Fugl-Meyer Assessment Of The Upper Extremity Research Articles

Upper-Limb Functional Recovery in Chronic Stroke Patients after COVID-19-Interrupted Rehabilitation: An Observational Study.

Background/Objectives: Upper-limb function of chronic stroke patients declined when outpatient rehabilitation was interrupted and outings restricted, owing to the novel coronavirus infection (COVID-19) pandemic. We investigated whether these patients recovered upper-limb function post-resumption of outpatient rehabilitation. Methods: In this observational study, 43 chronic stroke hemiparesis patients with impaired upper extremity function were scored for limb function via the Fugl-Meyer assessment of the upper extremity (FMA-UE) and the Action Research Arm Test (ARAT) after a structured interview, evaluation, and intervention. Scores at 6 and 3 months pre- and 3 months post-rehabilitation interruption were examined retrospectively; scores immediately and at 3 and 6 months post-resumption of care were examined prospectively. The amount of change for each time period and an analysis of covariance were performed with time as a factor, changes in the FMA-UE and the ARAT scores as dependent variables, and statistical significance at 5%. Results: The time of evaluation significantly impacted the total score, as well as part C and part D of FMA-UE and total, pinch, and gross movement of the ARAT. Post-hoc tests showed that the magnitude of change in limb-function scores from immediately to 3 months post-resumption was significantly higher than the change from 3 months pre- to immediately post-interruption for the total score and part D of the FMA-UE, as well as grip and gross movement of the ARAT (p < 0.05). Conclusions: Upper-limb functional decline in chronic stroke patients, caused by the COVID-19 pandemic-related therapy interruption and outing restrictions, was resolved approximately 3 months post-resumption of rehabilitation therapy. Our data can serve as reference standards for planning and evaluating treatment for chronic stroke patients with inactivity-related impaired upper-limb function.

IMPROVE study protocol, investigating post-stroke local muscle vibrations to promote cerebral plasticity and functional recovery: a single-blind randomised controlled trial

IntroductionSpasticity is a frequent disabling consequence following a stroke. Local muscle vibrations (LMVs) have been proposed as a treatment to address this problem. However, little is known about their clinical...

Improving Upper Limb Spasticity in Patients with Stroke by Electroacupuncture Therapy: a Pre- and Post-Treatment Study.

: Post-stroke upper limb spasticity (PS-ULS) causes a decline in the quality of life of patients by reducing their ability to perform normal daily activities. : We performed pre- and post-treatment analyses of the changes in stroke patients with ULS following constant electroacupuncture therapy (EAT). : Thirty patients with PS-ULS underwent 12 sessions of EAT over 4 weeks. After performing acupuncture therapy at four acupoints on the affected arm (LI11, LI10, LI4, and TE5), electrostimulation (60 Hz) was performed for 20 min. The modified Ashworth scale (MAS) and the Fugl-Meyer assessment of the upper extremity (FMA-UE) were measured as the outcome variables. : Following EAT, there was a significant decrease in the elbow MAS score (p < 0.001), a significant decrease in the wrist MAS score (p < 0.01), and a significant increase in the FMA-UE score (p < 0.001). Adverse events related to EAT were not reported. : EAT decreased upper limb spasticity and improved functional recovery at the elbow and wrist. Large-scale and rigorous clinical trials are needed to verify the efficacy of EAT.

Determining the Optimal Stimulation Sessions for TMS-Induced Recovery of Upper Extremity Motor Function Post Stroke: A Randomized Controlled Trial.

To find out the optimal treatment sessions of repetitive transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) for upper extremity dysfunction after stroke during the 6-week treatment and to explore its mechanism using motor-evoked potentials (MEPs) and resting-state functional magnetic resonance imaging (rs-fMRI), 72 participants with upper extremity motor dysfunction after ischemic stroke were randomly divided into the control group, 10-session, 20-session, and 30-session rTMS groups. Low-frequency (1 Hz) rTMS over the contralesional M1 was applied in all rTMS groups. The motor function of the upper extremity was assessed before and after treatment. In addition, MEPs and rs-fMRI data were analyzed to detect its effect on brain reorganization. After 6 weeks of treatment, there were significant differences in the Fugl-Meyer Assessment of the upper extremity and the Wolf Motor Function Test scores between the 10-session group and the 30-session group and between the 20- and 30-session groups and the control group, while there was no significant difference between the 20-session group and the 30-session group. Meanwhile, no significant difference was found between the 10-session group and the control group. The 20-session group of rTMS decreased the excitability of the contralesional corticospinal tract represented by the amplitudes of MEPs and enhanced the functional connectivity of the ipsilesional M1 or premotor cortex with the the precentral gyrus, postcentral gyrus, and cingulate gyrus, etc. In conclusion, the 20-session of rTMS protocol is the optimal treatment sessions of TMS for upper extremity dysfunction after stroke during the 6-week treatment. The potential mechanism is related to its influence on the excitability of the corticospinal tract and the remodeling of corticomotor functional networks.

Different doses of intermittent theta burst stimulation for upper limb motor dysfunction after stroke: a study protocol for a randomized controlled trial.

Upper limb motor recovery is one of the important goals of stroke rehabilitation. Intermittent theta burst stimulation (iTBS), a new type of repetitive transcranial magnetic stimulation (rTMS), is considered a potential therapy. However, there is still no consensus on the efficacy of iTBS for upper limb motor dysfunction after stroke. Stimulus dose may be an important factor affecting the efficacy of iTBS. Therefore, we aim to investigate and compare the effects and neural mechanisms of three doses of iTBS on upper limb motor recovery in stroke patients, and our hypothesis is that the higher the dose of iTBS, the greater the improvement in upper limb motor function. This prospective, randomized, controlled trial will recruit 56 stroke patients with upper limb motor dysfunction. All participants will be randomized in a 1:1:1:1 ratio to receive 21 sessions of 600 pulses active iTBS, 1,200 pulses active iTBS, 1,800 pulses active iTBS, or 1,800 pulses sham iTBS in addition to conventional rehabilitation training. The primary outcome is the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) score from baseline to end of intervention, and the secondary outcomes are the Wolf Motor Function Test (WMFT), Grip Strength (GS), Modified Barthel Index (MBI), and Stroke Impact Scale (SIS). The FMA-UE, MBI, and SIS are assessed pre-treatment, post-treatment, and at the 3-weeks follow-up. The WMFT, GS, and resting-state functional magnetic resonance imaging (rs-fMRI) data will be obtained pre- and post-treatment. The iTBS intervention in this study protocol is expected to be a potential method to promote upper limb motor recovery after stroke, and the results may provide supportive evidence for the optimal dose of iTBS intervention.

Wearable Integrated Volitional Control Electrical Stimulation Device as Treatment for Paresis of the Upper Extremity in Early Subacute Stroke Patients: A Randomized Controlled Non-inferiority Trial

ObjectiveTo investigate the effect of a wearable integrated volitional control electrical stimulation (WIVES) device that has been developed as more compact and simpler to use in daily life compared with conventional integrated volitional control electrical stimulation (IVES) devices. DesignRandomized controlled non-inferiority trial. SettingConvalescent rehabilitation ward. ParticipantsPatients with paresis of the upper extremity (UE) after early subacute stroke (N=20). InterventionsEligible patients were randomized to receive IVES treatment or WIVES treatment for 8 hours per day for 28 days in daily living, in addition to standard rehabilitation treatment. In both groups, the extensor digitorum communis on the affected side was the target muscle for stimulation. Main Outcome MeasurePrimary outcomes were assessed with Fugl–Meyer Assessment of the UE (FMA-UE) before and after treatment. Non-inferiority was determined with a specified margin of non-inferiority. ResultsTwenty patients completed the trial (IVES group: n=10, WIVES group: n=10). FMA-UE improved in both groups. The mean change in FMA-UE was 4.7 for the IVES group and 6.0 for the WIVES group (P>.05, 95% confidence interval: −6.73 to 4.13). The mean difference between the groups was 1.3, and the upper 95% confidence interval did not exceed the non-inferiority margin. ConclusionThe effectiveness of WIVES treatment is non-inferior to that of IVES treatment. As a portable device, IVES may facilitate the use of affected upper extremities in daily living and may help improve paresis of the UE.

Do kinematic measures, added to clinical measures, better predict upper extremity motor impairments at three months post-stroke?

ObjectivePredicting post-stroke recovery through prediction models is crucial for choosing appropriate treatment options. However, the existing models predominantly incorporate clinical measures although measurement of movement quality using kinematic measures is essential for distinguishing various types of recovery. Thus, this study aimed at determining if, by considering varied aspects of recovery, adding kinematic measurements over clinical measures would better predict upper extremity (UE) motor impairments at three months post-stroke. Materials and methodsEighty-nine stroke survivors (58.9 ± 11.8 years) were assessed for clinical predictors between 4 and 7 days, kinematic predictors within 1 month, and the impairment outcome of the Fugl Meyer Assessment of the UE (FM-UE) at three months post-stroke. Significant predictors (p<0.05) with a variation inflation factor (VIF) <10 were selected for model development. After performing further step-wise selection, three models incorporating clinical outcomes, kinematic measurements, and a combination of these two, respectively, were formulated. ResultsThe clinical model (R2 = 0.70) included shoulder abduction finger extension (SAFE) scores, the National Institutes of Health Stroke Scale (NIHSS), and the Montreal Cognitive Assessment (MoCA). The kinematic model (R2 = 0.34) included total displacement, total time, and reaction time. The combined model (R2 = 0.72) comprised of SAFE score and shoulder flexion. All the models had a minimal mean squared error on cross validation, which indicated a good validity. ConclusionThe performance of clinical and combined prediction models for predicting three-month post-stroke UE motor recovery was nearly similar. However, in order to detect minimal changes over time and to understand all aspects of motor recovery, there is a need to add instrument-based kinematic measures.

Novel personalized treatment strategy for patients with chronic stroke with severe upper-extremity impairment: The first patient of the AVANCER trial

Around 25% of patients who have had a stroke suffer from severe upper-limb impairment and lack effective rehabilitation strategies. The AVANCER proof-of-concept clinical trial (NCT04448483) tackles this issue through an intensive and personalized-dosage cumulative intervention that combines multiple non-invasive neurotechnologies. The therapy consists of two sequential interventions, lasting until the patient shows no further motor improvement, for a minimum of 11 sessions each. The first phase involves a brain-computer interface governing an exoskeleton and multi-channel functional electrical stimulation enabling full upper-limb movements. The second phase adds anodal transcranial direct current stimulation of the motor cortex of the lesioned hemisphere. Clinical, electrophysiological, and neuroimaging examinations are performed before, between, and after the two interventions (T0, T1, and T2). This case report presents the results from the first patient of the study. The primary outcome (i.e., 4-point improvement in the Fugl-Meyer assessment of the upper extremity) was met in the first patient, with an increase from 6 to 11 points between T0 and T2. This improvement was paralleled by changes in motor-network structure and function. Resting-state and transcranial magnetic stimulation-evoked electroencephalography revealed brain functional changes, and magnetic resonance imaging (MRI) measures detected structural and task-related functional changes. These first results are promising, pointing to feasibility, safety, and potential efficacy of this personalized approach acting synergistically on the nervous and musculoskeletal systems. Integrating multi-modal data may provide valuable insights into underlying mechanisms driving the improvements and providing predictive information regarding treatment response and outcomes. This work was funded by the Wyss-Center for Bio and Neuro Engineering (WCP-030), the Defitech Foundation, PHRT-#2017-205, ERA-NET-NEURON (Discover), and SNSF (320030L_197899, NiBS-iCog).

The Effect of Kinesio Taping Combined with Virtual-Reality-Based Upper Extremity Training on Upper Extremity Function and Self-Esteem in Stroke Patients

(1) Background: The purpose of this study is to investigate the effect of virtual-reality-based hand motion training (VRT) in parallel with the Kinesio Taping (KT) technique on upper extremity function in stroke patients and to present a more effective therapeutic basis for virtual reality training intervention. (2) Methods: First, 43 stroke patients were randomly assigned to two groups: 21 experimental subjects and 22 controls. The experimental group performed Kinesio Taping (KT) on the dorsal part of the hand along with virtual-reality-based hand motion training, and the control group performed only virtual-reality-based hand motion training. The intervention was conducted for a total of 30 sessions over 6 weeks. To evaluate changes in upper extremity function, the Fugl–Meyer Assessment of the Upper Extremity (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL) (including amount of use (AOU) and quality of movement (QOM)) were evaluated. In addition, the Self-Efficacy Scale (SEF) was evaluated to examine the change in the self-esteem of the study subjects. (3) Results: The experimental group who participated in the virtual reality training in parallel with the KT technique showed statistically significant improvement (** p &lt; 0.01) in the FMA-UE, WMFT, and MAL evaluations that investigate changes in upper extremity function. SEF evaluation also showed a statistically significant improvement (** p &lt; 0.01). A statistically significant difference between the two groups was observed in the evaluation of FMA-UE, WMFT, MAL-QOM, and SEF († p &lt; 0.05), showing that that combined intervention was more effective at improving upper extremity function than the existing VRT intervention. There was no statistical difference between the two groups in the MAL-AOU item, which is an evaluation of upper extremity function (p &gt; 0.05). There was a statistically significant difference between the two groups in the amount of change in upper limb function (†† p &lt; 0.01). (4) Conclusions: It was confirmed that virtual-reality-based hand motion training performed in parallel with the KT technique had a positive effect on the recovery of upper extremity function of stroke patients. The fact that the KT technique provided stability to the wrist by assisting the wrist extensor muscles appears to have improved the upper extremity function more effectively than VRT alone.

Quantitative measurement of finger usage in stroke hemiplegia using ring-shaped wearable devices

BackgroundIn post-stroke rehabilitation, positive use of affected limbs in daily life is important to improve affected upper-limb function. Several studies have quantitatively evaluated the amount of upper-limb activity, but few have measured finger usage. In this study, we used a ring-shaped wearable device to measure upper-limb and finger usage simultaneously in hospitalized patients with hemiplegic stroke and investigated the association between finger usage and general clinical evaluation.MethodsTwenty patients with hemiplegic stroke in an inpatient hospital participated in this study. All patients wore a ring-shaped wearable device on both hands for 9 h on the day of the intervention, and their finger and upper-limb usage were recorded. For the rehabilitation outcome assessments, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Simple Test for Evaluating Hand Function (STEF), Action Research Arm Test (ARAT), Motor Activity Log-14 (MAL), and Functional Independence Measure Motor (FIM-m) were performed and evaluated on the same day as the intervention.ResultsFinger usage of the affected hand was moderately correlated with STEF (r=0.48, p<0.05) and STEF ratio (r=0.47, p<0.05). The finger-usage ratio was moderately correlated with FMA-UE (r=0.56, p<0.05) and ARAT (r=0.53, p<0.05), and strongly correlated with STEF (r=0.80, p<0.01) and STEF ratio (r=0.80, p<0.01). The upper-limb usage of the affected side was moderately correlated with FMA-UE (r=0.46, p<0.05), STEF (r=0.55, p<0.05) and STEF ratio (r=0.54, p<0.05), and strongly correlated with ARAT (r=0.57, p<0.01). The upper-limb usage ratio was moderately correlated with ARAT (r=0.48, p<0.05) and STEF (r=0.55, p<0.05), and strongly correlated with the STEF ratio (r=0.61, p<0.01). By contrast, there was no correlation between MAL and any of the measurements.ConclusionsThis measurement technique provided useful information that was not biased by the subjectivity of the patients and therapists.

Effects of Therapist Intervention during Upper-Extremity Robotic Rehabilitation in Patients with Stroke.

This study aimed to determine whether the treatment effect differs for patients with stroke who perform robot-assisted upper-extremity rehabilitation by themselves compared to those whose rehabilitation is actively assisted by a therapist. Stroke patients with hemiplegia were randomly divided into two groups and received robot-assisted upper-limb rehabilitation for four weeks. In the experimental group, a therapist actively intervened in the treatment, while in the control group, the therapist only observed. After four weeks of rehabilitation, the manual muscle strength, Brunnstrom stage, Fugl-Meyer assessment of the upper-extremity (FMA-UE), box and block test, and functional independence measure (FIM) showed significant improvement in both groups compared to that before treatment; however, no interval change in spasticity was noted. The post-treatment values showed that the FMA-UE and box and block tests were significantly improved in the experimental group compared to those in the control group. Comparing the changes in the pre- and post-treatment values, the FMA-UE, box and block test, and FIM of the experimental group were significantly improved compared to those in the control group. Our results suggest that active intervention by therapists during robot-assisted upper-limb rehabilitation positively impacts upper-extremity function outcomes in patients with stroke.

Effects of cortico-cortical paired associative stimulation based on multisensory integration to brain network connectivity in stroke patients: study protocol for a randomized doubled blind clinical trial

Introduction: Brain has a spontaneous recovery after stroke, reflecting the plasticity of the brain. Currently, TMS is used for studies of single-target brain region modulation, which lacks consideration of brain networks and functional connectivity. Cortico-cortical paired associative stimulation (ccPAS) promotes recovery of motor function. Multisensory effects in primary visual cortex(V1) directly influence behavior and perception, which facilitate motor functional recovery in stroke patients. Therefore, in this study, dual-targeted precise stimulation of V1 and primary motor cortex(M1) on the affected hemisphere of stroke patients will be used for cortical visuomotor multisensory integration to improve motor function.MethodThis study is a randomized, double-blind controlled clinical trial over a 14-week period. 69 stroke subjects will be enrolled and divided into sham stimulation group, ccPAS low frequency group, and ccPAS high frequency group. All groups will receive conventional rehabilitation. The intervention lasted for two weeks, five times a week. Assessments will be performed before the intervention, at the end of the intervention, and followed up at 6 and 14 weeks. The primary assessment indicator is the ‘Fugl-Meyer Assessment of the Upper Extremity ’, secondary outcomes were ‘The line bisection test’, ‘Modified Taylor Complex Figure’, ‘NIHSS’ and neuroimaging assessments. All adverse events will be recorded.DiscussionCurrently, ccPAS is used for the modulation of neural circuits. Based on spike-timing dependent plasticity theory, we can precisely intervene in the connections between different cortices to promote the recovery of functional connectivity on damaged brain networks after stroke. We hope to achieve the modulation of cortical visuomotor interaction by combining ccPAS with the concept of multisensory integration. We will further analyze the correlation between analyzing visual and motor circuits and explore the alteration of neuroplasticity by the interactions between different brain networks. This study will provide us with a new clinical treatment strategy to achieve precise rehabilitation for patient with motor dysfunction after stroke.Trial registrationThis trial was registered in the Chinese Clinical Trial Registry with code ChiCTR2300067422 and was approved on January 16, 2023.

The effect of training using an upper limb rehabilitation robot (HEXO-UR30A) in chronic stroke patients: A randomized controlled trial.

Upper limb robotic rehabilitation can be beneficial to the patients when applied appropriately. HEXO-UR30A is a novel exoskeletal type upper limb rehabilitation robot that provides continuous passive motion to the shoulder joint. The purpose of this study is to evaluate the effectiveness of HEXO-UR30A on the patient's functional change, spasticity, and range of motion (ROM). We included stroke patients with upper limb hemiparesis of age > 19 years with spasticity grading of modified Ashworth scale < 3 and Brunnstrom recovery stage ≥ 4. The efficacy of the robot was investigated based on a rehabilitation program for 3 weeks. Patient's functions were compared before vs after treatment and between the HEXO group vs control. We conducted the Fugl-Meyer Assessment of the Upper Extremity, modified Barthel index, modified Ashworth scale, ROM, and Motricity Index upper limb. Patients' satisfaction was evaluated using a questionnaire after every 10 sessions of training. In the HEXO group, the Fugl-Meyer assessment for shoulder improved significantly (P value = .006*) compared with the control group (P value = .075). Both groups showed significant improvement (P value < .05) in Motricity Index upper limb after treatment. There were some improvements in the passive and active ROM. Patients in the HEXO group reported high satisfaction with upper limb rehabilitation. These results show that HEXO-UR30A can improve functional ability in chronic stroke patients. Moreover, the high satisfaction in patients might promote active involvement in upper limb rehabilitation.

Robot-Assisted Bimanual Training Improves Hand Function in Patients With Subacute Stroke: A Randomized Controlled Pilot Study.

Study DesignA randomized controlled pilot study.BackgroundBimanual therapy (BMT) is an effective neurorehabilitation therapy for the upper limb, but its application to the distal upper limb is limited due to methodological difficulties. Therefore, we applied an exoskeleton hand to perform robot-assisted task-oriented bimanual training (RBMT) in patients with stroke.ObjectiveTo characterize the effectiveness of RBMT in patients with hemiplegic stroke with upper limb motor impairment.InterventionsA total of 19 patients with subacute stroke (1–6 months from onset) were randomized and allocated to RBMT and conventional therapy (CT) groups. The RBMT and CT groups received 90 min of training/day (RBMT: 60 min RBMT + 30 min CT; CT: 60 min CT for hand functional training + 30 min regular CT), 5 days/week, for 4 weeks (20 sessions during the experimental period).AssessmentsClinical assessments, including the Fugl–Meyer assessment of the upper extremity (FMA-UE), action research arm test (ARAT), and wolf motor arm function test (WMFT), were conducted before and after the intervention.ResultsWithin-group analysis showed a significant improvement in the FMA-UE and WMFT in both the CT and RBMT groups. A significant improvement in the Fugl–Meyer assessment (FMA) of the wrist and hand for the distal part in the RBMT group occurred earlier than that in the CT group. A significant improvement in WMFT time was found in both groups, but the WMFT functional ability assessment was only found in the RBMT group. No significant improvements in ARAT assessment were observed in either the CT or RBMT groups. Compared with CT, significant improvements were found in terms of the proportion of minimally clinically important differences after RBMT in FMA-UE (χ2 = 4.34, p = 0.037). No adverse events were reported by any of the participants across all sessions.ConclusionsThis study is the first to apply RBMT to the distal part of the upper limb. Both RBMT and CT are effective in improving the upper limb function in patients with subacute stroke. RBMT shows superior potential efficacy in facilitating recovery of the distal part of upper extremity (UE) motor function in the early stage. Future randomized control studies with a large sample size and follow-up assessments are needed to validate the present conclusions.

Structural validity and internal consistency of a hypothesized factor structure of the Fugl-Meyer Assessment of the upper extremity

ABSTRACT Background Many studies have confirmed the psychometric properties of Fugl–Meyer Assessment of the upper extremity (FMA-UE). Although several modified versions of the FMA-UE form exist, their structural validity has not been fully established. Objectives To assess the structural validity and internal consistency of the original, short, and hypothesized FMA-UE forms. Methods In this cross-sectional, multicenter, observational study, the factor structure was assessed using confirmatory factor analysis (CFA) to evaluate the adequate model of each hypothetical FMA-UE form (original, 30-item, 27-item, and 6-item forms). The internal consistency of each FMA-UE form and subscale was assessed using Cronbach’s alpha after factor structure evaluation. Results We recruited 363 patients with first-episode stroke (median age = 70.0, median days = 75.0). The results of the original form models were not estimated by CFA. Of all FMA-UE forms, the 30-item form lacked three reflex items (4-factor, 30-item model) and the 27-item form lacked three reflex and three coordination items (3-factor, 27-item, second-order model); these forms demonstrated an adequate model fitness (root mean square error of approximation = 0.056/0.059, comparative fit index = 0.995/0.996, Tucker–Lewis index = 0.995/0.995). The 6-item form demonstrated a poor model fit. All FMA-UE forms and subscales showed a high internal consistency (Cronbach’s alpha>0.91). Conclusions Both 30- and 27-item FMA-UE forms showed a good factor structure; therefore, these forms are eligible for use in clinical practice. However, future studies should define the factor structure of the 6-item form.

Cortical Oxygenation during a Motor Task to Evaluate Recovery in Subacute Stroke Patients: A Study with Near-Infrared Spectroscopy.

In subacute stroke patients we studied cortical oxygenation changes by near-infrared spectroscopy (NIRS) during a motor task performed with the hemiparetic arm (15 s of reaching and grasping, 45 s of rest, repeated 6 times). Twenty-three subjects were included at baseline, compared with six healthy subjects, and restudied after 6 weeks of rehabilitation. Motor/premotor cortical changes in oxyhemoglobin detected by NIRS were quantified as the area under the curve (AUC) for the total cortex (TOT-AUC) and for both affected (AFF-AUC) and unaffected hemispheres (UN-AUC). The ratio between AUC and the number of task repetitions performed identified the cortical metabolic cost (CMC) or the oxygenation increase for a single movement. Fugl–Meyer assessment of the upper extremity (FMA-UE) was also performed. At baseline, both total and hemispheric CMC were significantly higher in stroke patients than in healthy subjects and inversely correlated with FMA-UE. After rehabilitation, changes in total-CMC and unaffected-CMC, but not Affected-CMC, were inversely correlated with variations in the FMA-UE score. A value > 5000 a.u. for the ratio baseline TOT-CMC/days since stroke was associated with not reaching the clinically important difference for FMA-UE after rehabilitation. In subacute stroke the CMC, a biomarker assessed by NIRS during a motor task with the hemiparetic arm, may describe cortical time/treatment reorganization and favor patient selection for rehabilitation.

Changes in motor paralysis involving upper extremities of outpatient chronic stroke patients from temporary rehabilitation interruption due to spread of COVID-19 infection: An observational study on pre- and post-survey data without a control group.

Outpatient rehabilitation was temporarily suspended because of coronavirus disease (COVID-19), and there was a risk that patients' activities of daily living (ADLs) would decrease and physical functions unmaintained. Therefore, we investigated the ADLs and motor functions of chronic stroke patients whose outpatient rehabilitation was temporarily interrupted. In this observational study, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and Barthel Index (BI) scores of 49 stroke hemiplegic patients at 6 and 3 months before rehabilitation interruptions were retrospectively determined and were prospectively investigated on resumption of outpatient rehabilitation. Presence or absence of symptoms and difficulties caused by the interruption period (IP) was investigated using a binomial method. Deltas were analyzed using a generalized linear model (GLM) according to the survey period. Age, sex, severity of FMA-UE immediately post-resumption and post-onset period were used as covariates. For survey items showing significant model fit, the 95% confidence interval of minimum detectable change (MDC95) was calculated, and the amount of change was compared. Questionnaire responses were tested via proportion ratio. Statistical significance was set at 5%. The FMA-UE part A and total scores were significantly model fit depending on periods. The estimated FMA-UE total score decreased by 1.64 (z = -2.38, p = 0.02) during the 3-month IP. No fits were observed by GLM in other parts of the FMA-UE, ARAT, or BI. The calculated MDC95 was 3.58 for FMA-UE part A and 4.50 for FMA-UE overall. Answers to questions regarding sleep disturbance and physical pain were significantly biased toward "no" in the psychosomatic function items (p<0.05). There was no bias in the distribution of answers to questions regarding joint stiffness, muscle weakness, muscle stiffness, and difficulty in moving arms and hands. All 16 questions regarding activities and participation items were significantly biased toward answers "no" (p<0.05). The FMA-UE part A and total scores were affected. Patients complained of subjective symptoms related to upper limb paralysis after the IP. Since ADLs of patients were maintained, the therapist can recommend that patients not receiving outpatient treatments be evaluated in relation to the shoulder, elbow, and forearm and instructed on self-training to maintain motor function.

Effectiveness of mirror therapy on upper limb function, activities of daily living, and depression in post-stroke depression patients.

Objectives This study aims to investigate the effects of mirror therapy (MT) on upper limb function, activities of daily living (ADLs), and depression in post-stroke depression patients. Patients and methods Between November 2018 and December 2019, a total of 60 post-stroke patients (33 males, 27 females; mean age: 58.45±11.13 years; range, 35 to 88 years) were included. The patients were randomly divided into either the cosntrol group (n=30) or the MT group (n=30). Regular occupational therapy was provided for the control group (two times per day for 30 min per session, five times per week over four weeks). Occupational therapy and MT were used to treat patients in the mirror group (one 30 min session once per day, five times per week over four weeks). Motor function (Fugl-Meyer Assessment of the Upper Extremity, FMA-UE), ADL (Modified Barthel Index, MBI) and depression (17-item Hamilton Depression Scale, HAMD-17) were used to evaluate the treatment outcomes. Results Before treatment, the mean HAMD-17, FMA-UE, and MBI scores showed no significant difference between the two groups (p>0.05). After treatment, the mirror group exhibited more significant improvements than the control group in terms of the mean HAMD-17, FM-UE, and MBI (p<0.05). After four weeks, the mean FMA-UE and MBI scores revealed more significant improvements than the baseline scores in the control group (p<0.01). The mean HAMD-17, FMA-UE, and MBI scores showed more significant improvements than the baseline scores in the MT group (p<0.001). Conclusion Based on these results, MT can effectively improve motor function, ADLs, and depression in post-stroke depression patients. The curative effectiveness of MT seems to be more prominent than the regular occupational therapy.

Dimensionality and item-difficulty hierarchy of the Fugl-Meyer assessment of the upper extremity among Japanese patients who have experienced stroke

ABSTRACT Background The Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) has been used in many clinical studies and in stroke rehabilitation. In studies evaluating psychometric properties, confirmatory factor analysis (CFA) indicated that the FMA-UE is a multidimensional tool. Item Response Theory One-Parameter Logistic (IRT1PL) supports that item-difficulty hierarchy can be used as a treatment index of upper extremity function for stroke recovery. However, studies on the psychometric properties of the FMA-UE in Asian populations are lacking. Objectives To investigate the dimensionality and item-difficulty hierarchy of the FMA-UE for stroke rehabilitation in Japanese patients. Methods This was a cross-sectional study. The participants comprised 268 individuals admitted for de novo stroke (median age, 70.0 years; median days since stroke onset, 78.5) in 22 hospitals in Japan. The dimensionality of the FMA-UE was evaluated using CFA of selected items. The item-difficulty hierarchy of the FMA-UE using the appropriately selected model was demonstrated using IRT1PL analysis after confirming dimensionality. Results Two reflex items were removed by utilizing the floor and ceiling effects. The 31- and 30-item FMA-UE exhibited a good model fit of the unidimensionality in the CFA. The 30-item FMA-UE was found to be a good model by model comparison (the 31-item vs. the 30-item). The item-difficulty hierarchy of the 30-item FMA-UE was found not to be consistent with the expected item order. Conclusions This study provides evidence that the FMA-UE has multidimensionality and the 30-item FMA-UE is a valid instrument for measuring upper-extremity impairment after stroke.

EEG-controlled functional electrical stimulation rehabilitation for chronic stroke: system design and clinical application.

Stroke is one of the most serious diseases that threaten human life and health. It is a major cause of death and disability in the clinic. New strategies for motor rehabilitation after stroke are undergoing exploration. We aimed to develop a novel artificial neural rehabilitation system, which integrates brain-computer interface (BCI) and functional electrical stimulation (FES) technologies, for limb motor function recovery after stroke. We conducted clinical trials (including controlled trials) in 32 patients with chronic stroke. Patients were randomly divided into the BCI-FES group and the neuromuscular electrical stimulation (NMES) group. The changes in outcome measures during intervention were compared between groups, and the trends of ERD values based on EEG were analyzed for BCI-FES group. Results showed that the increase in Fugl Meyer Assessment of the Upper Extremity (FMA-UE) and Kendall Manual Muscle Testing (Kendall MMT) scores of the BCI-FES group was significantly higher than that in the sham group, which indicated the practicality and superiority of the BCI-FES system in clinical practice. The change in the laterality coefficient (LC) values based on μ-ERD (ΔLCm-ERD) had high significant positive correlation with the change in FMA-UE(r = 0.6093, P = 0.012), which provides theoretical basis for exploring novel objective evaluation methods.