Motor Activity Log Quality Of Movement Research Articles

Predictors for Upper-Limb Functional Recovery Trajectory in Individuals Receiving Stroke Rehabilitation: A Secondary Analysis of Data from Randomized Controlled Trials.

The objective of the study was to determine predictors for upper-limb functional recovery trajectory after occupational therapy in a population with chronic stroke. In this retrospective secondary analysis, Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores before and after intervention and at the 3-month follow-up were used to divide 105 participants with chronic stroke into three groups of recovery trajectories: fast (participants who reached an improvement of 7 after intervention), extended (those who reached an improvement of 7 at follow-up), and limited (those who did not reach an improvement of 7) recovery. Comparisons among the three groups were made in demographics, stroke characteristics, and baseline assessment scores. Logistic regression analyses were performed to determine predictors for group membership. Time after onset of stroke and the baseline scores of FMA-UE, Stroke Impact Scale-Hand (SIS-Hand), Wolf Motor Function Test (WMFT)-Quality, WMFT-Time scores, Motor Activity Log-Amount of Use (MAL-AOU), and Motor Activity Log-Quality of Movement (MAL-QOM) scores were significantly different among the three groups. Univariate logistic regressions confirmed that SIS-Hand, WMFT-Quality, WMFT-Time, MAL-AOU, and MAL-QOM were significant predictors for both the fast versus limited recovery group membership and the extended versus limited group membership. Time after stroke onset and baseline FMA-UE were additional predictors for the fast versus limited recovery group membership. These findings may assist healthcare professionals in making optimal therapeutic decisions and in informing clients and caregivers about the outcomes of stroke recovery.

The effect of adding trunk restraint to task-oriented training in improving function in stroke patients: A systematic review and meta-analysis.

The effectiveness of trunk restraint on post-stroke arm motor function and daily function remain controversial. To evaluate the effect of adding trunk restraint to task-oriented rehabilitation of arm motor function and functional ability after stroke. Nine databases were systematically searched for randomized controlled trials studying the effects of trunk restraint in post-stroke task-oriented training. Researchers assessed methodological qualities using the Physiotherapy Evidence Database scale, and extracted data related to study participants, intervention, and outcomes. The overall effectiveness was calculated using a meta-analytic method. In total, ten articles met the inclusion criteria and nine trails (n = 255 subjects) were included in quantitative analyses. Meta-analysis revealed that trunk restraint exhibited a significant improvement on the Motor Activity Log-amount of use, 0.39 (95% CI: 0.25- 0.54), the Motor Activity Log-quality of movement, 0.45 (95% CI: 0.27- 0.63), the Fugl-Meyer Assessment (upper extremity), 1.09 (95% CI: 0.67- 1.51), Action Research Arm test, 4.51 (95% CI: 2.49- 6.54) and performance of Activities of daily living, 1.70 (95% CI: 0.19- 3.21) in trunk restraint group in patients at subacute stage, compared to the non-trunk restraint group, but no significant difference was found in patients with chronic stroke. Adding trunk restraint to task-oriented training may improve function in patients with subacute stroke.

Feasibility, Safety and Efficacy of a Virtual Reality Exergame System to Supplement Upper Extremity Rehabilitation Post-Stroke: A Pilot Randomized Clinical Trial and Proof of Principle.

(1) Background: Increasing the amount of therapy time has been shown to improve motor function in stroke survivors. However, it is often not possible to increase the amount of therapy time provided in the current one-on-one therapy models. Rehabilitation-based virtual reality exergame systems, such as Jintronix, can be offered to stroke survivors as an adjunct to traditional therapy. The goal of this study was to examine the safety and feasibility of providing additional therapy using an exergame system and assess its preliminary clinical efficacy. (2) Methods: Stroke survivors receiving outpatient rehabilitation services participated in this pilot randomized control trial in which the intervention group received 4 weeks of exergaming sessions in addition to traditional therapy sessions. (3) Results: Nine subjects in the intervention and nine subjects in the control group completed the study. The intervention group had at least two extra sessions per week, with an average duration of 44 min per session and no serious adverse events (falls, dizziness, or pain). The efficacy measures showed statistically meaningful improvements in the activities of daily living measures (i.e., MAL-QOM (motor activity log-quality of movement) and both mobility and physical domains of the SIS (stroke impact scale) with mean difference of 1.0%, 5.5%, and 6.7% between the intervention and control group, respectively) at post-intervention. (4) Conclusion: Using virtual reality exergaming technology as an adjunct to traditional therapy is feasible and safe in post-stroke rehabilitation and may be beneficial to upper extremity functional recovery.

Predictors of Clinically Important Changes in Actual and Perceived Functional Arm Use of the Affected Upper Limb After Rehabilitative Therapy in Chronic Stroke

ObjectiveTo identify the predictors of minimal clinically important changes in actual and perceived functional arm use of the affected upper limb after rehabilitative therapy. DesignRetrospective, observational cohort study. SettingOutpatient rehabilitation settings. ParticipantsA cohort of 94 patients with chronic stroke. InterventionsPatients received robot-assisted therapy, mirror therapy, or combined therapy for 4 weeks. Main Outcome MeasuresThe primary outcome measures, assessed pre- and post intervention, included actual functional arm use measured by an accelerometer and perceived functional arm use measured by the Motor Activity Log (MAL). Candidate predictors included age, sex, time after stroke, side of stroke, and scores on the Fugl-Meyer Assessment, Modified Ashworth Scale, Medical Research Council scale, Wolf Motor Function Test, MAL (quality of movement), and Nottingham Extended Activities of Daily Living. ResultsBeing male (odds ratio [OR], 3.17; 95% CI, 1.13-8.87) and having a higher than median Medical Research Council score (OR, 2.68; 95% CI, 1.12-6.41) significantly predicted minimal clinically important changes assessed by an accelerometer. Fugl-Meyer Assessment scores (odds ratio, 1.06; 95% CI, 1.02-1.11) were a significant predictor of achieving clinically important changes in MAL amount of use. Wolf Motor Function Test (quality) scores (OR, 3.05; 95% CI, 1.38-6.77) could predict clinically important improvements in MAL quality of movement. ConclusionsPredictors of clinically important changes in the use of the affected upper limb after robot-assisted therapy, mirror therapy, or combined therapy in patients with chronic stroke for 4 weeks differ for actual vs perceived use. Further studies are recommended to validate these findings in a larger sample.

Effects of sling and voluntary constraint during constraint-induced movement therapy for the arm after stroke: a randomized, prospective, single-centre, blinded observer rated study

To determine whether a combination of constraint-induced movement therapy and physiotherapy in stroke patients using different constraint regimens (sling versus voluntary constraint) changes or reduces motor deficits, the amount of functional use of the arm and whether the effects of treatment continue after 12 months. Forty-seven stroke patients were stratified and randomly divided into intensive physiotherapy programmes focused on regaining arm functions. Neurorehabilitation Unit of IInd Department of Neurology at Institute of Psychiatry and Neurology in Warsaw. Patients were randomly allocated to: the sling-constraint group (n = 24) or to the voluntary-constraint group (n = 23). Massed practice with the paretic arm (5 hours/day for 15 consecutive working days). Sling-constraint group had their arm immobilized in a hemi-sling during therapy. In addition, individual, 1-hour physiotherapy sessions were conducted in both groups. Rivermead Motor Assessment (RMA) Arm scale, (0-15), Motor Activity Log - Quality of Movement (MAL-QOM) (0-5 for 30 daily tasks). There was no significant difference between groups after therapy (MAL-QOM mean change for sling group 0.78, SD = 0.46 and for voluntary-constraint group 0.84, SD = 0.48; P = 0.687). All treated patients retained mean gains in real-world arm use (MAL-QOM) mean scores after 12 months follow-up compared with posttreatment values but there was no significant difference between groups (comparison of estimated mean change of MAL-QOM stated 0.23. 95% confidence interval = -0.04-0.50). Voluntary activity constraint in the intact arm is equivalent to sling, standard constraint during massed practice of paretic arm.

The EXCITE Trial: Predicting a Clinically Meaningful Motor Activity Log Outcome

Background and Objective . This study determined which baseline clinical measurements best predicted a predefined clinically meaningful outcome on the Motor Activity Log (MAL) and developed a predictive multivariate model to determine outcome after 2 weeks of constraint-induced movement therapy (CIMT) and 12 months later using the database from participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial. Methods. A clinically meaningful CIMT outcome was defined as achieving higher than 3 on the MAL Quality of Movement (QOM) scale. Predictive variables included baseline MAL, Wolf Motor Function Test (WMFT), the sensory and motor portion of the Fugl-Meyer Assessment (FMA), spasticity, visual perception, age, gender, type of stroke, concordance, and time after stroke. Significant predictors identified by univariate analysis were used to develop the multivariate model. Predictive equations were generated and odds ratios for predictors were calculated from the multivariate model. Results. Pretreatment motor function measured by MAL QOM, WMFT, and FMA were significantly associated with outcome immediately after CIMT. Pretreatment MAL QOM, WMFT, proprioception, and age were significantly associated with outcome after 12 months. Each unit of higher pretreatment MAL QOM score and each unit of faster pretreatment WMFT log mean time improved the probability of achieving a clinically meaningful outcome by 7 and 3 times at posttreatment, and 5 and 2 times after 12 months, respectively. Patients with impaired proprioception had a 20% probability of achieving a clinically meaningful outcome compared with those with intact proprioception. Conclusions. Baseline clinical measures of motor and sensory function can be used to predict a clinically meaningful outcome after CIMT.

Constraint-induced movement therapy improves upper extremity motor function after stroke

What is the effect of constraint-induced movement therapy (CIMT) on upper limb function in patients 3 to 9 months after stroke? Randomised controlled trial with concealed allocation and assessor blinding. Seven universities in the USA, recruiting participants from 247 medical facilities. 222 adults 3 to 9 months after their first ischaemic or haemorrhagic stroke with at least 10° of active extension at the wrist and at the thumb and two fingers. Participants also had to demonstrate adequate balance, transfer, sit-to-stand, and standing ability while wearing the mitt used to apply CIMT. One hundred and six patients were randomised to CIMT and 116 to usual care. CIMT involved wearing a restraining mitt on the less-affected hand for 90% of their waking hours over a 2-week period. On weekdays during this period, repetitive task practice and behavioural shaping with the hemiplegic hand were performed for up to 6 hours per day, with 30 minutes of additional practice of the tasks at home. Usual care ranged from no treatment after concluding formal rehabilitation to the application of orthotics or occupational/physical therapy on a domiciliary or outpatient basis. The primary outcomes were the Wolf Motor Function Test (WMFT), which includes measures of speed and strength of upper extremity motor function, and the Motor Activity Log (MAL), an interview-derived measure on a 0–5 scale of the amount and quality of performance of 30 common daily activities. The Stroke Impact Scale (SIS) health status interview was a secondary outcome measure. All outcomes were measured after treatment and at 4, 8, and 12 months post-treatment. From baseline to 12 months, the CIMT group showed greater improvements than the usual care group in: the WMFT Performance Time by 34% (95% confidence interval (CI) 12 to 51); the MAL Amount of Use by 0.43 (95% CI 0.05 to 0.80); and the MAL Quality of Movement by 0.48 (95% CI 0.13 to 0.84). The CIMT group also had a significantly greater decrease in self-perceived hand function difficulty on the SIS hand domain, by 9% (95% CI 0.3 to 19). Among patients who have had a stroke in the past 3 to 9 months, CIMT produces improvements in arm motor function that persist for at least one year.

Reliability and Validity of the Upper-Extremity Motor Activity Log-14 for Measuring Real-World Arm Use

In research on Constraint-Induced Movement (CI) therapy, a structured interview, the Motor Activity Log (MAL), is used to assess how stroke survivors use their more-impaired arm outside the laboratory. This article examines the psychometrics of the 14-item version of this instrument in 2 chronic stroke samples with mild-to-moderate upper-extremity hemiparesis. Participants (n=41) in the first study completed MALs before and after CI therapy or a placebo control procedure. In addition, caregivers independently completed a MAL on the participants. Participants (n=27) in the second study completed MALs and wore accelerometers that monitored their arm movements for 3 days outside the laboratory before and after an automated form of CI therapy. Validity of the participant MAL Quality of Movement (QOM) scale was supported. Correlations between pretreatment-to-posttreatment change scores on the participant QOM scale and caregiver MAL QOM scale, caregiver MAL amount of use (AOU) scale, and accelerometer recordings were 0.70, 0.73, and 0.91 (P<0.01), respectively. Internal consistency (alpha>0.81), test-retest reliability (r>0.91), stability, and responsiveness (ratio>3) of the participant QOM scale were also supported. The participant AOU and caregiver QOM and AOU scales were internally consistent, stable, and sensitive, but were not reliable. The participant MAL QOM scale can be used exclusively to reliably and validly measure real-world, upper-extremity rehabilitation outcome and functional status in chronic stroke patients with mild-to-moderate hemiparesis.