Post-stroke Hemiparetic Patients Research Articles

Robotic exoskeleton embodiment in post-stroke hemiparetic patients: an experimental study about the integration of the assistance provided by the REFLEX knee exoskeleton

Hemiparetic gait is the most common motor-disorder after stroke and, in spite of rehabilitation efforts, it is persistent in 50% of community dwelling stroke-survivors. Robotic exoskeletons have been proposed as assistive devices to support impaired joints. An example of these devices is the REFLEX knee exoskeleton, which assists the gait of hemiparetic subjects and whose action seems to be properly embodied by stroke survivors, who were able to adapt the motion of their non-assisted limbs and, therefore, reduce their compensation mechanisms. This paper presents an experimental validation carried out to deepen into the effects of REFLEX’s assistance in hemiparetic subjects. Special attention was paid to the effect produced in the muscular activity as a metric to evaluate the embodiment of this technology. Significant differences were obtained at the subject level due to the assistance; however, the high dispersion of the measured outcomes avoided extracting global effects at the group level. These results highlight the need of individually tailoring the action of the robot to the individual needs of each patient to maximize the beneficial outcomes. Extra research effort should be done to elucidate the neural mechanisms involved in the embodiment of external devices by stroke survivors.

Efficacy of ultrasound-guided subacromial bursa steroid injection for treating shoulder pain in post-stroke hemiparetic patients

Purpose: To assess the efficacy of ultrasound-guided subacromial bursa (SAB) steroid injection for treating hemiplegic shoulder pain (HSP) after stroke (CS), as well as its impact on joint mobility, and inflammatory mediators.Methods: Seventy-two (72) patients with CS-related HSP were divided into two groups: study and control groups. The study group received ultrasound-guided SAB injection of triamcinolone acetonide in addition to conventional treatment, while control group received only conventional rehabilitation. Both groups received 4 weeks of treatment and were assessed using pain visual analogue scale (VAS) and passive range of motion (PROM) indices before treatment and at 1, 4, and 12 weeks after treatment. Additionally, the Fugl-Meyer motor function (FMA-U) scale score, activities of daily living (ADL) score, modified Barthel index (MBI), serum IL-1β, IL-6, nitric oxide (NO) levels, and incidence of adverse reactions were assessed before and after 4 weeks of treatment.Results: The study group had a significantly higher total efficacy/effectiveness (86.11 %) compared to control group (53.89 %). Both groups showed initial decreases and subsequent increases in VAS and PROM from week 1 to week 12 after treatment. However, the study group had significantly lower VAS scores, angle of forward flexion, abduction, and external rotation at all time points compared to control group (p < 0.05). At week 4, the study group had significantly higher FMA-U, ADL, and MBI scores, as well as significantly lower IL-1β, IL-6, and NO levels when compared to control group (p < 0.05).Conclusion: Ultrasound-guided SAB steroid injection improves the efficacy of HSP after CS, improves joint mobility, and reduces serum levels of IL-1β, IL-6, and NO. Further large-sample studies with increased sample sizes and longer investigation periods are needed to validate these findings.

Therapeutic Effects of Robotic-Exoskeleton-Assisted Gait Rehabilitation and Predictive Factors of Significant Improvements in Stroke Patients: A Randomized Controlled Trial.

Robotic-exoskeleton-assisted gait rehabilitation improves lower limb strength and functions in post-stroke patients. However, the predicting factors of significant improvement are unclear. We recruited 38 post-stroke hemiparetic patients whose stroke onsets were <6 months. They were randomly assigned to two groups: a control group receiving a regular rehabilitation program, and an experimental group receiving in addition a robotic exoskeletal rehabilitation component. After 4 weeks of training, both groups showed significant improvement in the strength and functions of their lower limbs, as well as health-related quality of life. However, the experimental group showed significantly better improvement in the following aspects: knee flexion torque at 60°/s, 6 min walk test distance, and the mental subdomain and the total score on a 12-item Short Form Survey (SF-12). Further logistic regression analyses showed that robotic training was the best predictor of a greater improvement in both the 6 min walk test and the total score on the SF-12. In conclusion, robotic-exoskeleton-assisted gait rehabilitation improved lower limb strength, motor performance, walking speed, and quality of life in these stroke patients.

Measurement properties of the Brazilian Portuguese version of the Lower-Extremity Motor Activity Log for chronic hemiparetic poststroke patients.

Stroke is among the three leading causes of disability around the world, and it results in immediate difficulty in mobility and gait. There is a lack of instruments to evaluate what daily life is like for these individuals using their lower limbs in real-life environments (outside of the clinical environment). To perform the translation and cultural adaptation to Brazilian Portuguese of the Lower-Extremity Motor Activity Log (LE-MAL) and test its measurement properties in chronic poststroke individuals. The LE-MAL was translated into Brazilian Portuguese and adapted to the Brazilian culture. The comprehension and relevance of the final version were analyzed by a committee of specialists. The reliability, validity, and responsiveness of the LE-MAL/Brazil to detect changes after lower extremity constraint-induced movement therapy (LE-CIMT) and an intensive conventional therapy were tested. The LE-MAL/Brazil showed excellent inter- and intrarater reliability, with an intraclass correlation coefficient and Cronbach alpha > 0.70, as well as standard error of measurement and smallest detectable change < 10% of the total instrument score when applied by the same evaluators. The responsiveness of the LE-MAL/Brazil to detect changes showed better results after LE-CIMT than after the intensive conventional therapy, with most of the correlations > 0.50.

A quantitative lower limb function assessment method based on fusion of surface EMG and inertial data in stroke patients during cycling task

ObjectiveQuantitative methods provide an accurate way to determine lower-limb motor function level that is essential for post-stroke rehabilitation protocol setup. Due to less requirement of postural stability and balance control, cycling task is more suitable for stroke patients in acute period compared to gait tasks. However, the feasibility of motor function assessment under cycling task has been rarely studied. In this study, we investigated the locomotor performance under cycling task with comparing to a lower-limb movement sequence task and developed a motor assessment framework based on fusion of surface electromyography (sEMG) and inertial features. MethodsTen post-stroke hemiparetic patients were enrolled where sEMG signals and inertial data were measured and derived in both tasks. The task effect was investigated using one-way analysis of variance and feature difference between the affected and unaffected limbs was furtherly statistically analyzed. Ratios of feature were calculated based on which a motor function assessment model was built using a K-nearest neighbor regression algorithm. ResultsResults showed that patients had more significant differences in bilateral muscle activations and ratios of features in the cycling task had higher correlation with Fugl-Meyer assessment scores. The proposed model obtained a high accuracy prediction with a significant correlation (R2 = 0.99, MAE = 0.15, p < 0.001) in lower-limb motor score prediction. ConclusionThe study provides a novel motor assessment framework that validates the usability and feasibility of cycling task and has great potential in practical clinical assessment.

Immediate effect of shoe raise on unaffected side in gait of poststroke hemiparesis

PURPOSE: The purpose of the study was to observe the immediate changes on gait speed and qualitative gait parameters with and without the use of additional shoe raise on unaffected lower limb in poststroke hemiparetic patients. MATERIALS AND METHODS: Thirty-one participants with chronic stroke from SBB College of Physiotherapy, of either gender (40–70 years), able to walk 20 m with or without external aids were included in the study by purposive sampling. Patients with severe spasticity, fixed contractures, and audio, visual, or perceptual impairments were excluded from the study. An observational study was conducted where patients were tested under two conditions – pre- and postinserting a 1.5 cm shoe raise on the unaffected limb. Patients explained the nature of the study, and a 10-m walk test was performed along with video recording from anterior, posterior, and lateral views, which were later analyzed using Wisconsin Gait Scale (WGS). RESULTS: The mean age was 52.903 ± 8.423 and poststroke duration was 28.806 ± 1.836. Out of 31 patients, 20 were male and 11 female; 17 patients had right-sided hemiparesis, in 14 left-sided hemiparesis, out of which 26 were chronic and 5 were acute poststroke patients. Values for pre- and postscores of WGS were Z = −4.88, P = 0.000, and scores for speed were Z = −4.89, P = 0.000. CONCLUSION: From this study, it has been concluded that shoe raising, given on unaffected lower limb to hemiparetic patients, has shown a significant difference in pre- and postgait qualitative parameters and speed in both males and females of age group 40–70 years.

Psychometric properties of the Action Research Arm Test using decision rules for skipping items in hemiparetic patients after stroke: a retrospective study

Purpose Important properties have been studied using the Action Research Arm Test (ARAT) in patients with stroke. However, whether the ARAT subtests constitute a Guttman scale (i.e., items hierarchically ordered according to difficulty) remains unclear. Guttman scales can define decision rules for skipping items in patients with low endurance. This study investigated the psychometric properties of the ARAT when applying decision rules for post-stroke hemiparetic patients. Methods A retrospective, single-institution study was conducted between 2020 and 2021. Datasets of 30 patients with stroke-induced hemiparesis were collected from a previous study which employed the ARAT without decision rules, Fugl-Meyer assessment (FMA), Box and Block Test (BBT), and Motor Activity Log (MAL). The ARAT was rescored with decision rules for this study, and inter-rater reliability/agreement, parallel forms reliability, and construct validity were assessed. Results Parallel forms reliability (Spearman’s rho) was 0.99 (95% CI, 0.99–0.99) for both raters. The lower 95% CI limits of the sum and individual item scores in the reliability analysis exceeded the planned value (0.8). Construct validity values exceeded the planned value (0.8) for FMA, BBT, and MAL. Conclusion Decision rules can be used to skip ARAT items when assessing upper extremity motor function in stroke patients. IMPLICATIONS FOR REHABILITATION The Action Research Arm Test with decision rules for skipping items was valid and reliable for measuring upper extremity motor function in hemiparetic patients after stroke. The decision rules may reduce the burden of both patients and evaluators by decreasing the number of Action Research Arm Test items to be administrated.

EEG Correlation Coefficient Change with Motor Task Activation Can Be a Predictor of Functional Recovery after Hemiparetic Stroke.

Background: Recently, it was reported that the extent of cortico-cortical functional connections can be estimated by the correlation coefficient based on electroencephalography (EEG) monitoring. We aimed to investigate whether the EEG correlation coefficient change with motor task activation can predict the functional outcomes of hemiparetic stroke patients. Methods: Sixteen post-stroke hemiparetic patients admitted to our rehabilitation ward were studied. On admission, EEG recording to calculate the correlation coefficient was performed at rest and during motor task activation. For the analysis of the EEG data, the program software FOCUS (NIHON KOHDEN, Japan) was used. The motor function of paretic limbs was evaluated with the Fugl–Meyer Assessment (FMA) on admission and 4 weeks after admission. Results: Significant increases in the correlation coefficient with motor task activation were noted in C3-F3 or C4-F4, C3-F7 or C4-F8, and F3-F7 or F4-F8 of the lesional hemisphere. Among them, the rate of the correlation coefficient change in F3-F7 or F4-F8 in the lesional hemisphere was significantly correlated with the rate of the upper-limb FMA score change. Conclusion: The extent of the EEG correlation coefficient change with motor task activation in F3-F7 or F4-F8 of the lesional hemisphere may help predict the motor functional outcomes of hemiparetic upper limbs after stroke.

Changes of cortico-cortical neural connections associated with motor functional recovery after stroke

ObjectivesDuring functional recovery after stroke, some neural connections in the brain are augmented and new neural networks are constructed to compensate for impaired neurological functions. Recently, it was reported that the extent of cortico-cortical neural connections can be estimated by correlation analysis based on electroencephalography (EEG). The purpose of this study was to investigate changes of correlation coefficients in the cerebral cortex with motor functional recovery after stroke. Materials and methodsTwenty-two post-stroke hemiparetic patients admitted to our rehabilitation ward (mean age at admission: 71.4 ± 12.9 years old), were studied. For the evaluation of hemiparesis, Fugl-Meyer Assessment (FMA) was applied. All subjects underwent EEG with electrodes placed according to the international 10-20 system for correlation analysis, on admission to our ward and 4 weeks after admission. EEG data were analyzed with the program software FOCUS (NIHON KOHDEN, Japan), and squared correlation coefficients in some cortico-cortical areas of the cerebral cortex were calculated. ResultsThe correlation coefficients in some cortico-cortical areas of the lesional hemisphere, such as C3-F3 or C4-F4, C3-F7 or C4-F8, and F3-F7 or F4-F8, significantly increased with rehabilitation training. The change of the correlation coefficient in F3-F7 or F4-F8 and F7-T3 or F8-T4 in the lesional hemisphere was significantly correlated with the change of the upper-limb FMA. ConclusionsThe augmentation of cortico-cortical connections, represented by an increase of the correlation coefficient in the lesional hemisphere, may contribute to motor functional recovery, especially in hemiparetic upper limbs, after stroke.

Shear wave elastography of the brachioradialis spastic muscle and its correlations with biceps brachialis and clinical scales

BackgroundShear wave elastography technique estimates biological tissue shear elastic modulus (μ[kPa]), which can be used as an objective, muscle-specific indicator of stiffness increase caused by spasticity. We measured both the brachioradialis and biceps brachialis μ in hemiparetic post-stroke patients (n = 11). The spastic arm was compared with the supposedly non-affected contralateral limb and correlated with Fugl-Meyer Assessment and Modified Ashworth Scales. MethodsShear elastic modulus was estimated using an Aixplorer V.9 ultrasound device with the elbow at full extension. Average shear elastic modulus t-test, effect sizes, correlation matrix, spider plots and factor analysis were used to check for differences between spastic and nonspastic sides and explore relationships among the variables. FindingsSpastic brachioradialis μ (22.54 ± 11.59 kPa) and biceps brachialis (26.86 ± 12.07 kPa) were significantly greater than the non-spastic counterparts (13.13 ± 2.81 kPa, p = 0.031, ηp2 = 0.3846 for brachioradialis and 15.25 ± 5.00 kPa, p = 0.007, ηp2 = 0.5345 for biceps brachialis). Significant correlations were observed between the spastic brachioradialis and biceps μ and Modified Ashworth Scales, but no correlation with Fugl-Meyer Assessment. InterpretationElastography can provide muscle-specific shear elastic modulus estimations of spastic brachioradialis and biceps brachialis, which are distinct from the nonspastic side. In some patients, there was no clear correspondence of the Fugl-Meyer Assessment functional scale with Modified Ashworth Scales and μ, suggesting that spasticity is not the only determinant of arm function. Additionally, shear wave elastography of brachioradialis and biceps brachialis muscles may guide the spasticity treatment, for instance, selecting the preferable candidate for botulinum toxin therapy.

Effect of somatosensory stimulation on hand functions in post stroke hemiparetic patients

Somatosensory cues provide with the first chance to create a precise movement pattern and execute proper motor control. Somatosensory impairment can exacerbate hemiparesis, either directly because of a stroke or indirectly through the loss of the ability to interact with the environment. This study aims to investigate the effect of somatosensory stimulation on hand functions, dexterity, and handgrip strength in post stroke hemi paretic patients. This study is a randomized control trial research using two group's pre-posttest design. Thirty stroke hemi paretic patients (15 patients’ study (group A) received a selected physical therapy program in addition to somatosensory training., and 15 patients’ control (group B) received a selected physical therapy program only) participated in this study. Their age ranged from 50 to 67years. All patients undergone evaluation of handgrip strength(HGS) using handheld dynamometer, hand dexterity using box block test (BBT) and hand functional activities using Jepsen–Taylor hand function test (JTHFT). Unpaired t-test was conducted for comparison of the mean age between groups and comparison of handgrip strength, box and block test score and JTHFT between groups. Chi-squared test was conducted for comparison of sex distribution between groups.

Metabolic Energy Expenditure and Accelerometer-Determined Physical Activity Levels in Post-Stroke Hemiparetic Patients

BackgroundAssessment of metabolic energy expenditure in post-stroke patients using accelerometers is clinically important. However, understanding of the best placement of accelerometers on the body and methods for calculating activity counts are limited. MethodsThirty hemiparetic post-stroke patients participated in this cross-sectional study. Four triaxial accelerometers were attached to the hemiplegic and contralateral sides of the waist and ankles during various activities: lying, sitting, standing, stepping in place, and walking on a treadmill (1–5 kmh−1). Activity counts and metabolic energy expenditure of the patients were recorded simultaneously. Simple linear regression analyses were performed between the activity counts and energy expenditure. Activities were classified according to their intensity, using the definition of energetic sedentary behavior of post-stroke patients and a low fitness level group. ResultsThe best estimate of energy expenditure was obtained when the accelerometer was worn on the contralateral ankle and the activity counts was calculated using the vertical and anteroposterior axes (R2=0.812). Six classes of activity intensity (sedentary: ≤1.5 METs, very light: 1.51–1.79, light: 1.80–2.59, moderate: 2.60–3.39, hard: 3.40–4.39, and very hard: ≥4.40) and corresponding activity counts cut-off points are presented. ConclusionA triaxial accelerometer worn on the contralateral ankle and a method of calculating activity counts that includes at least the vertical and anteroposterior axes are recommended for estimating metabolic energy expenditure in post-stroke patients. The new activity counts cut-off points provide a significant advance in the interpretation of post-stroke monitoring in patients outside the hospital or rehabilitation center.

Indices of Loading and Propulsive Ability in the Gait of Patients With Chronic Stroke With Equinus Foot Deviation: A Correlation Study

In literature, indices of overall walking ability that are based on ground reaction forces have been proposed because of their ease of administration with patients. In this study, we analyzed the correlation between the indices of dynamic loading and propulsion ability of 40 chronic hemiparetic post-stroke patients with equinus foot deviation and a set of clinical assessments of ankle joint deviations and walking ability. Ankle passive and active range of motion (ROM) and triceps surae spasticity were considered, along with walking speed and three complementary scales of walking ability focusing respectively on the need for assistance on functional mobility, including balance and transfers, and the limitation in social participation. The correlation between the ground reaction force-based indices and both clinical and functional variables was carried out using the non-parametric Spearman correlation coefficient. Both indices were correlated to 8 of the 10 investigated variables, thus supporting their use. In particular, the dynamic propulsive ability was correlated with all functional scales (rho = 0.5, p < 0.01), and has the advantage of being a continuous variable. Among clinical assessments, limited ankle ROM affected walking ability the most, while spasticity did not. Since the acquisition of ground reaction forces does not require any patient prepping, the derived indices can be used during the rehabilitation period to quickly detect small improvements that, over time, might lead to the broad changes detectable by clinical scales, as well as to immediately highlight the lack of these improvements, thus suggesting adjustments to the ongoing rehabilitation approach.

Ultrasound-guided ethyl alcohol injection to the deep branch of the ulnar nerve to relieve hand spasticity in stroke patients: A case series.

Hand spasticity with a flexor pattern is a common problem affecting stroke patients and can result in pain, contractures, esthetic concerns, skin maceration, and overall loss of function. Poststroke (≥6 months) hemiparetic adult patients having a Modified Ashworth Scale (MAS) score of ≥1 for metacarpophalangeal flexion and thumb adduction spasticity were selected to receive an ultrasound-guided 20% ethyl alcohol block performed perineurally at the level of the deep branch of the ulnar nerve. Their MAS scores were evaluated pretreatment at 1 month and the change in MAS scores was assessed using Wilcoxon’s test. The threshold for statistical significance was set at p < 0.05. The mean MAS score for the flexor muscles of the 5 MCP joints and for thumb adduction was reduced from 3.3 ± 0.5 at pretreatment to 0.9 ± 0.5 at 1 month after the injection for the 10 patients. One month after the injection, the MAS scores were significantly reduced compared with those at pretreatment (p < 0.001), without complications. These are encouraging results showing that ultrasound-guided alcohol blocks of the deep branch of the ulnar nerve are safe and can help chronic stroke patients with metacarpophalangeal flexion and thumb adduction spasticity at 1 month.

Functional recovery in post-stroke patients on hemodialysis during the convalescent phase: a comparison with those not undergoing hemodialysis

BackgroundLow physical fitness is often found in patients undergoing hemodialysis. It may be possible that the recovery of impaired motor function with rehabilitative training might be affected when the patient is on hemodialysis. So far, however, no researcher has clinically investigated this issue in post-stroke patients. The purpose of this study is to clarify the difference of functional recovery during the convalescent phase between post-stroke patients with and without hemodialysis.MethodsA cohort of 82 post-stroke hemiparetic patients who were admitted to our rehabilitation hospital, were subjected. On the day of admission and discharge, some clinical parameters including Functional Independence Measure (FIM) and Functional Ambulation Category (FAC) were evaluated for each patient. The changes during the hospitalization and the values at the discharge in these parameters were statistically compared between the patients with and without hemodialysis.ResultsThe FIM motor score at the discharge was significantly lower in hemodialysis patients than non-hemodialysis patients (64.7 ± 21.2 points in hemodialysis patients and 81.8 ± 28.0 points in non-hemodialysis patients, p < 0.05). In addition, the frequency of FAC at the discharge of ≥ 3 was significantly lower in hemodialysis patients than non-hemodialysis patients (40.0% in hemodialysis patients and 72.2% in non-hemodialysis patients, p < 0.05).ConclusionIn patients undergoing hemodialysis seem to experience a worse functional recovery during the convalescent phase compared to those not undergoing hemodialysis. We might have to modify the rehabilitative program during the convalescent phase after stroke if the patient was on hemodialysis.

Electromyography-controlled gamified exercise system for the distal upper extremity: a usability assessment in subacute post-stroke patients

Purpose Movement repetition is known to play a key role in promoting functional improvements or maintaining functional levels in post-stroke hemiparetic patients. However, repetitive movements tend to be monotonous, making it challenging for patients to continue. Here, we developed a new gamified system to allow patients perform repetitive movements with enjoyment. The present study aimed to examine the usability of the system in subacute stroke patients. Method The exercise system comprised an electromyography-controlled operating system that enabled users to play a virtual game by repetitive finger and wrist movements on the affected side. A total of 13 patients with upper-limb hemiparesis underwent a single bout of exercise using the system and assessed its usability, satisfactoriness, enjoyability, etc. using the System Usability Scale (SUS), Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)-like questionnaire, and numerical rating scale (NRS). Results All the participants, who had a wide range of paretic levels, were able to perform the exercise using the system. Participants scored the system a median of 85.0 for SUS and 4.2 for the QUEST-like questionnaire, with an “excellent” in usability and “satisfied” in user satisfaction with the system. The median NRS scores for enjoyability, potential for continuous use, and effectiveness were 8.0, 9.0, and 9.0, respectively, which were greater than the scores for usual rehabilitation training for the upper extremity. Conclusions The novel electromyography-controlled gamified exercise system may have sufficient usability and enjoyability to motivate patients with a wide range of paretic levels to perform repetitive finger and wrist movements. IMPLICATIONS FOR REHABILITATION The electromyography-controlled gamified exercise system had overall positive perspectives on the usability of the system. This exercise system could help motivate patients with a wide range of paretic levels to perform repetitive finger and wrist movements.

Rehabilitation of the Shoulder Subluxation Based on Ultrasonographic Findings among Post Stroke Subjects: A Case Series.

Up to three-fourths of the poststroke subjects may experience shoulder subluxation as a challenging complication. The existing rehabilitation management is based on the clinical assessment. Ultrasonographic evaluation demonstrates findings, which cannot be discerned by the usual methods. To determine the effect of rehabilitation protocol based on the sonographic findings of the subluxed shoulder on reduction of the subluxation and upper limb motor recovery. Setting: Department of Occupational therapy of a Rehabilitation Institute. Study Design: A prospective case series. Subjects: 08 Poststroke hemiparetic patients with subluxed shoulder. Outcome measure: Ultrasongraphy of the bilateral shoulder joints, Fingerbreadth palpation method, Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FMA-UE). Intervention: As per the findings of the sonography, management in the form of shoulder support, physical agent modalities, motor therapy, and precautions and positioning was provided to the subjects for the period of 3 months. Post intervention, the participants showed 1 to 6 mm of reduction of acromion-greater tuberosity distance in addition to the reduction of atrophy and soft tissue or joint effusion. Furthermore, the participants also exhibited FMA-UE change ranging from 5 to 21. The ultrasonographic evaluation explores objective measurement and involvement of specific soft tissues among poststroke subject with the shoulder subluxation. The management based on the sonographic findings is an objective and valid approach.

Factors influencing locomotor capacity of hemiparetic post-stroke patients

Factors influencing locomotor capacity of hemiparetic post-stroke patients

Transcultural translation and validation of Fugl–Meyer assessment to Italian

Purpose The Fugl–Meyer Assessment is the most used and highly recommended clinical assessment of sensorimotor function after stroke. A standardized use of the scale in different countries requires translation and cultural validation to the target language. The objective of the study was to develop an official Italian version of the scale by transcultural translation and validation. Methods A standardized multistep translation protocol was adopted to achieve optimal conceptual and semantic equivalence. The developed Italian version was validated in 10 post-stroke hemiparetic patients. Items with low intra- and interrater agreement, quantified as percentage of agreement <70% and/or statistically significant disagreement in relative position or concentration, between different raters were identified and revised. Results All motor items received a high level of agreement with values well above 70%. Disagreements were observed in 6 items in the sensory, joint range and pain domains and 1 in one reflex item. Items showing disagreements were discussed and revised to establish the final Italian version. Conclusions The culturally validated Italian Fugl–Meyer Assessment can reliably be used in research and in clinical practice. A standardized use will improve the quality of sensorimotor assessment in stroke across Italy and allow reliable comparisons of stroke populations internationally. Implications for rehabilitation The Fugl–Meyer Assessment is the gold standard for evaluation of sensorimotor impairment after stroke. Having access to a transculturally validated official Italian version of Fugl–Meyer Assessment will improve the quality of sensorimotor assessment after stroke among Italian health professionals and researchers. A wider standardized use of the Fugl–Meyer Assessment in Italy will allow reliable international comparison of stroke rehabilitation outcomes.

Quantitative Assessment of Upper-Limb Motor Function for Post-Stroke Rehabilitation Based on Motor Synergy Analysis and Multi-Modality Fusion.

Functional assessment is an essential part of rehabilitation protocols after stroke. Conventionally, the assessment process relies heavily on clinical experience and lacks quantitative analysis. In order to objectively quantify the upper-limb motor impairments in patients with post-stroke hemiparesis, this study proposes a novel assessment approach based on motor synergy quantification and multi-modality fusion. Fifteen post-stroke hemiparetic patients and fifteen age-matched healthy persons participated in this study. During different goal-directed tasks, kinematic data and surface electromyography(sEMG) signals were synchronously collected from these participants, and then motor features extracted from each modal data could be fed into the respective local classifiers. In addition, kinematic synergies and muscle synergies were quantified by principal component analysis (PCA) and k weighted angular similarity ( k WAS) algorithm to provide in-depth analysis of the coactivated features responsible for observable movement impairments. By integrating the outputs of local classifiers and the quantification results of motor synergies, ensemble classifiers can be created to generate quantitative assessment for different modalities separately. In order to further exploit the complementarity between the evaluation results at kinematic and muscular levels, a multi-modal fusion scheme was developed to comprehensively analyze the upper-limb motor function and generate a probability-based function score. Under the proposed assessment framework, three types of machine learning methods were employed to search the optimal performance of each classifier. Experimental results demonstrated that the classification accuracy was respectively improved by 4.86% and 2.78% when the analysis of kinematic and muscle synergies was embedded in the assessment system, and could be further enhanced to 96.06% by fusing the characteristics derived from different modalities. Furthermore, the assessment result of multi-modality fusion framework exhibited a significant correlation with the score of standard clinical tests ( R = - 0.87, P = 1.98e - 5 ). These promising results show the feasibility of applying the proposed method to clinical assessments for post-stroke hemiparetic patients.