Fugl-Meyer Motor Assessment Scores Research Articles

Effect of motor imagery therapy on walking ability in patients with stoke and hemiplegia

Objective To investigate the effect of motor imagery therapy on walking ability in patients with stroke and hemiplegia. Methods Thirty-six patients with stroke and hemiplegia were divided into group A and group B based on the odd or even admission number,with 19 patients in each group. From the first to the third week,patients in group A were treated with conventional rehabilitation therapy combined with motor imaginary therapy,and those in group B only received conventional rehabilitation therapy. During the fourth and fifth week( washout period),both patients in group A and group B did not receive formal conventional rehabilitation therapy and motor imaginary therapy. In the sixth to eighth week,patients in group B received conventional rehabilitation therapy combined with motor imaginary therapy,and those in group A only received conventional rehabilitation therapy. The walking ability of patients in two groups was assessed with lower extremity Fugl-Meyer motor assessment( FMA),functional ambulation category( FAC) and Tinetti gait assessment( TGA)scales before treatment,and at the end of the third week,fifth week and eighth week. Results There was no significant difference in FMA,FAC and TGA scores between two groups before treatment( P 0. 05). The scores of each scale at the end of the third week,fifth week and eighth week were significantly higher than those before treatment in two groups( P 0. 01). At the end of the third week,the score of each scale in group A was significantly higher than that in group B( P 0. 01). At the end of the eighth week,the score of each scale in group B was significantly higher than that in group A( P 0. 01). Conclusion On the basis of conventional rehabilitation therapy,motor imagery therapy can further improve the walking ability in patients with stroke and hemiplegia and enhance the efficacy of rehabilitation training.

A Standardized Approach to the Fugl-Meyer Assessment and Its Implications for Clinical Trials

Background. Standardizing scoring reduces variability and increases accuracy. A detailed scoring and training method for the Fugl-Meyer motor assessment (FMA) is described and assessed, and implications for clinical trials considered. Methods. A standardized FMA scoring approach and training materials were assembled, including a manual, scoring sheets, and instructional video plus patient videos. Performance of this approach was evaluated for the upper extremity portion. Results. Inter- and intrarater reliability in 31 patients were excellent (intraclass correlation coefficient = 0.98-0.99), validity was excellent (r = 0.74-0.93, P < .0001), and minimal detectable change was low (3.2 points). Training required 1.5 hours and significantly reduced error and variance among 50 students, with arm FMA scores deviating from the answer key by 3.8 ± 6.2 points pretraining versus 0.9 ± 4.9 points posttraining. The current approach was implemented without incident into training for a phase II trial. Among 66 patients treated with robotic therapy, change in FMA was smaller (P ≤ .01) at the high and low ends of baseline FMA scores. Conclusions. Training with the current method improved accuracy, and reduced variance, of FMA scoring; the 20% FMA variance reduction with training would decrease sample size requirements from 137 to 88 in a theoretical trial aiming to detect a 7-point FMA difference. Minimal detectable change was much smaller than FMA minimal clinically important difference. The variation in FMA gains in relation to baseline FMA suggests that future trials consider a sliding outcome approach when FMA is an outcome measure. The current training approach may be useful for assessing motor outcomes in restorative stroke trials.

Improvements in spasticity and motor function using a static stretching device for people with chronic hemiparesis following stroke

We investigated the effect of a static stretching device on spasticity and motor function for people with chronic hemiparesis following stroke. Ten participants with chronic hemiparesis following stroke who had severe spasticity and incomplete weakness of the affected wrist and hand were recruited. The stretching device consisted of a resting hand splint, a finger and thumb stretching system, and a frame. The stretched state was maintained for 10 minutes/session, and the static stretching program was performed for 2 sessions/day and 7 days/week for 4 weeks. Spasticity and motor function of the affected wrist and hand were assessed three times with intervals of 4 weeks (twice [Pre-1, Pre-2] before and once [Post-1] after starting the static stretching program). The effect of the static stretching device was assessed using modified Ashworth scale (MAS) scores, by measuring active range of motion (AROM), and using the wrist and hand subsection of the Fugl-Meyer motor assessment (FMA). The main effects of the static stretching program on MAS scores for wrist and metacarpophalangeal (MCP) joints and FMA scores were significant. AROMs of MCPs and wrist showed an increase, however, no significant main effects of the static stretching program were observed. MAS in flexor muscles of MCP joints showed a significant decreased from Pre-2 (mean ± standard deviation (SD): 2.56 ± 0.55; median and interquartile range (IQR): 2.42, 2.12-3.08) to Post-1 (mean ± SD: 1.05 ± 0.49; median and IQR: 1.08, 0.87-1.50) (P < 0.001), and MAS in wrist flexor muscles also showed a significant decrease from Pre-2 (mean ± SD: 3.20 ± 0.78; median and IQR: 3.0, 2.75-4.0) to Post-1 (mean ± SD: 1.90 ± 0.73; median and IQR: 2.0, 1.0-2.5) (P < 0.001). FMA score also showed a significant increase from Pre-2 (11.3 ± 6.09) to Post-1 (14.5 ± 6.20) (P < 0.001). It was found that the static stretching device effectively relieved spasticity and improved motor function in subjects with severe spasticity and incomplete weakness following stroke.

Assessing Longitudinal Change in Coordination of the Paretic Upper Limb Using On-Site 3-Dimensional Kinematic Measurements

It is largely unknown how adaptive motor control of the paretic upper limb contributes to functional recovery after stroke. This paucity of knowledge emphasizes the need for longitudinal 3-dimensional (3D) kinematic studies with frequent measurements to establish changes in coordination after stroke. A portable 3D kinematic setup would facilitate the frequent follow-up of people poststroke. This case report shows how longitudinal kinematic changes of the upper limb can be measured at a patient's home using a portable 3D kinematic system in the first 6 months poststroke. The outcomes of the upper-limb section of the Fugl-Meyer Motor Assessment (FMA), the Action Research Arm Test (ARAT), and 3D kinematic analyses were obtained from a 41-year-old man with a left hemispheric stroke. Three-dimensional kinematic data of the paretic upper limb were collected during a reach-to-grasp task using a portable motion tracker in 5 measurements during the first 6 months after stroke. Data from an individual who was healthy were used for comparison. The FMA and ARAT scores showed nonlinear recovery profiles, accompanied by significant changes in kinematic outcomes over time poststroke. Specifically, elbow extension increased, forward trunk motion decreased, peak hand speed increased, peak hand opening increased, and peak hand opening occurred sooner after peak hand speed. This case report illustrates the feasibility of frequently repeated, on-site 3D kinematic measurements of the paretic upper limb. Early after stroke, task performance was mainly driven by adaptive motor control, whereas adaptations were mostly reduced at 26 weeks poststroke. The presented approach allows the investigation of what is changing in coordination and how these changes are related to the nonlinear pattern of improvements in body functions and activities after stroke.

Low-frequency electrical stimulation can improve ability in the activities of daily living soon after stroke

Objective To assess the efficacy of low-frequency electrical stimulation (LES) in improving ability in the activities of daily living (ADL) of subjects after a recent stroke. Methods In a randomized controlled trial, 37 subjects with a first stroke were randomly divided into an electrical stimulation (ES) group and a control group. In the ES group (n = 19 ) electrodes were applied on the motor points of the tibialis anterior, the peroneal longus and the peroneus brevis muscles. Stimulation current was applied at an intensity set to cause full ankle extension. The stimulus pulse was a symmetric biphasic wave with frequency of 30 Hz, a pulse width of 200 μs, a duty cycle of 5 s on and 5 s off ramped up and down for 1 s each and amplitude up to 90 mA. The current amplitude was adjusted according to each subject's comfort. Stimulation lasted for 30 min/d, 5 d/week for 3 weeks. All subjects in the 2 groups also received a standard rehabilitation program. Evaluations included the Fugl-Meyer motor assessment (FMA) for the lower extremity and the modified Barthel index (MBI) for ADL ability. Measurements were recorded before treatment and after 2 and 3 weeks of treatment. Results Before treatment there was no significant difference between the two groups in terms of age, time post-stroke, stroke severity or the baseline measurements. After 2 and 3 weeks of treatment, the FMA scores in the ES group were significantly higher than those of the control group. The MBI scores in the ES group were also significantly higher than in the control group. The average MBI transferring, walking and stair climbing scores in the ES group were all significantly higher than those in the control group after either 2 or 3 weeks. Conclusion Three weeks of LES can improve ADL ability soon after stroke. Key words: Low-frequency electrical stimulation; Stroke; Activities of daily living

Mental practice and upper extremity function after stroke

Objective To explore the effects of mental practice on upper extremity function after stroke. Methods Thirty sub-acute stroke patients were randomly divided into a treatment group ( n=15 ) and a control group (n=15). The patients in the control group were treated with conventional therapy. The patients in the treat-ment group were treated with motor imagery therapy in addition. All patients were assessed using the Fugl-Meyer mo-tor assessment (FMA) and the motor assessment scale (bIAS) before treatment and after 2, 4 and 8 weeks of treat-ment. Results After 2 weeks of treatment, average MAS scores in the treatment group improved significantly com-pared with before treatment, but there was no significant difference between the two groups. After 4 weeks, FMA and MAS scores in the two groups had improved, and the FMA scores in the treatment group were significantly higher than those of the control group. After 8 weeks, the FMA and MAS scores of both groups had further improved significant-ly, but the average FMA and MAS scores in the treatment group were now significantly higher than those in the control group. Conclusions Mental practice can improve the functional performance of the upper extremities of stroke pa-tients. Key words: Mental practice; Stroke; Hemiplegia; Upper extremities

Ipsilateral deficits of targeted movements after stroke

Kim SH, Pohl PS, Luchies CW, Stylianou AP, Won Y. Ipsilateral deficits of targeted movements after stroke. Arch Phys Med Rehabil 2003;84:719-24. Objective: To test the hypotheses that targeted movements of both the ipsilateral and the contralateral extremities of stroke survivors would be prolonged compared with those from a control group without stroke, and that the ipsilateral deficit would occur in movements toward small, but not large, targets. Design: Descriptive study. Setting: Motor performance laboratory. Participants: Convenience sample of right-handed individuals including 10 who were more than 6 months poststroke with Fugl-Meyer Motor Assessment scores greater than 75% for the upper (UEs) and lower (LEs) extremities, and a comparison group of 20 age-matched adults without stroke. Interventions: Not applicable. Main Outcome Measures: The average time required for the stylus, held with the hand or strapped to the foot, to travel from leaving 1 target to contacting the second target (ie, movement time) and the average time the stylus rested on the target (ie, dwell time). Results: Regardless of target size, movement and dwell times for both UEs of the stroke group were prolonged compared with those of the comparison group. Regardless of target size, dwell time for both LEs of the stroke group was prolonged compared with that of the comparison group. Conclusions: After stroke, the ipsilateral extremities may show subtle deficits in targeted movements.

Muscle Weakness and Cocontraction in Upper Limb Hemiparesis: Relationship to Motor Impairment and Physical Disability

The purpose of this article is to describe the relationship between poststroke upper limb muscle weakness and cocontraction, and clinical measures of upper limb motor impairment and physical disability. Electromyographic (EMG) activity of the paretic and nonparetic wrist flexors and extensors of 26 chronic stroke survivors were recorded during isometric wrist flexion and extension. The root mean square (RMS) of the EMG signal was used as a measure of strength of contraction. A ratio of RMS of antagonist and agonist muscles was used as a measure of cocontraction. Upper limb motor impairment and physical disability were assessed with the Fugl-Meyer motor assessment (FMA) and the arm motor ability test (AMAT), respectively. The strength of muscle contraction was significantly stronger in the nonparetic limb (P < 0.001). The degree of cocontraction was significantly greater in the paretic limb (P < 0.001). The strength of muscle contraction in the paretic limb correlated significantly with FMA (r = 0.62 to 0.87,P ≤ 0.001) and AMAT (r = 0.66 to 0.80, P ≤ 0.001) scores. Similarly, the degree of cocontraction correlated significantly with FMA (r = -0.70 to -0.64, P ≤ 0.001) and AMAT (r = -0.72 to -0.62, P ≤ 0.001) scores. Muscle weakness and degree of cocontraction correlate significantly with motor impairment and physical disability in upper limb hemiplegia. This relationship may provide insights toward development of specific interventions. However, additional studies are needed to demonstrate a cause and effect relationship.