Development and validation of a scale for rating motor compensations used for reaching in patients with hemiparesis: the reaching performance scale (original) (raw)
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Relationships between sensorimotor impairments and reaching deficits in acute hemiparesis
Neurorehabilitation and neural repair, 2006
To determine the relationships between sensorimotor impairments and upper extremity reaching performance during the acute phase of stroke and to determine which, if any, measures of sensorimotor impairment can predict variance in reaching performance during this phase. Sensorimotor impairments of upper extremity (UE) strength, active range of motion, isolated movement control, light touch sensation, joint position sense, spasticity, and shoulder pain were evaluated in a group of 46 individuals with acute hemiparesis (mean time since insult = 9.2 days). Subjects performed a reaching task to a target placed on their affected side. Three-dimensional kinematic analyses were used to assess reaching speed, accuracy, and efficiency. Forward stepwise multiple linear regression analyses were used to determine which impairment was the best predictor of variance in reaching performance. Measures of UE strength predicted the largest proportion of variance in the speed, accuracy, and efficiency ...
Clinical Neurophysiology, 2007
Objective-To investigate upper extremity muscle activation and recovery during the first few months after stroke. Methods-Subjects with hemiparesis following stroke were studied performing a reaching task at an acute time point (mean = 9 days post-stroke) and then again at a subacute time point (mean = 109 days post-stroke). We recorded kinematics and electromyographic activity of 6 upper extremity muscles. Results-At the acute time point, the hemiparetic group had delayed muscle onsets, lower modulation ratios, and higher relative levels of muscle activation (%MVIC) during reaching than controls. From the acute to the subacute time points, improvements were noted in all three variables. By the subacute phase, muscle onsets were similar to controls, while modulation ratios remained lower than controls and %MVIC showed a trend toward being greater in the hemiparetic group. Changes in muscle activation were differentially related to changes in reaching performance. Conclusions-Our data show that improvements in muscle timing and decreases in the relative level of volitional activation may underlie improved reaching performance in the early months after stroke. Significance-Given that stroke is one of the leading causes of persistent physical disability, it is important to understand how the ability to activate muscles changes during the early phases of recovery after injury.
Journal of neuroengineering and rehabilitation, 2015
Various robotic technologies have been developed recently for objective and quantitative assessment of movement. Among them, robotic measures derived from a reaching task in the KINARM Exoskeleton device are characterized by their potential to reveal underlying motor control in reaching movements. The aim of this study was to examine the clinical usefulness and validity of these robot-derived measures in hemiparetic stroke patients. Fifty-six participants with a hemiparetic arm due to chronic stroke were enrolled. The robotic assessment was performed using the Visually Guided Reaching (VGR) task in the KINARM Exoskeleton, which allows free arm movements in the horizontal plane. Twelve parameters were derived based on motor control theory. The following clinical assessments were also administered: the proximal upper limb section in the Fugl-Meyer Assessment (FMA-UE(A)), the proximal upper limb part in the Stroke Impairment Assessment Set (SIAS-KM), the Modified Ashworth Scale for the...
Effect of robot-assisted and unassisted exercise on functional reaching in chronic hemiparesis
2001
A common therapeutic approach for the rehabilitation of patients with hemiparesis involves repetitive voluntary movements with manual assistance from a therapist ("active-assist therapy"). We used a novel robotic device to deliver a controlled form of active-assist therapy in chronic stroke patients (N = 7). To examine the utility of direct mechanical assistance in rehabilitation of voluntary arm movements, a matched group of subjects with chronic hemiparesis (N = 7) performed the same repetitive exercises without the aid of the robotic device. Each group performed 24 therapy sessions over 8 weeks. We found that both groups demonstrated significant improvements in straightness of voluntary reaching movements, with limited improvements in range. Only the group that received robotic therapy significantly improved the smoothness of reaching. Improvements in both groups transferred to an unpracticed reaching movement and the timed performance of functional tasks. There were no significant differences in the magnitude of improvements between the two groups. These results suggest that it is the action of repetitively attempting to move, rather than the mechanical assistance provided by the robot, that stimulates arm movement recovery. However, imposing a smooth trajectory during practice of the reaching movements may help subjects learn how to produce smoother movements. In addition, practicing robot-assisted or unassisted reaching movements apparently improves control processes that generalize to other functional movements.
The objectives of this study were to compare manual dexterity (gross and fine) and coordination performance of the ipsilateral upper extremity of the right hemisphere stroke patients with the same side of a healthy group, and to determine the relationship of ipsilateral upper extremity dexterity and disability. Methods: In a non-randomized analytical study, 30 individuals with a unilateral first-ever stroke from outpatient rehabilitation clinics and 30 age and sex-matched adults without history of neurological disorders were enrolled. Purdue Pegboard, Box and Block, and Finger to Nose tests were used to measure dexterity (fine and gross) and coordination performance of the stroke group compared with the same hand of the healthy group. The Barthel index was also used to assess disability or dependency of stroke patients in basic activities of daily living. Results: Results showed that stroke individuals with involvement of ipsilateral hand had less coordination and dexterity when compared to the same hand of normal subjects (P=0.001). In addition, the relationship of gross and fine manual dexterity performance of the ipsilateral upper extremity with disability, including dependence in basic activities of daily living, were significant respectively (r=0.376, r=0.391). Conclusion: People with right stroke had significant ipsilateral upper extremity impairments (manual dexterity and coordination tasks), and this hand dexterity deterioration had an impact on their dependence in basic activities of daily living.
Measurement properties of the Reaching Performance Scale for Stroke
Disability and Rehabilitation, 2019
Aim: Reaching Performance Scale for Stroke (RPSS) evaluates the upper limb reach-to-grasp movement quality and compensatory movements. The objective of the study was to test the reliability, construct validity, and interpretability of the Brazilian-Portuguese RPSS. Methods: Fifty-one individuals (mean age 62 ± 10.8 years), with acute-to-chronic stroke (range: 1-300 months) were video recorded while performing a reach-to-grasp task of a cone placed both close and far from the individual. Their degree of motor impairment ranged from 4 to 59 points in the Fugl-Meyer scale. Results: Reaching Performance Scale for Stroke showed excellent intra-(ICC 2,1 ¼ 1.00) and interrater (ICC 2,1 ¼ 0.98-0.99) reliability, and redundant internal consistency (Cronbach's a ¼ 0.98). The construct validity between RPSS and Fugl-Meyer scale was strong (Spearman rho ¼ 0.88-0.89; p < 0.0001). The scale was able to discriminate individuals with mild or moderate upper limb impairment from those with severe impairment. We found ceiling and floor effects. Conclusions: Reaching Performance Scale for Stroke showed excellent reliability and redundant internal consistency. The construct validity with the Fugl-Meyer scale was strong. Reaching Performance Scale for Stroke was able to discriminate individuals with different levels of upper limb impairment. ä IMPLICATIONS FOR REHABILITATION Post-stroke individuals develop compensatory strategies to perform reaching movements with the paretic upper limb. The Reaching Performance Scale for Stroke provides a quantitative and qualitative evaluation of the reach-to-grasp movement.
Archives of Physical Medicine and Rehabilitation, 2004
Objectives: To characterize fine motor control through finger tapping in both arms of 10 patients with chronic stroke, to make baseline comparisons with matched controls, and to examine the responsiveness of deficits seen in stroke patients after 6 weeks of bilateral arm-based training. Design: Nonrandomized controlled, cohort before-after trial. Setting: Research institution. Participants: Ten people from the community with chronic unilateral ischemic stroke and 10 age-and sex-matched healthy controls. Participants with hemiparesis had completed all conventional care and were more than 6 month poststroke. Inclusion criteria were at least 6 months since a unilateral stroke, ability to follow simple instructions and 2-step commands, volitional control of the nonparetic arm, and at least minimal antigravity movement in the shoulder of the paretic arm. Interventions: Not applicable. Main Outcome Measures: Measurements included rate and timing consistency of unilateral tapping at a preferred and a maximal rate and the accuracy and stability of interlimb coordination in bilateral simultaneous (inphase) and alternating (antiphase) tapping at a preferred rate. Results: Nonparetic finger control was similar to that of the nondisabled participants except under bilateral conditions, where it was less consistent. A subgroup with residual paretic finger function, had slower and less consistent paretic finger tapping, as well as less accurate and more variable interlimb coordination; however, basic bilateral coupling relationships were preserved. Bilateral arm-based training improved bilateral nonparetic consistency but slowed unilateral preferred tapping. Training also improved paretic fine motor control in 2 of 4 participants with mild stroke severity. The 2 responders, with dominant hemisphere lesions, indicated a possible recovery advantage with bilateral training for such lesions. Conclusions: In general, nonparetic finger control for tapping was preserved but paretic finger control was compromised. Disruption of nonparetic control of tapping, particularly consistency of tapping, occurred during bilateral tapping tasks but was responsive to 6 weeks of bilateral arm-based training. Despite the apparent lack of training specificity, the generalizable effects of bilateral arm training to fine motor interlimb coordination may reflect central motor control mechanisms for upper-extremity coordination, which may be accessed and may influence the recovery of arm function after stroke.