Functional Performance Of Daily Activities Research Articles

The effect of a six-week home physiotherapy program on symptoms and activities of daily living in post-COVID-19 patients following hospital discharge

Introduction: Patients following the acute stage of Severe Acute Respiratory Syndrome Coronavirus 2 were shown to present with persisting symptoms including fatigue, dyspnea, joint pain, and chest pain. The aim of this study was to investigate the effect of a 6-week home physiotherapy program on the psychological and physical symptoms, as well as the physical abilities to perform activities of daily living in post-COVID-19 patients. Methods: The subjects were 39 adult patients who had been diagnosed with COVID-19 and had been hospitalized at the University Clinical Center of Kosovo. Patients initially underwent a physiotherapy assessment 2-3 weeks after discharge from the hospital, including sociodemographic data, psychological and physical symptoms, and functional performance in daily activities using the Patient-Specific Functional Scale (PSFS). Based on their functional capacity, the patients received two types of brochures for a home physiotherapy program that was carried out over the next 6 weeks. Upon the completion of the physiotherapy program, 23 patients reported for the second physiotherapy assessment. The Mann–Whitney Wilcoxon test was used for comparison of the variables obtained during the first and second assessments. Results: Pre–post analysis showed that the symptoms including excessive fatigue, difficulty breathing, and insomnia were significantly less present following the home physiotherapy program (p = 0.005; p = 0.008; p = 0.034). On the PSFS scale, the mean score increased from 5.2 (2.1) to 7.8 (0.5) for stair climbing, from 5.5 (1.8) to 8.8 (1.6) for walking longer distances, and from 3.7 (3.2) to 4.0 (5.6) for running. Conclusion: Although limited by the absence of a control group, the findings from this study indicate that home physiotherapy intervention can be feasible and effective in enhancing psychological and physical symptoms, as well as activities of daily living in post-COVID-19 patients following hospitalization.

Virtual reality skateboarding training for balance and functional performance in degenerative lumbar spine disease

BackgroundDegenerative lumbar spine disease (DLD) is a prevalent condition in middle-aged and elderly individuals. DLD frequently results in pain, muscle weakness, and motor impairment, which affect postural stability and functional performance in daily activities. Simulated skateboarding training could enable patients with DLD to engage in exercise with less pain and focus on single-leg weight-bearing. The purpose of this study was to investigate the effects of virtual reality (VR) skateboarding training on balance and functional performance in patients with DLD.MethodsFourteen patients with DLD and 21 age-matched healthy individuals completed a 6-week program of VR skateboarding training. The motion capture and force platform systems were synchronized to collect data during a single-leg stance test (SLST). Musculoskeletal simulation was utilized to calculate muscle force based on the data. Four functional performance tests were conducted to evaluate the improvement after the training. A Visual Analogue Scale (VAS) was also employed for pain assessment.ResultsAfter the training, pain intensity significantly decreased in patients with DLD (p = 0.024). Before the training, patients with DLD took longer than healthy individuals on the five times sit-to-stand test (p = 0.024). After the training, no significant between-group differences were observed in any of the functional performance tests (p > 0.05). In balance, patients with DLD were similar to healthy individuals after the training, except that the mean frequency (p = 0.014) was higher. Patients with DLD initially had higher biceps femoris force demands (p = 0.028) but shifted to increased gluteus maximus demand after the training (p = 0.037). Gluteus medius strength significantly improved in patients with DLD (p = 0.039), while healthy individuals showed consistent muscle force (p > 0.05).ConclusionThis is the first study to apply the novel VR skateboarding training to patients with DLD. VR skateboarding training enabled patients with DLD to achieve the training effects in a posture that relieves lumbar spine pressure. The results also emphasized the significant benefits to patients with DLD, such as reduced pain, enhanced balance, and improved muscle performance.

Quality of Life among Individuals with Stroke in Jordan

Abstract 
 Background and aims: Stroke has long-term consequences for the functional performance of daily activities. Evaluating the impact of stroke on health and wellbeing is essential in designing stroke-specific programs supporting home and community participation. This study described the impact of stroke on quality of life as reported by stroke survivors. Additionally, this study examined the effect of different personal and clinical characteristics on the quality of life among adults with stroke. Materials and Methods: This cross-sectional study encompassed a sample of 64 adults with stroke (mean age 58.9 years) who are currently receiving rehabilitation services after stroke onset. Outcome measures included the Stroke Impact Scale (SIS) and its subdomains to assess the self-perceived disability following a stroke. The data analysis plan included MANOVA, followed by ANOVA of main effects and post-hoc analyses. Results: Jordanian individuals with stroke had a mean SIS total score of 59.9 (SD ±15.4, Range 25.8– 94) indicating moderate levels of quality of life following stroke. Furthermore, patients reported that hand function, strength, activities of daily living (ADL), participation, and emotions domains received lower mean scores of SIS in these areas. Participants with a higher number of previous strokes had significantly lower emotional subdomain scores on the SIS (p=0.001). Participants with aphasia had significantly lower scores in the memory (p< 0.001) and communication subdomains (p=0.0001). Conclusion: Individuals with stroke reported moderate levels of disability after stroke onset. Having aphasia, and an increased number of previous strokes were associated with greater challenges in quality of life following stroke.
 Keywords: Stroke, Quality of Life, Performance, Rehabilitation.

Current trends in graft choice for primary anterior cruciate ligament reconstruction – part II: In-vivo kinematics, patient reported outcomes, re-rupture rates, strength recovery, return to sports and complications

Postoperative patient satisfaction after anterior cruciate ligament reconstruction (ACL-R) is influenced mainly by the degree of pain, the need for reoperation, and functional performance in daily activities and sports. Graft choice has shown to have an influence on postoperative outcomes after ACL-R. While patient reported outcomes measurements do not differ between graft options, evidence shows that normal knee kinematics is not fully restored after ACL-R with an increase in postoperative anterior tibial translation (ATT). Postoperative graft rupture rates seem to favor bone-patella-tendon-bone (BPTB) and quadriceps tendon (QT) autografts over HT or allografts. While return to sports rates seem comparable between different graft types, postoperative extensor strength is reduced in patients with BPTB and QT whereas flexion strength is weakened in patients with HT. Postoperative donor site morbidity is highest in BPTB but comparable between HT and QT. With all graft options having advantages and drawbacks, graft choice must be individualized and chosen in accordance with the patient.

Perfil de força de preensão manual em pacientes idosos com câncer de próstata

Objetivo: analisar o perfil de Força de Preensão Manual em pacientes idosos com câncer de próstata, atendidos em instituição hospitalar filantrópica do Recife.Métodos: estudo transversal com análise de dados secundários, coletados no Ambulatório de Oncogeriatria do Instituto de Medicina Integral Professor Fernando Figueira, utilizando uma amostra por conveniência com uma amostragem de 72 idosos. A análise estatística foi realizada utilizando o programa estatístico STATA 12. O teste de Kolmogorov-Smirnov foi aplicado a variáveis numéricas para se determinar a normalidade da amostra. Em caso de não normalidade, foi utilizado o teste de Mann-Whitney. Adotou-se o nível de significância de 0,05%.Resultados: observou-se uma Força de Preensão Manual reduzida nos pacientes com estadiamento de uma doença mais avançada quando comparado a outros estágios mais localizados ou clinicamente melhores (estadiamento I: 27,78 vs. estadiamento IV: 27,20 no braço dominante (p=0, 340)/ estadiamento I: 27,33 vs. estadiamento IV: 24,13 no braço não dominante) sendo esse resultado melhor reproduzido na mão não dominante (p=0,090). Por meio da análise das comorbidades (hipertensão, diabetes, cardiomiopatia e osteoartrite) em relação à mão dominante e não dominante, não foram verificadas diferenças significativas na Força de Preensão Manual na presença ou ausência das comorbidades analisadas tanto na mão dominante quanto da não dominante (p=0,189 vs.p=0,437).Conclusões: o estudo trouxe subsídios relevantes sobre a importância da Força de Preensão Manual como um importante parâmetro geral para força e um indicativo de saúde, principalmente quando analisados em idosos com câncer, onde afeta significativamente sua função física e neuromuscular, incluindo atrofia muscular, diminuição da força muscular e diminuição do desempenho funcional em atividades diárias, comprometendo significativamente a qualidade de vida e seu prognóstico.

NeuroHeal Reduces Muscle Atrophy and Modulates Associated Autophagy.

Muscle wasting is an unmet medical need which leads to a reduction of myofiber diameter and a negative impact on the functional performance of daily activities. We previously found that a new neuroprotective drug called NeuroHeal reduced muscle atrophy produced by transient denervation. Aiming to decipher whether NeuroHeal has a direct role in muscle biology, we used herein different models of muscle atrophy: one caused by chronic denervation, another caused by hindlimb immobilization, and lastly, an in vitro model of myotube atrophy with Tumor Necrosis Factor-α (TNFα). In all these models, we observed that NeuroHeal reduced muscle atrophy and that SIRT1 activation seems to be required for that. The treatment downregulated some critical markers of protein degradation: Muscle Ring Finger 1 (MuRF1), K48 poly-Ub chains, and p62/SQSTM1. Moreover, it seems to restore the autophagy flux associated with denervation. Hence, we envisage a prospective use of NeuroHeal at clinics for different myopathies.

The effects of weight-bearing exercise on postural control and fatigue index of elderly males

Aims: Functional decline in activities of daily living caused by chronic fatigue and postural control weakness are common symptoms of aging that needed to be considered. Therefore, the aim of the study was to investigate the effects of weight-bearing exercise (WBE) on postural control and Fatigue Index of elderly males. Materials and Methods: Fifty-two elderly men of Qazvin City were volunteered to participate in the research and were allocated randomly into the two groups of either WBE (n = 26; 67.3 ± 2.4 years) or control group (n = 26; 68.1 ± 2.9 years). Functional test including maximal tolerance to treadmill walking (MTW) and test of Blood Lactate Acid Concentration (BLA) were considered as Fatigue Index before and after exercise intervention. In addition, good balance test was used to measure postural balance via static and dynamic balance. The exercise group performed (WBE) in a seven consecutive day, lasting 30 min in a session. Independent t-test and paired t-test were used to analyze the data at the significance level of 0.05. Results: The results suggested that both functional test (MTW [P = 0.003]; BLA [P = 0.02]) and postural control (static balance index [P = 0.001]; dynamic balance indices [P = 0.001]) were significantly improved in exercise group compared to control group. Conclusion: It appears that WBE would improve the functional performance of daily activities (postural control and fatigue tolerance) in the geriatric population.

Self-perceived occupational performance of community-dwelling adults living with stroke.

Stroke has long-term consequences for functional performance of daily activities. Evaluating client-perceived occupational performance provides insight for designing stroke-specific programs supporting home and community participation. This study describes the personal characteristics and self-perceived occupational performance in community-dwelling adults with stroke. A retrospective chart review was undertaken of 25 stroke survivors who sought services at a community-based centre. The outcome measures were the Canadian Occupational Performance Measure (COPM) to evaluate self-perceived occupational performance and the Montreal Cognitive Assessment (MoCA) to screen for cognitive impairment. The analysis used descriptive statistics. Mean participant age was 64 years, and most participants were Caucasian males (72%). The mean cognitive function score was 22.1 on MoCA, and the mean COPM performance and satisfaction subscores were 4.1 and 3.9, respectively. The top three challenging daily activities were driving, seeking employment, and functional mobility. Stroke-specific community programs should emphasize the diverse performance concerns important to stroke survivors.

Investigating The Effects Of Obesity On Fitness Among Community-dwelling Older Adults In Taiwan

Obesity is a critical health issue, increasing the risk for chronic diseases, including hypertension, diabetes mellitus, and coronary artery disease, in the elderly. However, the impact of obesity on physical fitness, which is important for functional performance of daily activities among the community-dwelling elderly, has not been evaluated. PURPOSE: We investigated obesity-related changes in physical fitness among community-dwelling elderly individuals. METHODS: Sixty-nine elderly individuals (67 women and 2 men; age, 73.26±6 years) were recruited and classified into the obese (BMI ≥27.0 kg/m2, n=17) or non-obesity (BMI <27.0 kg/m2, n=52) group. Weight, height, and waist girth were measured for all individuals. The following physical fitness tests were evaluated: back scratch, sit-and- reach, 30-s sit-to-stand, 2-min leg lift, single leg balance, and the timed up-and-go (8 feet walk distance). Between-group differences were evaluated using independent sample t-tests, with a p-value <0.05 denoting statistical significance (SPSS statistical software, version 19.0). RESULTS: The prevalence of obesity was 24.6% in our study group. Weight and waist girth were lower in the non-obese than in the obese group: 19% (t (67) =5.492, p<0.01) and 13% (t (67) = 3.443, p=0.001), respectively. Performance on the back scratch test and single leg balance was better for the non-obese than for the obese group: back scratch (-22.9±15.3 cm versus -10.1±16.1 cm, respectively, p=0.005) and single leg balance (12.4±14.8 s versus 26.1±31.7 s, respectively, p=0.018). Performance for the non-obese and obese group was comparable on the sit-and-reach test (7.9±13.7 cm versus 7.0±8.0 cm, respectively, p=0.790), 30-s sit-to-stand (19.3±5.3 repetitions versus 18.1±3.5, respectively, p=0.412) and 2-min leg lift (131.9±36.9 repetitions versus 114.7±25.5, respectively, p=0.079). CONCLUSIONS: We identified some effects of obesity among community-dwelling elderly individuals, such as single leg balance, which could lead to restriction in activities of daily living and an increased risk of falling.

Phisical modalities on the functional performance in knee osteoarthritis: a sytematic review

Abstract Introduction: Despite recent advances in the treatment of osteoarthritis (OA), few studies have evaluated the longitudinal effect of physical modalities in functional capacity in patients with knee OA. Thereby, since the physical components and pain can affect the functional performance of daily activities, the effect of these treatment’s form is still to be established. Objective: Evaluate the effectiveness of therapeutic ultrasound, electrical stimulation and phototherapy in the functional performance, in patients with knee osteoarthritis. Methods: Articles present in the PubMed, Lilacs, SciELO and PEDro’s databases were evaluated. The used keywords were “pulsed ultrasound therapy”, “ultrasound therapy”, “electric stimulation” and “low level laser therapy” in combination with “knee osteoarthritis”. Were included in this presented review, randomized clinical studies using ultrasound, electrical and laser stimulation in subjects with knee osteoarthritis. To evaluate the methodological quality of the selected studies, was used the PEDro’s scale. The dependent variables of the study were: pain, physical function, joint stiffness, life quality and functional performance. Results: 268 studies were found, of these, 41 studies met eligibility criteria and were classified for analysis in full. The used methodology in the studies varied widely, however, in most cases there was improvement in functional performance of individuals with knee OA, with the use of physical modalities, for the pulsed ultrasound, continuous ultrasound, electrical stimulation and laser resourses. Conclusion: The physical modalities used in the studies demonstrated improvement in functional performance of individuals with knee OA.

Do isometric, isotonic and/or isokinetic strength trainings produce different strength outcomes?

IntroductionSeveral studies have been developed to determine which type of muscular action (isometric, isotonic and isokinetic) elicits more gains in functional strength and muscle mass. The comparisons between training outcomes are inconclusive due to lack of exercise standardization. ObjectiveTo compare muscle strength, mass, and functional performance in response to isometric, isotonic, and isokinetic contractions, when training loads (volume and intensity) are equated. MethodData were derived from a university community-recruited sample (n = 31 men). InterventionsUntrained men were assigned to isotonic (IT), isometric (IM), or isokinetic (IK) group, and trained their dominant quadriceps muscle 3 sessions/week for 8 weeks with a dynamometer. Muscle strength was assessed using Cybex 6000 dynamometer; the triple-hop-distance test was used to assess functional performance, and dual energy x-ray absorptiometry to assess lean muscle mass. ResultsAfter training, muscle lean muscle mass increased in isometric (+3.1%, p < 0.01) and isotonic groups (+3.9%, p < 0.01); only the isokinetic group showed a significant improvement in the triple-hop-distance test (4.84%, p < 0.01). ConclusionClinicians should consider isometric training as an alternative for isotonic training to gain muscle mass, and isokinetic training to improve functional performance of daily activities and/or sports.

The psychometric properties of the Chinese version\u2014reintegration to normal living index (C-RNLI) for identifying participation restriction among community-dwelling frail older people

BackgroundThe Reintegration to Normal Living Index (RNLI) was developed to measure reintegration to normal living after major traumas/illnesses. Its psychometric properties remain unknown when used to measure participation restriction under the World Health Organization’s International Classification of Functioning, Disability, and Health (WHO-ICF) framework. This study examines the psychometric properties of the Chinese version-RNLI to measure WHO-ICF participation restriction among community-dwelling pre-frail and frail older people.MethodsA cross-sectional study was conducted in community and day-care centres in Hong Kong between May 2015 and January 2016. Through face-to-face interviews, information was collected on the participants’ demographic background, medical history, frailty status, depressive mood, functional performance in daily activities, and participation restriction. The internal consistency, test-retest reliability, and construct and convergent validity of the C-RNLI were assessed.ResultsTwo hundred and ninety-nine pre-frail or frail community-dwelling older people with a mean age of 79.53 were recruited. A confirmatory factor analysis showed that the C-RNLI has a two-factor structure comprised of “participation in physical activities” and “participation in social events”. The test-retest coefficient was 0.71. The Cronbach’s alpha of the total C-RNLI score, and those of the factors “participation in physical activities” and “participation in social events” were 0.88, 0.82 and 0.84, respectively. Pre-frail older people had significantly higher scores for the factors “participation in physical activities” (z = −5.05, <0.01) and “participation in social events” (z = −6.04, p < 0.01) than frail older people. Older people from community centres had significantly higher scores for the factors “participation in physical activities” (z = −4.48, <0.01) and “participation in social events” (z = −4.03, p < 0.01) than older people from day-care centres. The factors “participation in physical activities” and “participation in social events” of the C-RNLI were significantly convergent with depressive mood (rs = −0.25 and rs = −0.39, respectively) and functional performance in daily activities (rs = 0.28 and rs = 0.45, respectively).ConclusionsThe C-RNLI is a two-factor structured scale with acceptable level of reliability and validity to measure WHO-ICF participation restriction among community-dwelling pre-frail and frail older people.

Identifying functional impairment and rehabilitation needs in patients newly diagnosed with inoperable lung cancer: a structured literature review

Patients newly diagnosed with inoperable lung cancer experience a symptom distress burden that may impact upon functional performance in daily activities. This structured review examines empirical evidence to see how functional limitation and rehabilitation needs are represented in the supportive care literature in this population. Early access to rehabilitation services may ameliorate the impact, but evidence of need following diagnosis is required. Electronic databases Medline, Web-of-Science, Cinahl, AMED and PsychINFO were searched in April 2014. Hawker's criteria were used to assess methodological quality. The World Health Organization International Classification for Functioning Disability and Health (WHO-ICF) guided framework analysis and narrative synthesis. Thirty-two articles selected for further analysis included heterogeneous studies exploring the following conceptually diverse dimensions: quality of life, symptoms, functional performance and unmet supportive care needs at diagnosis and first treatment phase. Studies, mostly utilising patient self-report measures, reveal functional impairments, limitations and restrictions influenced by personal and environmental factors across all WHO-ICF domains. Two studies included objective evaluations of function. Six studies explored functional performance as a primary aim. Five studies suggested specific or general rehabilitation interventions to address identified needs. Needs associated with a diagnosis of inoperable lung cancer impact on daily life in the peri and early post-diagnostic period across all WHO-ICF domains. Specific functional impairments, limitations and restrictions and the potential role of rehabilitation services are rarely explored objectively or discussed in the supportive care literature for this population. Research is needed to guide the development of effective rehabilitation interventions acceptable to patients, health care commissioners and providers that address the impact of a new lung cancer diagnosis on functional performance.

G356 Teachers’ experiences of working with children with Autism and sensory processing needs

AimsThe purpose of this project was to investigate teachers’ perceptions of their experiences of the Sensory Processing Pathway for children with a diagnosis of autism, identifying strengths and limitations and...

The Influence of Hand Use on Dressing Outcome in Cognitively Impaired Stroke Survivors

Introduction: The daily task of dressing oneself requires multiple complex skills, which are often taken for granted by those free from ill-health or disability. Independence in dressing allows an individual to maintain a sense of dignity and choice over his or her appearance. Occupational therapy aims to restore independent functional performance in daily activities. Dressing independence requires both physical and cognitive skills. For survivors of stroke, impairment of such skills can pose great difficulty to their dressing performance. Method: The aim of this study was to examine the effect of arm paresis and cognitive impairment on upper body dressing ability using a cognitively impaired cohort of stroke participants (n = 70), and to explore the importance of bimanual activity when dressing in the presence of cognitive impairment. Dressing ability was assessed at baseline and immediately following a 6-week period of dressing practice with an occupational therapist. Results: Thirty-six participants were able to use a bimanual dressing method at baseline. The chi-square test for independence indicated a strong association between dressing method (bimanual or unimanual) and independence in upper body dressing, p&lt;0.001. The dressing success of the bimanual group was significantly greater than that of the unimanual group at both assessment time points. Conclusion: Cognitively impaired stroke survivors do perform better at upper body dressing when they are able to use both hands as compared with one, but those with arm paresis preventing bimanual activity may still improve their dressing performance significantly with practice.

Cognition and functional performance in daily activities before and after pontine and extrapontine myelinolysis: A case study

Central pontine and extrapontine myelinolysis (CPEM) is a rare neurological condition usually due to rapid correction of hyponatremia. CPEM is mainly characterized by motor deficits (typically quadraparesis or extrapyramidal features) but neurobehavioral symptoms were also reported in the literature. However, very few studies on the neuropsychological and functional performance in daily activities have been performed in this population. In this case study, a 55-year-old woman had neuropsychology and functional evaluations prior and after the first manifestations of CPEM. The patient presented motor impairments characterized by parkinsonism symptoms and decreased dexterity. Several neurobehavioral deficits were observed including emotional lability, impulsivity, altered judgment, and disinhibition. Executive dysfunctions and impulsivity were observed during neuropsychological and functional evaluations, limiting the patient's autonomy in complex activities of daily living. The patient recovered progressively from most motor, neurobehavioral and cognitive deficits.

Poster 176: Neuropsychology and Functional Performance in Daily Activities Associated With Pontine and Subcortical Demyelination: A Case Study

Objective: Central pontine and extra pontine myelinolysis (CPEM) is a rare neurological disease characterized by demyelination of the pons and other subcortical regions, secondary to rapid normalization of hyponatremia. A variety of movement disorders, psychiatric and behavioral manifestations can occur. However, very few studies on neuropsychological functioning and none on functional performance in daily activities have been reported.

Functional performance of children with developmental coordination disorder at home and at school

This study investigated the functional performance of daily activities at home and at school in a population-based sample of children with different degrees of motor coordination impairment and competence. Sixteen children (seven males, nine females; mean age 8 y, SD 9 mo) with developmental coordination disorder (DCD), 25 with suspected DCD ([sDCD] 17 males, eight females; mean age 7 y 6 mo, SD 8 mo), and 63 children without motor problems (39 males, 24 females; mean age 7 y 9 mo, SD 7 mo) were recruited from public schools (Grades 1-3, age 6 y 4 mo-9 y 10 mo) using the Chinese version of the Developmental Coordination Disorder Questionnaire, the Movement Assessment Battery for Children, and the Bruininks-Oseretsky Test of Motor Proficiency. Functional performance was assessed using the Chinese versions of the Vineland Adaptive Behavior Scales and the School Function Assessment-Chinese version. The functional performance of children with DCD and sDCD was statistically significantly lower than those without DCD (p's<0.05). chi(2) and logistic regression analyses showed significant differences among all groups in the proportion of children scoring at the 'inadequate' adaptive level of home performance (p's<0.05). There were also significant differences among the groups in the proportion of children scoring below the cut-off in school performance (p's<0.05). The findings show the pervasive impact of DCD on children's functional performance in daily activities at home and at school.

Potential Predictors of Motor and Functional Outcomes After Distributed Constraint-Induced Therapy for Patients With Stroke

Background. Selection of patients who are most and least likely to benefit from constraint-induced therapy (CIT) for the upper extremity is uncertain. Objective. This study investigated demographic and clinical characteristics that may predict outcomes for a distributed form of CIT. Methods. A group of 57 patients were treated with distributed CIT, and 7 potential predictors were identified, including age, sex, side of stroke, time since stroke, spasticity, neurologic status, and movement performance of the distal part of the upper extremity. Treatment outcome was assessed in terms of motor performance, perceived functional ability of the affected hand, and functional performance of daily activities, measured by Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and Functional Independence Measure (FIM), respectively. Results. Motor ability of the distal part of the upper extremity and time since stroke were significantly predictive of outcomes on the FMA (adjusted R 2 = 0.18, P = .002) and the MAL subtest quality of movement (adjusted R 2 = 0.43, P < .0001). Motor ability and age were significant predictors of amount of use measured by the MAL (adjusted R 2 = 0.20, P = .001). None of the variables exhibited a predictive relationship with the FIM. Conclusions. The best predictor for motor outcomes after distributed CIT was greater motor ability of the distal part of the upper extremity, which is consistent with the presence of residual motor pathways that may respond to training. The FMA may be of value in stratifying patients for their likelihood to benefit from distributed CIT protocols.

Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study

Objective: To evaluate changes in (1) motor control characteristics of the hemiparetic hand during the performance of a functional reach-to-grasp task and (2) functional performance of daily activities in patients with stroke treated with modified constraint-induced movement therapy. Design: Two-group randomized controlled trial with pretreatment and posttreatment measures. Setting: Rehabilitation clinics. Subjects: Thirty-two chronic stroke patients (21 men, 11 women; mean age=57.9 years, range=43—81 years) 13—26 months (mean 16.3 months) after onset of a first-ever cerebrovascular accident. Intervention: Thirty-two patients were randomized to receive modified constraint-induced movement therapy (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for three weeks. Main measures: Kinematic analysis was used to assess motor control characteristics as patients reached to grasp a beverage can. Functional outcomes were evaluated using the Motor Activity Log and Functional Independence Measure. Results: There were moderate and significant effects of modified constraint-induced movement therapy on some aspects of motor control of reach-to-grasp and on functional ability. The modified constraint-induced movement therapy group preplanned reaching and grasping (P=0.018) more efficiently and depended more on the feedforward control of reaching (P=0.046) than did the traditional rehabilitation group. The modified constraint-induced movement therapy group also showed significantly improved functional performance on the Motor Activity Log (P<0.0001) and the Functional Independence Measure (P=0.016). Conclusions: In addition to improving functional use of the affected arm and daily functioning, modified constraint-induced movement therapy improved motor control strategy during goal-directed reaching, a possible mechanism for the improved movement performance of stroke patients undergoing this therapy.