of speed on elbow translation and elbow angle. Paired t-tests were used to evaluate left to right differences.

Results.?Right elbow anterior-posterior translation was found to be significantly different during slow and fast and slow and normal speeds. Vertical and medial-lateral translation of the right elbow was significantly different between slow and fast speeds. No significant effects for speed during left elbow movement or side-to-side movement were found. No significant effects were found for elbow angle across speeds or from side-to-side. Three patterns of elbow movement emerged for anterior-posterior and medial-lateral translation and for elbow angle.

Conclusions.?Results indicated that elbow translation was related to propulsion speed. Work involving this population is needed for further understanding of upper extremity kinematic patterns.     

强制性使用运动疗法在亚急性期和慢性期脑卒中患者中的效力

目的：强制性使用运动疗法（CIMT）是近年来针对脑卒中后上肢功能障碍的一种新的康复训练技术。本研究目的是评价和比较CIMT在亚急性期和慢性期脑卒中患者中的康复效力。方法：30例脑卒中偏瘫患者参与此研究，其中亚急性期组患者14例（平均病程3．5个月），慢性期组患者16例（平均病程12．1个月）。在CIMT治疗期间要求两组患者健侧穿戴吊带和夹板来限制健侧肢体动作，每天清醒时固定时间不少于90％，连续12天。同时接受塑形训练．密集的训练患侧肢体活动，完成日常生活中的动作，连续2周共10个工作日。在接受CIMT治疗前和治疗后用上肢功能测验（UEFT）来评价两组患者的上肢运动功能。结果：两组患者在CIMT治疗前UEFT的比较差异无显著性意义（P〉0.05），在治疗后两组患者UEFT的比较差异无显著性意义（P〉0．05），但是亚急性期组治疗后UEFT的改善值明显高于慢性期组患者治疗后UEFT的改善值，两组改善值的比较差异有显著性意义（P〈0．05）。亚急性期组患者和慢性期组患者在CIMT在治疗前、后UEFT的比较差异有显著性意义（P〈0.001），但CIMT在上肢运动功能改善效果上亚急性期组患者优于慢性期组患者（效应值ES：1.51：0.89）。结论：本文的研究结果表明CIMT在亚急性期和慢性期患者中均显现出较大的康复效力，尤其在亚急性期患者中显现出更大的康复效力。     

Biomechanic modeling of sit-to-stand to upright posture for mobility assessment of persons with chronic stroke

OBJECTIVE: To test the suitability of using biomechanic measures associated with a minimum measured input model (MMIM) approach to assess mobility of people with chronic stroke during the execution of a sit-to-stand (STS) to upright posture motor task. DESIGN: Single group, observational. SETTING: Institutional settings in the United States and Italy. PARTICIPANTS: Twenty-nine subjects with chronic unilateral lower-limb impairments and resultant mobility limitations secondary to stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Manual measurement of lower-limb strength; performance-based tests including repeated chair standing, walking speed, and standing balance; and ground reactions measured with a force platform during STS and upright posture. The ground reactions were fed to a telescopic inverted pendulum model of the musculoskeletal system. Parameters representing the model outputs were compared with performance-based and strength measures to assess, respectively, motor ability and impairment-related changes in subjects' motor strategies. RESULTS: The parameters derived from the model effectively differentiated between motor strategies associated with different performance-based scores, and allowed the identification of relevant difficulties encountered in STS execution. These difficulties could be associated with different strength scores. This was also true for subjects scoring the maximum in both performance-based and strength tests. CONCLUSIONS: The MMIM is a relatively inexpensive and noninvasive approach that enhances mobility assessment of hemiparetic subjects with different motor ability levels. It provides information that correlates well with performance-based and strength scores and, in addition, it allows for subject-specific motor strategy identification.     

Left/right judgement does not influence the effect of mirror therapy after stroke

Abstract

Purpose: To investigate the correlation between left/right judgement and the effect of mirror therapy (MT). A partial aim was to describe adverse effects of MT. Methods: This prospective follow-up study included 36 stroke patients, mean time since stroke was 33?d, SD 23. Left/right judgement is the ability to judge a pictured hand as belonging to one side of the body or the other. In this study, left/right judgement was established before the onset of MT by asking the patient to recognise left and right hands in photographs. Patients were tested before and after the intervention with the motor assessment scale (MAS) and two-point discrimination (2PD). The correlation between left/right judgement and the change of effect measured on the MAS and 2PD were tested by Spearman’s rank correlation. Results: The ability to perform left/right judgement before the onset of MT had no significant correlation with change of effect measured on the MAS and 2PD (rho ?0.169, p?=?0.363 and rho?=??0.227, p?=?0.219). Thirty-one patients completed the intervention without adverse effects. Conclusion: Left/right judgement does not influence the effect of MT. There seems to be no reason to test the ability to perform left/right judgement before the onset of MT. MT is an intervention without major adverse effects.

• Implications for Rehabilitation

• Mirror therapy (MT) is a method for treating sensory and motor disturbances post-stroke.

• It is important to clarify whether the ability to perform left/right judgement influences the effect of MT.

• In this study, left/right judgement does not influence the effect of MT.

• Based on the results of this study, testing and training left/right judgement before commencing MT cannot be recommended.