Fugl-Meyer Assessment Of Upper Extremity Research Articles

EEG Responses to Upper Limb Pinprick Stimulation in Acute and Early Subacute Motor and Sensorimotor Stroke: A Proof of Concept.

Electroencephalogram (EEG) during pinprick stimulation has the potential to unveil neural mechanisms underlying sensorimotor impairments post-stroke. A proof-of-concept study explored event-related peak pinprick amplitude and oscillatory responses in healthy controls and in people with acute and subuacutemotor and sensorimotor stroke, their relationship, and to what extent EEG somatosensory responses can predict sensorimotor impairment. In this study, 26 individuals participated, 10 people with an acute and early subacute sensorimotor stroke, 6 people with an acute and early subacute motor stroke, and 10 age-matched controls. Pinpricks were applied to the dorsa of the impaired hand to collect somatosensory evoked potentials. Time(-frequency) analyses of somatosensory evoked potential (SEP) data at electrodes C3 and C4 explored peak pinprick amplitude and oscillatory responses across the three groups. Also, in stroke, (sensori-)motor impairments were assessed with the Fugl Meyer Assessment Upper Extremity (FMA) and Erasmus modified Nottingham Sensory Assessment (EmNSA) at baseline and 7 to 14days later. Mixed model analyses were used to address objectives. It was demonstrated that increased beta desynchronization magnitude correlated with milder motor impairments (R2adjusted = 0.213), whereas increased beta resynchronization and delta power were associated to milder somatosensory impairment (R2adjusted = 0.550). At the second session, larger peak-to-peak SEP amplitude and beta band resynchronization at baseline were related to greater improvements in EMNSA and FMA scores, respectively, in the sensorimotor stroke group. These findings highlight the potential of EEG combined with somatosensory stimuli to differentiate between sensorimotor and motor impairments in stroke, offering preliminary insights into both diagnostic and prognostic aspects of upper limb recovery.

Synergy-based motor therapy for post-stroke hemiparetic subjects: A randomized controlled trial

Objectives: Motor recovery is inclusively based on the severity of abnormal coupling or the abnormal synergistic actions among the post-stroke hemiparetic subjects. The normal synergistic pattern shall be incorporated to inhibit the abnormal synergistic behavior to attain motor control. Materials and Methods: A randomized controlled double blinded (assessor and subjects) trial was conducted in a rehabilitation institute. One hundred and thirty-six post-stroke (mean duration, 12.73 ± 9.52 months) hemiparetic subjects were conveniently selected and randomly allocated in two groups (experimental, 68 and control, 68). The experimental group received synergistic-based motor therapy (SBMT) protocol and the control group of the subjects received the conventional occupational therapy intervention. Both of the groups received dose-matched intervention for the period of 3 months, 48 sessions (4/week). Normal synergistic linkage was being exploited to encounter the abnormal synergistic patterns. The main outcome measures were Fugl-Meyer Assessment – upper extremity (FMA-UE), arm (FMA-A), wrist-hand (FMA-WH) for the motor recovery and Finger Breadth Palpation method (FBP) for the shoulder subluxation. Results: In comparison to the control group, the experimental group exhibited highly significant results. The mean score of FMA-UE was changed to 41.32 ± 11.50 from the pre-intervention score of 25.76 ± 15.26 (P < 0.001). Post-intervention, the mean score of FMA-A was increased to 26.89 ± 0.93 from 17.36 ± 1.21 (P < 0.001). The pre-assessment score of FMA-WH was 8.29 ± 0.96 and post-intervention, it was increased to 14.13 ± 0.88 (P < 0.001). The experimental group of subjects was recorded to have a reduction in the shoulder subluxation. The grade of FBP reduced to 0.39 ± 0.11 from the pre-intervention score of 1.23 ± 0.13 (P < 0.001). Conclusion: SBMT was concluded to be superior and highly significant than the conventional intervention for enhancing upper limb motor recovery among post-stroke hemiparetic subjects. Further, the grade of shoulder subluxation was also found to be significantly reduced among the SBMT group participants in comparison to the control subjects.

Myoelectric pattern recognition with virtual reality and serious gaming improves upper limb function in chronic stroke: a single case experimental design study

BackgroundMyoelectric pattern recognition (MPR) combines multiple surface electromyography channels with a machine learning algorithm to decode motor intention with an aim to enhance upper limb function after stroke. This study aims to determine the feasibility and preliminary effectiveness of a novel intervention combining MPR, virtual reality (VR), and serious gaming to improve upper limb function in people with chronic stroke.MethodsIn this single case experimental A-B-A design study, six individuals with chronic stroke and moderate to severe upper limb impairment completed 18, 2 h sessions, 3 times a week. Repeated assessments were performed using the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), grip strength, and kinematics of the drinking task at baseline, during, and post intervention. The results were analyzed by using visual analysis and Tau-U statistics.ResultsAll participants improved upper limb function assessed by FMA-UE (Tau-U 0.72–1.0), and five out of six improved beyond the minimal clinical important difference (MCID). Four participants improved ARAT and grip strength scores (Tau-U 0.84–1.0), with one reaching the MCID for ARAT. Three out of four participants in the kinematic analysis achieved improvements beyond the MCID in movement time and smoothness, two with a Tau-U > 0.90, and two participants improved trunk displacement beyond the MCID (Tau-U 0.68). Most participants showed some deterioration in the follow-up phase.ConclusionsMPR combined with VR and serious gaming is a feasible and promising intervention for improving upper limb function in people with chronic stroke.Trial Registration: ClinicalTrials.gov, reference number NCT04154371.

Transcutaneous electrical acupoint stimulation for upper limb spasticity after stroke: effect andd feasibility—a randomised pilot study

ImportanceLimb spasticity is a common issue among stroke patients. Transcutaneous electrical acupoint stimulation (TEAS) is recommended as an alternative therapy for managing upper limb spasticity after stroke; however, its potential...

Prediction of clinical efficacy of acupuncture intervention on upper limb dysfunction after ischemic stroke based on machine learning: a study driven by DSA diagnostic reports data.

To develop a machine learning-based model for predicting the clinical efficacy of acupuncture intervention in patients with upper limb dysfunction following ischemic stroke, and to assess its potential role in guiding clinical practice. Data from 1,375 ischemic stroke patients with upper limb dysfunction were collected from two hospitals, including medical records and Digital Subtraction Angiography (DSA) reports. All patients received standardized acupuncture treatment. After screening, 616 datasets were selected for analysis. A prediction model was developed using the AutoGluon framework, with three outcome measures as endpoints: the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), and the Modified Barthel Index (MBI). The prediction model demonstrated high accuracy for the three endpoints, with prediction accuracies of 84.3% for NIHSS, 77.8% for FMA-UE, and 88.1% for MBI. Feature importance analysis identified the M1 segment of the Middle Cerebral Artery (MCA), the origin of the Internal Carotid Artery (ICA), and the C1 segment of the ICA as the most critical factors influencing the model's predictions. Notably, the MBI emerged as the most sensitive outcome measure for evaluating patient response to acupuncture treatment. Additionally, secondary analysis revealed that the number of sites with cerebral vascular stenosis (specifically 1 and 3 sites) had a significant impact on the final model's predictions. This study highlights the M1 segment, the origin of the ICA, and the C1 segment as key stenotic sites affecting acupuncture treatment efficacy in stroke patients with upper limb dysfunction. The MBI was found to be the most responsive outcome measure for evaluating treatment sensitivity in this cohort.

The Effect of Home-Based Robotic Rehabilitation on Individuals with Disabilities in Community Settings: A Pilot Study.

Background: With South Korea's growing aging population, the demand for accessible rehabilitation solutions is increasing. Home-based robotic rehabilitation presents a feasible alternative to conventional in-clinic rehabilitation. This study explores the impact of the Rebless robotic rehabilitation device in a home-based setting for people with physical disabilities and their caregivers. Methods: We prospectively collected data from individuals with brain disorders or physical disabilities living in Dongdaemun-gu, from August 2023 to March 2024. Participants completed an 8-week rehabilitation program using the Rebless robotic device. Assessments were conducted at baseline and after the eight-week program, measuring motor function, caregiver burden, and quality of life. Exercises were performed three times weekly for at least 90 min total. Results: We conducted an intervention with 26 adults with physical or neurological disabilities, of which 20 completed the program. Significant improvements were observed in upper limb function within the elbow exercise group (Fugl-Meyer assessment for upper extremity, p = 0.043) and a reduction in caregiver burden across the total groups (Zarit Burden Interview, p = 0.003). However, no statistically significant changes were found in balance and mobility measures (Berg balance scale, timed up-and-go, 10 m walk test). Conclusions: Home-based robotic rehabilitation demonstrates potential for improving upper limb function and reducing caregiver burden and mental health, proving beneficial to both patients and caregivers.

Upper-extremity motor recovery after stroke: A systematic review and meta-analysis of usual care in trials and observational studies.

A better knowledge of upper-extremity (UE) recovery in patients with stroke receiving usual care (UC) is crucial for informing clinicians on expected recovery and serves as reference for future studies. This systematic review and meta-analysis aimed to assess rate and amount of recovery of UE with UC in the subacute phase of stroke and identify covariates of UE recovery. PRISMA-guidelines were used for search in PubMed, Cinahl and PEDro. Observational studies (OS) and UC groups of randomized control trials (RCT) of adults with subacute stroke and UE paresis were included, each reporting UE function at least at two time points. Placebo-, sham-controlled, dose-matched trials and trials with <10 participants were excluded. From 1220 records, 54 papers (19 OS and 35 RCTs) involving 2774 subacute stroke patients were included. Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) were most frequently reported UE outcomes. Across RCTs, FMA-UE and ARAT improved 10 and 8 points, respectively, on average at 4-weeks from baseline. In OS, FMA-UE, improved 12 points at 12weeks and 16 points at 24weeks from baseline. Stroke severity, UE function, and lesion load of the cortico-spinal tract at baseline were associated with UE recovery. UE function in subacute stroke showed improvements that exceeded the threshold for clinically important change across RCTs and OS. This review provides estimates of expected change in UC groups for sample size calculations and planning of future trials, thereby enhancing statistical power and comparability of findings.

Effects of a Wearable-Based Intervention on the Hemiparetic Upper Limb in Persons With Stroke: A Randomized Controlled Trial

Introduction Wearables have emerged as a transformative rehabilitation tool to provide self-directed training in the home. Objective. In this study, we examined the efficacy of a novel wearable device, “Smart Reminder” (SR), to provide home-based telerehabilitation for hemiparetic upper limb (UL) training in persons with stroke. Methods Forty stroke survivors from community support groups were randomized (stratified by the period after stroke onset and impairment severity) to either the SR group or the sham device group. Participants received either 20 hours of telerehabilitation using the SR device or training with pictorial handouts and a sham device over 4 weeks. In addition, all participants wore a standard accelerometer for 3 hours each day, 5 times a week, outside the prescribed training. Participants were assessed by a masked assessor at baseline, post-intervention (week 4), and follow-up (week 8). The outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test, Motor Activity Log, muscle strength, active range of motion and amount of movement of the UL, and compliance rate of training. Results The SR group improved substantially in their FMA-UE scores after treatment (mean difference = 2.05, P = .036) compared to the sham group. Also, adherence to the training using the SR device was significantly higher, 97%, than the sham group, 82.3% (P = .038). Conclusion The 4-week telerehabilitation program using a “SR” device demonstrated potential efficacy in improving FMA-UE scores of the hemiparetic upper limb. However, it did not significantly enhance the performance of the affected limb in daily activities. The trial was registered on ClinicalTrial.gov (URL: http://www.clinicaltrials.gov) with the identifier NCT05877183.

A case series on combining repetitive transcranial magnetic stimulation with conventional rehabilitation therapies for upper limb motor-function restoration

This case series reports the integration of repetitive transcranial magnetic stimulation (rTMS) with conventional rehabilitation therapies in three early subacute ischemic stroke patients with upper limb motor impairment. In Malaysia, data on the combination of rTMS with intensive rehabilitation for stroke patients remains limited. The three patients with completely paretic upper limb, began therapy on post-stroke day 20, 16, and 15, respectively. They received rTMS sessions with inhibitory protocols targeting the contralesional primary motor area (M1) at 1 Hz, 5 days per week for 2 weeks (10 sessions). Each session included 1800 pulses at 120% resting motor threshold for 40 minutes, followed by 60 minutes of upper limb motor-function training. Outpatient occupational therapy was then continued for 3 months. All patients showed neurological and functional recovery as measured by the Medical Research Council scale and Fugl-Meyer Assessment-Upper Extremity Motor. The gains were observed immediately after the 10 rTMS sessions and persisted at 3 months post-stroke. Furthermore, all patients also achieved total independence in daily activities, with Modified Barthel Index scores of 99-100. No serious adverse events were reported. This case series suggests that combining rTMS with conventional rehabilitation therapies during the early subacute phase may enhance upper limb motor function recovery in stroke patients.

A Randomized Controlled Trial to Test the Effects of Repetitive Peripheral Magnetic Stimulation Versus Neuromuscular Electrical Stimulation in Patients with Spastic Hemiparesis After Stroke (REPMAST): Study Protocol.

Innovative therapies are needed to reduce disability, facilitate activities of daily living, and improve the quality of life in patients with stroke. Non-invasive methods of stimulating the peripheral and central nervous system are increasingly being used to enhance the effects of existing therapies in stroke rehabilitation. One potentially relevant method for achieving greater improvement is repetitive peripheral magnetic stimulation (rPMS). This randomized controlled trial (RCT), the Peripheral MAgnetic stimulation in patients with spastic hemiparesis after Stroke Trial (REPMAST), will investigate whether rPMS improves upper extremity function, spasticity, and activities of daily living in patients with stroke compared with neuromuscular stimulation (NMS). REPMAST is an interventional, randomized controlled single-blinded study. Patients with subacute stroke are randomized to receive rPMS or NMS five days a week for three weeks in addition to standard rehabilitation therapy. The primary outcome is the change in the Fugl-Meyer Assessment for Upper Extremity between the beginning and end of the stimulation sessions. Secondary outcomes include changes in the Katz Index of Independence in Activities of Daily Living, the Timed Up and Go Test, the Modified Ashworth Scale, and the Tardieu Scale. A total sample size of 138 patients (69 in each group) is required to investigate the superiority of rPMS compared with NMS. The aim of this RCT is to provide evidence for an effective peripheral stimulation treatment for stroke recovery.

Three-dimensional kinematic analysis can improve the efficacy of acupoint selection for post-stroke patients with upper limb spastic paresis: A randomized controlled trial.

China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis (PSSP-UL). Although acupuncture is known to be effective for PSSP-UL, there is room to enhance its efficacy. This study explored a semi-personalized acupuncture approach for PSSP-UL that used three-dimensional kinematic analysis (3DKA) results to select additional acupoints, and investigated the feasibility, efficacy and safety of this approach. This single-blind, single-center, randomized, controlled trial involved 74 participants who experienced a first-ever ischemic or hemorrhagic stroke with spastic upper limb paresis. The participants were then randomly assigned to the intervention group or the control group in a 1:1 ratio. Both groups received conventional treatments and acupuncture treatment 5days a week for 4weeks. The main acupoints in both groups were the same, while participants in the intervention group received additional acupoints selected on the basis of 3DKA results. Follow-up assessments were conducted for 8 weeks after the treatment. The primary outcome was the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) response rate (≥ 6-point change) at week 4. Secondary outcomes included changes in motor function (FMA-UE), Brunnstrom recovery stage (BRS), manual muscle test (MMT), spasticity (Modified Ashworth Scale, MAS), and activities of daily life (Modified Barthel Index, MBI) at week 4 and week 12. Sixty-four participants completed the trial and underwent analyses. Compared with control group, the intervention group exhibited a significantly higher FMA-UE response rate at week 4 (χ2=5.479, P = 0.019) and greater improvements in FMA-UE at both week 4 and week 12 (both P < 0.001). The intervention group also showed bigger improvements from baseline in the MMT grades for shoulder adduction and elbow flexion at weeks 4 and 12 as well as thumb adduction at week 4 (P=0.007, P=0.049, P=0.019, P=0.008, P=0.029, respectively). The intervention group showed a better change in the MBI at both week 4 and week 12 (P=0.004 and P=0.010, respectively). Although the intervention group had a higher BRS for the hand at week 12 (P = 0.041), no intergroup differences were observed at week 4 (all P>0.05). The two groups showed no differences in MAS grades as well as in BRS for the arm at weeks 4 and 12 (all P>0.05). Semi-personalized acupuncture prescription based on 3DKA results significantly improved motor function, muscle strength, and activities of daily living in patients with PSSP-UL. Chinese Clinical Trial Registry ChiCTR2200056216. Please cite this article as: Huang XY, Liao OP, Jiang SY, Tao JM, Li Y, Lu XY, Li YY, Wang C, Li J, Ma XP. Three-dimensional kinematic analysis can improve the efficacy of acupoint selection for post-stroke patients with upper limb spastic paresis: A randomized controlled trial. J Integr Med. 2024; Epub ahead of print.

Efficacy of anodal transcranial direct current stimulation for upper extremity function after ischemic stroke: A systematic review of parallel randomized clinical trials

BackgroundAlthough existing studies had shown therapeutic effects of transcranial direct current stimulation (tDCS) on upper limb dysfunction after stroke, previous systematic reviews had mostly provided general analyses on the polarity of tDCS and the type of stroke, with inconsistent results. We aimed to determine the efficacy of anodal transcranial direct current stimulation in enhancing upper extremity function following ischemic stroke. MethodsA comprehensive search was conducted across a variety of databases, spanning from their inception to March 15th, 2024.The focus was on parallel randomized clinical trials published that explored the impact of anodal transcranial direct current stimulation on upper extremity function in ischemic stroke patients. Data extraction and quality assessment were conducted independently by two reviewers. The Cochrane Risk of Bias Tool was utilized to assess the risk of bias in the included studies. ResultsA total of 19 studies involving 1032 participants were included in the analysis. The pooled results of these studies indicated that anodal transcranial direct current stimulation had a positive impact on the Fugl-Meyer Assessment Upper Extremity, Wolf Motor Function Test, Resting Motion Threshold, and Barthel Index Score in ischemic stroke patients with upper extremity dysfunction. Follow-up data suggested the potential long-term efficacy of anodal transcranial direct current stimulation in ischemic stroke. Reported adverse reactions indicated that anodal transcranial direct current stimulation was relatively safe for stroke patients. ConclusionsAnodal transcranial direct current stimulation is an effective intervention and relatively safe and effective intervention for improving upper extremity function in ischemic stroke patients.

The effect of trunk control on sitting balance and upper extremity functions in patients with subacute stroke.

Impairment of trunk control is a common problem after stroke, and trunk impairment may affect many functions such as breathing, speech, limb movements and transfers. The present study was aimed to investigate the effect of trunk control on sitting balance and upper extremity functions in individuals with subacute stroke. A total of 30 patients with subacute stroke (14 female, 16 male) were included in this study. The mean age of the included patients was 59.80 ± 13.22 years, and the mean disease duration was 2.90 ± 1.38 months. Trunk Impairment Scale (TIS), Trunk Control Test (TCT), Function in Sitting Test (FIST), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Brunnstrom Recovery Stages of Arm (BRS-A) and Brunnstrom Recovery Stages of Hand (BRS-H) were performed to the patients. The results of our study showed that there was a strong positive correlation was found between TIS and FIST (r = 0.765, p < 0.001). There was also a positive moderate correlation between TCT and FIST, FMA-UE, BRS-A and BRS-H (r = 0.67, r = 0.49, r = 0.49, r = 0.44; p < 0.05; respectively). There was a positive moderate correlation between TIS and FMA-UE, BRS-A and BRS-H (r = 0.67, r = 0.65 and r = 0.58; p < 0.005; respectively). In conclusion, trunk control has been shown to be a factor associated with sitting balance and upper extremity function in patients with subacute stroke.

Efficacy of manual lymphatic drainage combined with repetitive transcranial magnetic stimulation in post-stroke complex regional pain syndrome: a pilot study

Purpose The aim of this study was to investigate the efficacy of manual lymphatic drainage (MLD) combined with repetitive transcranial magnetic stimulation (rTMS) on the recovery of upper limb in patients with post-stroke complex regional pain syndrome (CRPS). Methods This pilot study was conducted with 54 patients with post-stroke CRPS. Patients were randomized into three groups: the MLD combined with rTMS group (MLD + rTMS group), the rTMS group and the sham-rTMS group. The results of numeric rating scale (NRS), volumetric measurement, Fugl-Meyer assessment of upper extremity (FMA-UE), CRPS severity score (CSS), generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) before and after the intervention were analyzed. Results Fifty-four participants (37 males, 17 females; mean age 66.11 ± 8.43 years; range, 18 to 85) were included in the study. Among groups, improvements were statistically significant with superiority of rTMS + MLD group after treatment (p < 0.05). NRS, GAD-7, and PHQ-9 in the rTMS + MLD group improved more significantly than those in the rTMS group (p < 0.05). Conclusion MLD combined with rTMS has an add-on efficacy on the basis of rTMS therapy in post-stroke patients, especially in pain. MLD could also have an effect on anxiety and depression.

Robot-mediated impairment-oriented and task-specific training on upper limb post stroke: feasibility and preliminary effects on physical function and quality of life.

To assess the feasibility and safety of conducting robot-mediated impairment training (RMIT) and robot-mediated task-specific training (RMTT). The device deployed is the Optimo Regen (OR®), capable of delivering both impairment-oriented training and task-specific training. This was a single-centre, randomized, single-blinded, two-arm, parallel group, controlled trial. Patients fulfilling criteria were randomized into either the RMIT or RMIT + RMTT group and provided with 20 h of robotic therapy on top of standard care. A total of 4 patients were recruited, with 2 patients receiving treatment in each arm. The study was feasible, with a 66.7% enrolment rate, 75% completion rate, and 100% attendance for each intervention session. We achieved a 90% satisfaction rate with no serious adverse effects. All patients had improvement of motor power, Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Functional Independence Measure (FIM), Hospital Anxiety and Depression Scale (HADS), and quality of life scores at 1 month. FIM continued to improve at 3 months post-commencement of intervention. There was relative ease of use of the device. This trial is feasible. A full-scale study is warranted, to compare RMIT against RMTT, which is a novel application.

Effect of intermittent theta burst stimulation on upper limb function in stroke patients: a systematic review and meta-analysis.

Stroke is a serious health issue that affects individuals, families, and society. Particularly, the upper limb dysfunction caused by stroke significantly reduces the quality of life for patients and may lead to psychological issues. Current treatment modalities are not fully effective in helping patients regain upper limb motor function to optimal levels. Therefore, there is an urgent need to explore new rehabilitation methods to address this issue. The purpose of this meta-analysis and systematic review is to explore the effects of intermittent theta burst stimulation (iTBS) on upper limb function in stroke patients. We searched PubMed, Cochrane Library, Embase, Web of Science, PEDro and China National Knowledge Internet as of April 8, 2024. Retrieved a total of 100 articles. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated. The study included a total of 9 trials and involved 224 patients. The results demonstrate that compared to the control group, iTBS therapy significantly improved Fugl-Meyer assessment-upper extremity (FMA-UE) scores (SMD = 0.88; 95% CI = 0.11-1.66; P = 0.03, I 2 = 84%), Action Research Arm Test (ARAT) scores (SMD = 0.83; 95% CI = 0.16-1.50; P = 0.02, I 2 = 57%), and Barthel Index (BI) scores (SMD = 0.93; 95% CI = 0.53-1.32; P < 0.0001, I 2 = 0%) in stroke patients. The comprehensive evidence suggests that iTBS has superior effects in improving upper limb function and activities of daily living in stroke patients.

Modeling Upper Limb Rehabilitation-Induced Recovery after Stroke: The Role of Attention as a Clinical Confounder.

People who have survived stroke may have motor and cognitive impairments. High dose of motor rehabilitation was found to provide clinically relevant improvement to upper limb (UL) motor function. Besides, mounting evidence suggests that clinical, neural, and neurophysiological features are associated with spontaneous recovery. However, the association between these features and rehabilitation-induced, rather than spontaneous, recovery has never been fully investigated.The objective was to explore the association between rehabilitation dose and UL motor outcome after stroke, as well as to identify which variables can be considered potential candidate predictors of motor recovery. People who survived stroke were assessed before and after a period of rehabilitation using motor, cognitive, neuroanatomical, and neurophysiological measures. We investigated the association between dose of rehabilitation and UL response (ie, Fugl-Meyer Assessment for upper extremity [FMA-UE]), using ordinary least squares regression as the primary analysis. To obtain unbiased estimates, adjusting covariates were selected using a directed acyclic graph. Baseline FMA-UE was the only factor associated with motor recovery (b = 0.99; 95% CI = 0.83 to 1.15 points). Attention emerged as a confounder of the association between rehabilitation and final FMA-UE (b = 5.5; 95% CI = -0.8 to 11.9 points), influencing both rehabilitation and UL response. Preserved attention in people who have survived stroke might lead to greater UL motor recovery, albeit estimates have high levels of variability. Moreover, the increase in the dose of rehabilitation can lead to 5.5 points improvement on the FMA-UE, a nonsignificant but potentially meaningful finding. The approach described here discloses a new framework for investigating the effect of rehabilitation treatment as a potential driver of recovery. Attentional resources could play a key role in UL motor recovery. There is a potential association between amount of UL recovery and dose of rehabilitation delivered, needing further exploration. Preserved attention and rehabilitation dose are candidate predictors of UL motor recovery.

Bimanual Arm Trainer Versus Traditional Occupational Therapy Services in Upper Extremity Function.

Upper extremity (UE) dysfunction resulting from stroke significantly affects a person's ability to complete self-care activities, consequently diminishing functional independence. Effective interventions that improve UE function in persons with stroke are needed. To explore the effectiveness of the Bimanual Arm Trainer (BAT) compared with traditional occupational therapy treatment sessions (i.e., a control group) on improving UE function after acute ischemic stroke. Clinical trial, two-group, nonrandomized repeated-measures design. Inpatient rehabilitation facility. Twenty-seven persons with ischemic stroke and an Action Research Arm Test (ARAT) score ≤17. Minimum of three 10-min sessions on the BAT. ARAT, Upper Extremity Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA-UE). Both the intervention and control groups showed significant improvement on the ARAT from evaluation to discharge (main effect of time: p = .02). There was no statistically significant main effect of group and no significant Time × Group interaction (p = .63). FMA-UE scores also improved significantly in the intervention group from evaluation to discharge (p < .001). FMA-UE scores were not available for the control group. Both the intervention and control groups demonstrated significant improvements in UE function from evaluation to discharge. There were no statistically significant differences between groups, indicating that the BAT results in similar improvements in UE function, as would be expected in traditional occupational therapy. Further research is warranted to examine additional BAT programs, use different outcome measures, and assess participants over a longer time span. Plain-Language Summary: The Bimanual Arm Trainer (BAT) is a novel device that can be used in occupational therapy to improve arm function among stroke patients. There is limited research on BAT's effectiveness in improving arm function among stroke patients. In an acute inpatient rehabilitation setting, we compared outcome scores of patients who received traditional occupational therapy services with those who also used the BAT. Both groups achieved significant improvements in arm function from evaluation to discharge. We found that the addition of the BAT interventions did not significantly affect the outcome measure scores for either group. We conclude that more research is needed to examine additional BAT programs, use different outcome measures, and assess participants over a longer period of time.

Association between depression and adherence to upper limb exercises among community-dwelling stroke survivors: A cross-sectional study.

Upper limb recovery after stroke tends to be slower and incomplete. Participation in motor rehabilitation and exercise adherence are crucial to improve motor recovery. However, post-stroke depression (PSD) could impede active participation in exercises. Therefore, this study investigates the association between depression and exercise adherence among community-dwelling stroke survivors. This cross-sectional study was conducted among 215 stroke survivors undergoing motor rehabilitation between February 2021 and January 2023. Patient Health Questionnaire-9 (PHQ-9) and Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) were measured to assess depression symptoms and exercise adherence, respectively. Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was administered to identify the influence of impairment on these factors. Chi-square and multinomial and binary logistic regression analyses were applied to determine the relationships between these measurements. Using the Chi-square test, the PHQ-9 was significantly associated with SS-MAHE (p < 0.05). Logistic regression analysis revealed that patients with moderate depression had lower odds of exercise adherence (OR:0.69, 95%CI:0.56, 0.85, p < 0.01) compared to those with no depression. Type of exercises such as movement-based (OR:2.00, 95%CI:1.80, 2.24, p < 0.001) and task-based exercises (OR:1.80, 95%CI:1.53, 2.13, p < 0.001), had higher adherence odds compared to those not exercising. Severe impairment (FMA-UE) was significantly associated with lower exercise adherence (OR:0.71, 95%CI:0.54, 0.94, p < 0.05) and an increased risk of minimal depression (RR:11.09, 95%CI:1.17, 105.04, p < 0.05) compared to mild impairment. PSD significantly impacts exercise adherence, with moderate depression notably reducing adherence rates. Incorporating mental health support into stroke rehabilitation could improve exercise adherence and potentially enhance upper limb motor recovery outcomes.

Interpreting Variations in Fugl-Meyer Assessment Protocols: Results and Recommendations From a Nominal Group Consensus Process

ObjectiveTo identify variations among administration and scoring instructions of 6 upper extremity Fugl-Meyer Assessment (FMA-UE) protocols and to achieve consensus regarding optimal administration procedures. DesignNominal group consensus technique comprised of iterative independent reviews of protocol content, anonymous voting, and group consensus meetings. SettingClinicians working in clinical practice and research settings participated in virtual meetings via Zoom. ParticipantsTen experts in stroke rehabilitation and administration of the FMA-UE contributed to the interprofessional consensus group. InterventionsNot applicable. Main Outcome MeasuresQualitative reviews of each FMA-UE protocol and rater responses (agree/disagree) regarding variations in general administration instructions (ie, instructions that could affect the scoring of many individual test items) were discussed and analyzed during a 3-phase consensus process. An a priori target of 80% or greater agreement was used to determine group consensus. ResultsConsensus was attained for 7 of 10 general administration instructions. Recommendations from our consensus group summarize “best practice” general instructions for researchers and clinicians. A case example, in which we found up to a 21-point difference between the highest and lowest FMA-UE scores, highlights the potential effect of these protocol variations. ConclusionsVariations among FMA-UE administration protocols during stroke rehabilitation studies can lead to discrepancies in the interpretation and translation of research findings across institutions and limit the perceived value and uptake of standardized assessments for evidence-based practice. The results of this nominal group consensus provide a first step toward developing cohesive FMA-UE recommendations for wider dissemination and review.