Lower Extremity Motor Coordination Research Articles

Correlation between mobility assessed by the Modified Rivermead Mobility Index and physical function in stroke patients.

[Purpose] The purpose of this study was to investigate the relationship between mobility assessed by the Modified Rivermead Mobility Index and variables associated with physical function in stroke patients. [Subjects and Methods] One hundred stroke patients (35 males and 65 females; age 58.60 ± 13.91 years) participated in this study. Modified Rivermead Mobility Index, muscle strength (manual muscle test), muscle tone (Modified Ashworth Scale), range of motion of lower extremity, sensory function (light touch and proprioception tests), and coordination (heel to shin and lower-extremity motor coordination tests) were assessed. [Results] The Modified Rivermead Mobility Index was correlated with all the physical function variables assessed, except the degree of knee extension. In addition, stepwise linear regression analysis revealed that coordination (heel to shin test) was the explanatory variable closely associated with mobility in stroke patients. [Conclusion] The Modified Rivermead Mobility Index score was significantly correlated with all the physical function variables. Coordination (heel to shin test) was closely related to mobility function. These results may be useful in developing rehabilitation programs for stroke patients.

Motor Recovery, Tonus of the Plantar Flexor Muscles, and Age are Predictors of the Lower Limb Motor Coordination in Stroke Survivors

Motor coordination (MC) or dexterity refers to the ability to perform a motor task in an accurate, rapid, and controlled manner. Adequate coordination of the lower limbs is important for the performance of activities of daily living and for an independent life and in stroke individuals, MC impairments contribute significantly to disability. The Lower Extremity Motor Coordination Test (LEMOCOT) was developed to assess the motor coordination of the lower limbs and is a simple test with good clinical utility, adequate psychometric properties, and has been considered one of the best to assess lower limb MC. Many factors may predict MC, such as age, gender, body mass index, and muscular strength, but these factors may depend upon the characteristics of the investigated sample. Menezes et al. investigated the potential predictors of the lower limb MC, assessed by the LEMOCOT scores, in stroke survivors, and found that motor recovery, tonus of the plantar flexor muscles, and age reached significance (p<0.05), explaining 54% of the variance in the LEMOCOT scores. These findings could help rehabilitation professionals to evaluate MC deficits and plan interventions aimed at improving MC of the lower limbs for stroke subjects, based upon the knowledge of the possible factors that could contribute to MC impairments.

Lower Limb Motor Coordination of Stroke Survivors, Based Upon Their Levels of Motor Recovery and Ages

Objective: To describe the motor coordination (MC) of the paretic lower limb of stroke survivors based upon their levels of motor recovery and ages and to compare their LEMOCOT scores with those predicted for healthy subjects of similar ages and genders. Methods: MC was assessed by the Lower Extremity Motor Coordination Test (LEMOCOT). The participants were divided, according to their ages and levels of motor recovery, based upon the Fugl-Meyer (FM) lower limb section scores (mild impairments: FM ≥ 23 and severe impairments: FM <23). To compare the LEMOCOT scores of the paretic lower limb with those predicted for healthy subjects, the predicted equations for the non-dominant lower limb of healthy subjects of similar ages and genders were employed. Results/Discussion: Age did not influence the LEMOCOT scores, but the subjects with severe motor impairments always showed lower scores, when compared to those with mild impairments, regardless of their ages. The subjects with mild motor impairments reached 75%, while those with severe motor impairments reached only 20% of the predicted scores for healthy subjects. Conclusions: The findings suggested that the subjects with mild motor impairments had better MC, than those with severe impairments, regardless of their ages. Furthermore, the subjects with mild motor impairments reached 75%, whereas those with severe impairments reached only 20% of the predicted scores for healthy subjects

Measurement properties of the lower extremity motor coordination test in individuals with stroke

To evaluate the construct validity, inter- and intra-rater reliabilities, best scoring method and testing methods (direct vs video observations), and to determine the smallest real difference (SRD) and standard error of the measurement (SEM) of the lower Extremity Motor Coordination Test (LEMOCOT). Methodological study. Thirty-six stroke subjects. Outcomes include measures of motor recovery, muscular tone, strength, motor coordination, foot tactile sensation, and gait speed. The LEMOCOT scores were able to discriminate between stroke individuals from those predicted for healthy subjects, between the paretic and non-paretic limbs for both the sub-acute and chronic groups and differentiated between individuals with different functional levels and degrees of motor recovery. For the intra- and inter-rater reliabilities, very high and significant coefficients were found for both the paretic and non-paretic lower limbs for both groups (intra-class correlation coefficients (ICC) > 0.97, p < 0.0001). Significant differences were found regarding all scoring methods (18.91 < F < 27.49, p < 0.0001), but they were not clinically important and all showed adequate test-retest reliability and acceptable SRD and SEM (< 15%) values. There was also agreement between the scores from the direct and video observations. The LEMOCOT demonstrated adequate measurement properties in stroke subjects and, therefore, could be an appropriate measure for research and clinical purposes.

Reference Values and Psychometric Properties of the Lower Extremity Motor Coordination Test

Objectives(1) To create predictive nomograms for the dominant and nondominant limbs on the Lower Extremity Motor Coordination Test (LEMOCOT) using reference values, and (2) to determine the inter- and intrarater reliability for the LEMOCOT; the best scoring method (first vs mean of the first 2 vs mean of the last 2 vs mean of 3 vs the highest of 3 trials); the best testing method (direct vs video observation); and the ability to detect real change (smallest real difference [SRD] and standard error of the measurement [SEM]). DesignNormative and methodological study. SettingMetropolitan area. ParticipantsHealthy individuals (N=320, 50% women) in 7 age groups: 20 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and ≥80 years. Each group had 50 participants, except for ≥80 years (n=20). InterventionsNot applicable. Main Outcome MeasureLEMOCOT. ResultsAge and sex explained 48% of the variance in the LEMOCOT scores for the dominant limb and 44% for the nondominant limb (125<F<148; P<.001). No significant differences were found regarding the different scoring methods (.12<F<1.02; .10<P<.92), and all of them demonstrated good reliability (intraclass correlation coefficients between .90 and .99; P<.001). There was agreement between scores from direct and video observation (limits of agreement −1.99 to 1.85; −1.55 to 1.62). Appropriate SEM (2.27–1.85) and SRD (6.27–5.11) values were found. ConclusionsReference values were determined for the LEMOCOT, and predictive nomograms were created based on age and sex. The LEMOCOT is reliable, needing only 1 trial (after familiarization) to generate reliable scores; can be scored from either direct or video observation; and has the ability to detect real change over time.

Reliability and Validity of Step Test Scores in Subjects With Chronic Stroke

Hong S-J, Goh EY, Chua SY, Ng SS. Reliability and validity of step test scores in subjects with chronic stroke. ObjectivesTo establish (1) the intrarater and interrater reliabilities of step test (ST) scores in subjects with chronic stroke, (2) the ST's known-groups validity and cutoff scores for distinguishing subjects with chronic stroke from healthy adults older than 50 years, and (3) the convergent validity of ST scores with lower-limb muscle strength, coordination, balance performance, and walking speed. DesignCross-sectional study. SettingUniversity-based rehabilitation center. ParticipantsConvenience sample of subjects (N=30): community-dwelling subjects with chronic stroke (n=15) and healthy adults older than 50 years (n=15). InterventionsNot applicable. Main Outcome MeasuresST scores; handheld dynamometer measurements of bilateral lower-limb muscle strength; lower-extremity motor coordination test (LEMOCOT) scores; Berg Balance Scale scores; walking speed as measured by a 5-meter walk test. ResultsST scores showed excellent intrarater reliability, with intraclass correlation coefficients ranging from .981 to .995 and interrater reliability ranging from .996 to .999. A cutoff score of 13 on the paretic side was found to distinguish the healthy adults older than 50 years from subjects with stroke at a sensitivity of 87% and a specificity of 87%. A cutoff score of 11 on the nonparetic side was found to distinguish the healthy adults from subjects with stroke at a sensitivity of 100% and a specificity of 67%. ST scores of the paretic limb demonstrated a significant correlation with muscle strength, the LEMOCOT scores of the paretic leg, and walking speed. ST scores of the nonparetic limb demonstrated a significant correlation with muscle strength and the LEMOCOT scores of the paretic leg. ConclusionsThe ST is a reliable measurement tool when the number of steps is counted by either experienced or inexperienced examiners by viewing videotapes. ST scores with both the paretic limb and the nonparetic limb are sensitive in distinguishing subjects with chronic stroke from healthy adults older than 50 years.

ASSESSMENT OF LOWER EXTREMITY MOTOR COORDINATION IN OPERATED PATIENTS

Objective: To establish any changes up to the second postoperative month in pain, disability, performance, kinesiophobia, and lower extremity motor coordination of patients operated on for lumbar disc hernia. Methods: Forty-five patients with lumbar disc hernia were included in the study preoperatively, and were followed up until the second postoperative month. Pain and disability, walking and stair-climbing performances, and kinesiophobia were measured; and motor coordination tests were practiced with the Lower Extremity MOtor COordination Test (LEMOCOT). Results: The worst scores of pain, disability, performance, kinesiophobia, and LEMOCOT measurements were in the preoperative period; while the best ones were observed in the 2 months following the surgery. Conclusion: The measurements of pain, disability, performance, kinesiophobia, and lower extremity coordination usually performed in the cases operated on with a diagnosis of lumbar disc hernia are significantly affected from the initial period until the second postoperative month.

Gaze Control and Foot Kinematics During Stair Climbing: Characteristics Leading to Fall Risk in Progressive Supranuclear Palsy

Does gaze control influence lower-extremity motor coordination in people with neurological deficits? The purpose of this study was to determine whether foot kinematics during stair climbing are influenced by gaze shifts prior to stair step initiation. Twelve subjects with gaze palsy (mild versus severe) secondary to progressive supranuclear palsy were evaluated during a stair-climbing task in a cross-sectional study of mechanisms influencing eye-foot coordination. Infrared oculography and electromagnetic tracking sensors measured eye and foot kinematics, respectively. The primary outcome measures were vertical gaze fixation scores, foot lift asymmetries, and sagittal-plane foot trajectories. The subjects with severe gaze palsy had significantly lower lag foot lift relative to lead foot lift than those with a mild form of gaze palsy. The lag foot trajectory for the subjects with severe gaze palsy tended to be low, with a heading toward contact with the edge of the stair. with severe gaze palsy were 28 times more likely to experience "fixation intrusion" (high vertical gaze fixation score) during an attempted shift of gaze downward than those with mild ocular motor deficits (odds ratio [OR]=28.3, 95% confidence interval [CI]=6.4-124.8). Subjects with severe gaze shift deficits also were 4 times more likely to have lower lag foot lift with respect to lead foot lift than those with mild ocular motor dysfunction (OR=4.0, 95% CI=1.7-9.7). The small number of subjects and the variation in symptom profiles make the generalization of findings preliminary. Deficits in gaze control may influence stepping behaviors and increase the risk of trips or falls during stair climbing. Neural and kinematic hypotheses are discussed as possible contributing mechanisms.

Validation of a New Lower-Extremity Motor Coordination Test

Desrosiers J, Rochette A, Corriveau H. Validation of a new lower-extremity motor coordination test. Objective To determine the test-retest reliability and construct validity of a new lower-extremity motor coordination test, the Lower Extremity MOtor COordination Test (LEMOCOT). Design To test reliability, subjects with impairments in at least 1 lower extremity were evaluated twice by the same evaluator. To test construct validity, the LEMOCOT scores obtained from subjects who had had a stroke were correlated with physical, functional, cognitive, and perceptual tests. Setting Geriatric day hospital and functional intensive rehabilitation unit. Participants In the reliability test, 29 people (mean age, 69.6y; range, 28–87y); in the construct validity, 144 people who recently had had a stroke. Intervention Not applicable. Main outcome measures In addition to the LEMOCOT, the following measures were used for construct validity: the Fugl-Meyer Assessment (motor function), Berg Balance Scale, 5-m walking test, 2-minute walking test, Functional Autonomy Measurement System, Modified Mini-Mental State Examination, and Motor-Free Visual Perceptual Test. Results Intraclass correlation coefficients (ICCs) indicated that test-retest reliability is good (right-side ICC=.88; left-side ICC=.83). The construct validity of the LEMOCOT was demonstrated by obtaining high correlations with physical and functional tests ( r range, .62–.79; P<.001) and no correlations with cognitive ( r=.11, P=.20) or visual perceptual tests ( r=.15, P=.08) and by discriminating between subjects discharged to long-term care versus other living environments ( P<.001). Conclusions The LEMOCOT is a simple lower-extremity motor coordination test that showed good test-retest reliability and construct validity. It can be used in clinical and research settings, specifically with people who have had a stroke. Other studies should be carried out to confirm its psychometric properties.