Abstract
Background: Spontaneous use of the more-affected arm is a meaningful indicator of stroke recovery. The Bilateral Arm Reaching Test (BART) was previously developed to quantify arm use by measuring arm choice to targets projected over a horizontal hemi-workspace. In order to improve clinical validity, we constrained the available movement time, thereby promoting more spontaneous decision making when selecting between the more-affected and less affected arm during the BART.Methods: Twenty-two individuals with mild to moderate hemiparesis were tested with the time-based BART in three time-constraint conditions: no-time constraint, medium, and fast conditions. Arm use was measured across three sessions with a 2-week interval in a spontaneous choice block, in which participants were instructed to use either the more-affected or the less-affected arm to reach targets. We tested the effect of time-constraint condition on the more-affected arm use, external validity of the BART with the Actual Amount of Use Test (AAUT), and test-retest reliability across the three test sessions.Results: The fast condition in the time-based BART showed reduced use of the more-affected arm compared to the no-time constraint condition P < 0.0001) and the medium condition P = 0.0006; Tukey post hoc analysis after mixed-effect linear regression). In addition, the fast condition showed strong correlation with the AAUT r = 0.829, P < 0.001), and excellent test-retest reliability (ICC = 0.960, P < 0.0001).Conclusion: The revised BART with a time-restricted fast condition provides an objective, accurate, and repeatable measure of spontaneous arm use in individuals with chronic stroke hemiparesis.
Highlights
Spontaneous use of the more-affected upper extremity post-stroke is often lower than would be expected from impairment levels [1, 2], with low use associated with a reduced quality of life [3]
Inclusion criteria were: [1] ischemic or intraparenchymal hemorrhagic stroke without intraventricular extension with confirmatory neuroimaging more than 180 days (6 months) after onset; [2] Age ≥21 and no upper limit; [3] impaired arm/hand motor function indicated by the Fugl-Meyer motor and coordination score no less than 19 out of 66 on the total motor score [14]; [4] no arm/hand neglect as determined by Albert Test; [5] Mini-Mental State Examination (MMSE) score >24/30; and [6] no previous or current musculoskeletal injury or conditions that limited arm/hand use
More-affected arm use decreased in the fast- (18.9 ± 2.9) compared to the medium- (27.5 ± 1.9) and compared to the no time constraint-condition (30.7 ± 1.8; P < 0.0001 between the fast- and no time constraint-condition, P = 0.0006 between the fast- and medium-condition)
Summary
Spontaneous use of the more-affected upper extremity post-stroke is often lower than would be expected from impairment levels [1, 2], with low use associated with a reduced quality of life [3]. The three instruments commonly used for measuring spontaneous arm/hand use in the natural environment are the Motor Activity Log [MAL; [5]], the Actual Amount of Use Test [AAUT; [6]], and accelerometers [7, 8]. With BART, arm use is measured in a spontaneous choice block, in which participants are instructed to choose either the more-affected or the less-affected arm to reach displayed targets on a table. The Bilateral Arm Reaching Test (BART) was previously developed to quantify arm use by measuring arm choice to targets projected over a horizontal hemi-workspace. In order to improve clinical validity, we constrained the available movement time, thereby promoting more spontaneous decision making when selecting between the more-affected and less affected arm during the BART
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