Stroke Rehabilitation Assessment Of Movement Research Articles

The effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke

ABSTRACT Background Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear. Objectives This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. Methods The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods. Results The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia (p = 0.011) and quality of life (p = 0.009) are significant determinants of active energy expenditure and quality of life (p = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods (p > 0.05). Conclusions The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation.

Comparing distributed versus massed practice on functional recovery and Brain-Derived Neurotrophic Factor (BDNF) in acute stroke subjects.

Globally, stroke is known to be one of the major health problems, resulting in disability among an aging population. Rehabilitation is a process of re-learning of skills, lost due to brain injury. Many factors influence motor learning post neurological insult and practice is one of the key factors which influence relearning or reacquisition of lost motor skills. Practice can be varied concerning order (blocked or random), scheduling (massed or distributed), or whole and part practice. The study observed the effect of variations in practice schedules on motor and functional recovery. Thirty-two acute stroke subjects were recruited and equally divided into two groups (16 in massed and 16 in distributed). Both groups received an accelerated skill acquisition program (ASAP) for six sessions a week for 2 weeks. Pre- and post-outcome measures included stroke rehabilitation assessment of movement (STREAM) for motor recovery, modified Barthel index (MBI) for functional recovery, and brain-derived neurotrophic factor (BDNF) for neuroplasticity. The median scores of participants in the massed practice group before the intervention, of STREAM total, MBI, and BDNF were 23.5, 19, and 0.65, respectively, whereas post values of STREAM total, MBI, and BDNF were 40.5, 60.5, and 0.75, respectively. The median scores of the distributed practice group of the pre-STREAM total, MBI, and BDNF were 23.5, 6.5, and 0.70, respectively, whereas the post-STREAM total, MBI, and BDNF were 41, 45.5, and 0.80, respectively. P-value was reported to be <0.05 while comparing pre- and post-values of STREAM, MBI, and BDNF within both intervention groups. The median change scores of STREAM, MBI, and BDNF reported P ≥ 0.05 when compared between the groups. Both the groups had significant recovery post-intervention designed based on ASAP, about impairment mitigation, pursuing skilled movement leading to significant functional gains. Appropriate timing along with optimal dosage became an active ingredient in functional recovery in acute stroke subjects. The distributed practice might have added effect of spacing, resulting in easier learning and accuracy of skills. The study reveals that distributed practice can be part of regular clinical practice to enhance functional recovery in acute stroke rehabilitation.

Treino de circuito para controlo postural em utente com AVC isquémico ínfero-lateral esquerdo pôntico: estudo de caso

Introduction: The number of strokes has increased in recent years. As a result, postural control may be affected leading to gait disturbance. Circuit training is one of the therapeutic possibilities in which there are multiple stations, allowing multiple repetitions within the same session. This study aimed to describe the gait evolution following the application of a circuit training centered on the postural control in a post pons stroke patient. Material and methods: A male 50-year-old patient suffered a left infero-lateral pons stroke. Initially the patient was assessed using various scales, such as: Stroke Rehabilitation Assessment of Movement (STREAM), Berg Balance Scale, Timed-up-go (TUG) and 10-meter walking test. The patient was submitted to a circuit training for one hour per day with four exercise stations, five times a week for four weeks and was reevaluated at the end of the treatment. Results: There were reported improvements of 24 points in STREAM scale, 17 points in Berg Balance Scale, 0,4 m/s in 10-meter walk test and a decrease of 7,22 seconds in TUG. Conclusion: The application of a circuit training therapy targeted on postural control resulted in gait and balance improvements in this patient.

The Influence of Giving Sensomotoric Stimulation to Improve Functional Ability in Patients with Stroke

BACKGROUND: Sensory stimulation can help individuals regain sensitivity by paying attention to sensory input and its relationship to the activity to be carried out. Sensory stimulation combined with functional exercise is the main determinant of functional improvement in stroke. The study of the intensity and duration of therapy has not been widely carried out. AIM: The purpose of this study was to evaluate the influence of sensorimotor stimulation given intensively to improve functional abilities in patients with stroke and to ensure that there was no deterioration in their medical condition as a result of initial therapy. MATERIALS AND METHODS: This research method uses a pre-experimental design with a one-group pre-posttest involving 30 patients meeting predefined inclusion criteria in a one-group pre- and post-test design. The program consists of 16 sessions of sensomotoric stimulation and functional activity training in the physiotherapy gymnasium and daily sessions of ADL at home over 6 weeks. The efficacy of the program was evaluated by a stroke rehabilitation assessment of movement and a functional independence measure. RESULTS: A significant difference was observed in both motor skill (p = 0.00) and functional ability (p = 0.00) obtained on the 6th week of assessment. In a comparison of the benefits of therapy in two gender groups (p = 0.96 and 0.20), age groups (p = 0.55 and 0.86), and stroke severity (p = 0.50 and 0.64). The result showed there is no significant difference in the benefits of therapy applied to all of these groups. CONCLUSION: Sensomotoric stimulation given from the 1st day of stroke and continued intensively has been found to have a better impact on motor skills and functional ability.

Psychometric properties of Fullerton Advanced Balance Scale in patients with stroke

ABSTRACT Background Patients experience falls frequently after stroke. Preserved or acquired balance skills decrease fall risk and improve independence. Feasibility of Fullerton Advanced Balance Scale (FAB) has been shown in balance assessment in some neurological diseases except stroke. Objectives The purpose of this study was to investigate the reliability and validity of Turkish version of FAB (FAB-T) in patients with stroke (PwS). Methods This cross-sectional study included 51 PwS (60.64 ± 7.66 years). Reliability analyses were conducted with Cronbach’s alpha, intraclass correlation coefficient (ICC), and Spearman correlation analysis. Intra-rater and inter-rater reliability were assessed with three raters. FAB-T, Stroke Rehabilitation Assessment of Movement (STREAM), Brunnstrom Recovery Stages (BRS), Barthel Index (BI), and 36-Item Short Form Health Survey (SF-36) were used for convergent validity. Correlations of FAB-T with Berg Balance Scale (BBS) and Mini-Balance Evaluation Systems Test (Mini-BESTest) were measured for concurrent validity. Spearman correlation analysis was used for convergent and concurrent validity. For predictive validity patients’ self-reports of falling were analyzed with ROC. Results Intra-rater (ICC = 0.998) and inter-rater reliability (ICCs = 0.984; 0.984; 0.990), and internal consistency (Cronbach’s alpha = 0.930) were excellent. FAB-T had good correlations with STREAM (ρ = 0.677) and BI (ρ = 0.628), moderate correlations with BRS (ρ = 0.504 and ρ = 0.579) and physical function of SF-36 (ρ = 0.436). FAB-T excellently correlated with Mini-BESTest and BBS (ρ = 0.928 and ρ = 0.942). The cutoff score of FAB-T was determined to be 21.5 points, with sensitivity of 84% and specificity of 61% (AUC = 0.749). Conclusions FAB-T is a reliable and valid balance assessment tool with an acceptable accuracy of fall prediction in PwS.

BOBATH vs. TASK-ORIENTED TRAINING AFTER STROKE: An assessor-blind randomized controlled trial

ABSTRACT Objectives To evaluate/compare the effects of the Bobath concept and task-oriented training on motor function, muscle thickness, balance, gait, and perception of goal achievement in patients with stroke. Methods Thirty-two patients were randomly divided into Bobath and task-oriented groups. Exercises were applied for one hour a day, three days a week, for eight weeks. Clinical (Trunk Impairment Scale (TIS), Stroke Rehabilitation Assessment of Movement (STREAM), Goal Attainment Scale (GAS), balance, gait)) and trunk muscle thickness assessments (with ultrasound) were performed. Results Thirty patients completed the study. TIS, STREAM, and GAS scores were increased in both groups (all p < 0.05). Bilateral rectus abdominis thickness was found to have increased in the Bobath group whereby this increase was better when compared with the task-oriented group (p < 0.05). The limits of stability increased in both groups (p < 0.05). Postural sway was decreased in the anteroposterior (normal stability eyes open) in the Bobath group and the anteroposterior (perturbated stability eyes closed) in the task-oriented group. Velocity, step length, and functional ambulation profile scores increased, and double support of the paretic side decreased in the task-oriented group (all p < 0.05). Conclusions The Bobath concept appears to be superior to task-oriented training in increasing the thickness of rectus abdominis in patients with stroke. Although the task-oriented training provided significant improvement, especially in terms of gait, no superiority was found between the two rehabilitation approaches in terms of functional ability.

COMPLEX NEUROREHABILITATION OF POST-STROKE PATIENTS

Relevance. There are studies on the positive effect of electric current on neuronal excitability and activity of the cerebral cortex, depending on the chosen mode. But it is not known whether there will be a positive clinical effect from transcranial electrical stimulation of the brain in patients who have suffered an ischemic stroke.&#x0D; Objective: evaluation of the clinical effectiveness of the complex method of neurorehabilitation of post-stroke patients.&#x0D; Material and methods. Treatment of 150 patients with ischemic type of acute violation of cerebral circulation was carried out. The total sample was randomly divided into four clinical groups: І (n=30) – traditional therapy, ІІ (n=40) – application against the background of traditional therapy of neuroprotection in the acute and early recovery period with peptidergic compounds (cerebrolysin 40 ml per day), ІІІ ( n=40) – application of traditional therapy with transcranial micropolarization of the brain, IV (n=40) – application against the background of traditional therapy of combined neuroprotection in the acute and early recovery period with peptidergic compounds in combination with micropolarization of the brain.&#x0D; All patients during the observation period were repeatedly assessed the motor function of the upper limb using the Action Research Arm Test (ARAT), in its own modification with the assessment of the extension function of the fingers of the hand. Additionally, functional recovery after a stroke was assessed using the STREAM (Stroke Rehabilitation Assessment of Movement) scale, assessment of the function of the upper limb using the Fugl-Meyer FMA-UE test and the lower limb using the FMA-LE test.&#x0D; Disturbances in the motor-coordination sphere were additionally assessed using the stabilometry method on the ST-150 platform, using the following subtests: Romberg test, combined coordination-motor test, static test, dynamic test, as well as the foot reception test. Statistical processing was performed by the method of variance analysis.&#x0D; Results. As a result of rehabilitation measures, locomotion function and fine motility of the upper limb are restored in all patients. Recovery of upper extremity fine motility and stato-dynamic indicators in patients who received neuroprotective effects during the treatment of stroke is permanent. Positive dynamics are monitored throughout the entire period of catamnetic observation.&#x0D; The use of peptidergic drugs has a greater neurorehabilitation effect than the isolated use of micropolarization. The combined use of micropolarization and peptidergic metabolic support in patients with ischemic stroke significantly improves the functional results of rehabilitation at all stages of observation.&#x0D; According to the FMA-UE test, statistically significant differences compared to controls were observed in the subtests of mobility in the carpal joint and fingers of the hand, as well as voluntary movements with synergy. In patients of the I group, the score on the AII subscale was 15.2 ± 0.2 points, in the II group – 17.3 ± 0.3 points, in the III group – 17.3 ± 0.4 points, and in patients in the IV group – 17, 2±0.3 points (p&lt;0.05). The score on subscale B (mobility of the wrist) for patients of group I was 8.2±0.1 points, group II – 9.0±0.1 points, group III – 9.4±0.1 points, group IV – 9.5±0.1 points (p&lt;0.05). According to subscale C (mobility of the fingers of the hand), the average score in the I group was 11.8±0.2 points, in the II group – 13.0±0.3 points, in the III group – 13.5±0.2 points, and in the IV group – 13.6±0.2 points (p&lt;0.05).&#x0D; According to the data of the FMA-LE test in domain EII (voluntary movements with synergy) in the control (I) group one year after ischemic stroke, the score corresponded to the level of 10.3±0.3 points, in the II group - 13.0±0.4 points, in group III – 13.5±0.3 points, in group IV – 13.6±0.4 points (p&lt;0.05). For the EIII domain (voluntary movements with mixed synergy), the indicators increased to 2.8±0.1 points in the I group, to 3.2±0.1 points in the II group, to 3.3±0.1 points in the III group, up to 3.5±0.1 points – in the IV group (p&lt;0.05). The total FMA-LE score was 74.2±2.4 points for the I group, 78.5±2.6 points for the II group, 79.5±3.2 points for the III group, and 80 for the IV group 80.7±2.5 points (p&lt;0.05).&#x0D; Conclusions. As a result of rehabilitation measures, all patients recover locomotion function, fine motility of the upper limb. The greatest increase in indicators is characteristic of the EFAT subtest, which evaluates the function of straightening the fingers of the hand.The use of peptidergic drugs has a greater neurorehabilitation effect than the isolated use of micropolarization. The combined use of micropolarization and peptidergic metabolic support in patients with ischemic stroke significantly improves the functional results of early rehabilitation.

Translation and validation of stroke impact scale-16 in Urdu for Pakistan.

To translate and validate the Urdu version of stroke impact scale-16 for Pakistani society. The prospective cohort study was conducted from February 2018 to February 2020 after approval from the ethics review board of The University of Lahore, Lahore, Pakistan, and copmprised patients with mild to moderate stroke who were recruited from five public and two private hospitals of the Punjab province. Established guidelines were followed to translate the Stroke Impact Scale-16. The patients were concurrently evaluated on Barthel Index, Stroke Rehabilitation Assessment of Movement, Modified Rivermead Mobility Index, Modified Rankin Scale, Short Form 36 Health Survey Questionnaire and the Hospital Anxiety and Depression Scale to assess the validity of Stroke Impact Scale-16, and spearmen correlation coefficient was used to determine the correlation among the scales. Analysis of variance was employed to determine the discriminant validity. Intraclass correlation coefficient, weighted kappa, Cronbach's alpha and item-total correlation were calculated to establish the stability and consistency of Stroke Impact Scale-16. Data was analysed using SPSS 25. Of the 90 patients, 50(55.5%) were females and 40(45.5%) were males. The subjects were aged 50-80 years. The correlation of Stroke Impact Scale-16 was strong with the established tools and ranged from 0.78 to 0.91. The discriminant validity was also significant (p<.001) across all Modified Rankin Scale levels. The Intraclass correlation coefficient was 0.94 and Cronbach's alpha was 0.91 for test-retest reliability and internal consistency, respectively. All corrected item-total correlation values exceeded the priori minimum standard (>0.40) and ranged from 0.51 to 0.68. The weighted kappa for item reliability also achieved priori criteria (>0.40) and ranged from 0.53 to 0.88. With slight modifications, the Urdu version of Stroke Impact Scale-16 was found to have satisfactory psychometric properties and can be used in clinical and research settings for stroke survivors in Pakistan.

Using Machine Learning to Develop a Short-Form Measure Assessing 5 Functions in Patients With Stroke

ObjectiveThis study aimed to develop and validate a machine learning-based short measure to assess 5 functions (the ML-5F) (activities of daily living [ADL], balance, upper extremity [UE] and lower extremity [LE] motor function, and mobility) in patients with stroke. DesignSecondary data from a previous study. A follow-up study assessed patients with stroke using the Barthel Index (BI), Postural Assessment Scale for Stroke (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) at hospital admission and discharge. SettingA rehabilitation unit in a medical center. ParticipantsPatients (N=307) with stroke. InterventionsNot applicable. Main Outcome MeasuresThe BI, PASS, and STREAM. ResultsA machine learning algorithm, Extreme Gradient Boosting, was used to select 15 items from the BI, PASS, and STREAM, and transformed the raw scores of the selected items into the scores of the ML-5F. The ML-5F demonstrated good concurrent validity (Pearson's r, 0.88-0.98) and responsiveness (standardized response mean, 0.28-1.01). ConclusionsThe ML-5F comprises only 15 items but demonstrates sufficient concurrent validity and responsiveness to assess ADL, balance, UE and LE functions, and mobility in patients with stroke. The ML-5F shows great potential as an efficient outcome measure in clinical settings.

Classification of Limb and Mobility Impairments in Persons With Stroke Using the STREAM.

Classification of functional impairment in persons with stroke can influence treatment planning but this information is missing in the Stroke Rehabilitation Assessment of Movement (STREAM) Scale. This study aimed to establish the classification of limb mobility impairments and item difficulty of the STREAM. Rasch analysis was conducted on the STREAM scores to examine the person and item reliability, the item difficulty, and level of impairments. A total of 240 participants were evaluated using the STREAM, the Fugl-Meyer Stroke Assessment (FM), and the Functional Ambulation Categories (FAC). The concurrent validity of the STREAM extremity (STREAM-E) category with the FM-motor category and the STREAM mobility (STREAM-M) category with the FAC category was analyzed using the Spearman rank-order correlation. Person reliabilities of the STREAM-E and STREAM-M were 0.92 and 0.80, respectively. High-item reliability was observed in both STREAM-E (0.97) and STREAM-M (0.99). The STREAM items "flexes hip and knee in supine" and "rolls onto side" were the easiest items, whereas the "dorsiflexes affected ankle with knee extended" item was the most difficult item. The STREAM-E category demonstrated excellent concurrent validity with the FM-motor category (ρ = 0.83) in classifying individuals with stroke into 5 groups: mild, moderate, moderately severe, severe, and very severe limb impairment. The STREAM-M category showed a moderate correlation with the FAC category (ρ = 0.71) in categorizing persons with stroke into 3 groups: mild, moderate, and severe mobility impairment. Findings can be used in the assessment and treatment planning of persons with stroke.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A373).

Effects of Trunk Exercise on Unstable Surfaces in Persons with Stroke: A Randomized Controlled Trial.

Background: Improving balance-related ability is an important goal in stroke rehabilitation. Evidence is needed to demonstrate how this goal could be better achieved. Aim: Determine if trunk exercises on unstable surfaces would improve trunk control and balance for persons in the subacute stage of stroke. Design: An assessor-blind randomized controlled trial. Setting: Inpatients in the department of rehabilitation in a general hospital. Population: Patients who suffered a first-time stroke with onset from one to six months. Methods: Inpatients with stroke were assigned to upper limb exercises (control group, n = 17) or trunk exercises on unstable surfaces (experimental group, n = 18) to receive training twice a week for six weeks, in addition to their daily conventional stroke rehabilitation. Sensorimotor function tests, including hand grip, plantar sensitivity, stroke rehabilitation assessment of movement and Fugl-Meyer lower extremity motor scale, and clinical outcome assessments, including Trunk Impairment Scale and 6 m walk test, were conducted before and after six weeks of training. The center of the pressure area while maintaining static posture and peak displacement while leaning forward, as well as the average speed of raising the unaffected arm, were measured in sitting without foot support, sitting with foot support and standing to reflect trunk control, sitting balance and standing balance, respectively. Results: The between-group differences in the sensorimotor functions were nonsignificant before and after training. Compared with the control group, the experimental group had significantly greater forward leaning and faster arm raising in sitting without foot support, higher Trunk Impairment Scale total score, and shorter 6 m walking time after training, but not before training. Conclusion: Trunk exercises on unstable surfaces could further improve trunk control, the ability to raise the unaffected arm rapidly in sitting, and walking for persons in the subacute stage of stroke. This intervention may be considered to be included in stroke rehabilitation.

Adaptação transcultural e validação da versão moçambicana da Stroke Rehabilitation Assessment of Movement

Introdução: A utilização de instrumentos de medida padronizados e fidedignos é um pré-requisito das boas práticas da Fisioterapia e permite monitorizar os resultados da intervenção e reclamar credibilidade científica para a profissão. A Stroke Rehabilitation Assessment of Movement (STREAM) é um instrumento muito utilizado na avaliação das limitações a nível do movimento voluntário e da mobilidade básica em utentes com sequelas de Acidente Vascular Cerebral (AVC). Objetivo: Contribuir para a adaptação transcultural e validação da versão portuguesa da STREAM, ao contexto cultural e linguístico Moçambicano. Materiais e Métodos: Foram utilizadas duas amostras distintas: 1) 9 peritos analisaram a validade de conteúdo; 2) 70 utentes com sequelas de AVC selecionados por conveniência do Hospital Central de Nampula (HCN) e do Hospital Geral de Mavalane (HGM), foram submetidos à aplicação da escala STREAM por 6 observadores independentes, com a finalidade de analisar a fiabilidade do instrumento. Resultados: A versão Moçambicana da STREAM, revelou para a validade de conteúdo, um consenso absoluto (100%) entre os elementos do painel de peritos; para a reprodutibilidade inter-observador, os valores do Coeficiente de Correlação Intraclasse (CCI) indicaram um índice de concordância perfeita, com valores de CCI que variaram entre 0,980-0,993 no HCN e entre 0,980-1,000 no HGM e, uma boa consistência interna com valores de alfa de Cronbach entre 0,904-0,998 no HCN e entre 0,881-1,000 no HGM, para cada uma das 3 subescalas e para o total da escala. Conclusão: A versão Moçambicana da escala STREAM revelou ser válida e fiável para as propriedades psicométricas investigadas (...)

The Effect of High- and Low-Frequency Repetitive Transcranial Magnetic Stimulation Therapy on Serum Brain-Derived Neurotropic Factor Level and Motor Ability in Ischemic Stroke Patients: A Single-Center Study

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is widely used in various neurological cases. rTMS is an effective method of restoration in patients with disability due to central nervous system disorder.&#x0D; AIM: This study aimed to determine the effect of high and low frequency of rTMS on serum brain-derived neurotropic factor (BDNF) levels and motoric abilities in ischemic stroke patients.&#x0D; METHODS: The study design was an experiment with a purposive sampling consecutive on 27 samples with the onset of ischemic stroke 6 months. The study was conducted from February to October 2018; samples were recruited from Neurology Ward of Wahidin Sudirohusodo hospital and its affiliating centers. The serial of rTMS intervention was delivered in “Brain” Clinic center. After fulfilling the inclusion criteria and the initial examination of serum BDNF and motor ability, samples were randomly divided into two groups, intervention group who received standard therapy with rTMS therapy (n = 14) and the control group who only received standard therapy (n = 13). rTMS was given for 2 min frequency of 1 Hertz (Hz) contralesion and 5 Hz ipsilesion every day for 10 days. Assessment of serum BDNF levels and motor skills was conducted on days 1 and 10 of the study. Serum BDNF levels were measured by the monoclonal antibody ELISA technique while motor skills were measured based on the score of the Stroke Rehabilitation Assessment of Movement (STREAM). Serum BDNF values and the STREAM delta score were compared between the two groups of samples.&#x0D; RESULTS: The results showed significant changes only occurred in motor abilities in both groups of samples after 10 days of rTMS therapy with the Wilcoxon test (p &lt; 0.5). The Mann–Whitney U-test showed a more significant change (p &lt; 0.5) in the treatment group than in the control (p = 0.5).&#x0D; CONCLUSION: rTMS has an effect on improving motor ability in ischemic stroke patients. This change in motor abilities is not related to serum BDNF levels in this study.

Intra rater reliability and validity of simplified stroke rehabilitation assessment of movement (s-stream) scale on voluntary movement of the limbs and basic mobility in patients with stroke – An observational study

Introduction: A stroke is a clinical syndrome characterised by rapidly developing clinical symptoms and / or signs of focal, and at times global, loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin. Globally, cerebrovascular disease (stroke) is a second leading cause of death. For providing a better management we must evaluate the patient with a good valid and reliable tool. In physiotherapy for evaluating the stroke subjects mobility and functional activity there are many assessment tools are available for assessing Balance, Functional activity, mobility and gait through Berg Balance Scale, Functional Independence Measure, Barthal Index and observational Gait Analysis. Other than these scales, Stroke Rehabilitation Assessment of Movement Scale (STREAM) is one of the good reliable and valuable scale for the assessing of mobility and functional activity in stroke patients . Aim of the Study: The aim of this study was to evaluate the Intra rater reliability and validity of Simplified- STREAM (S-STREAM) Scale on mobility and functional activity in patients with Stroke. Materials and Methods: This study was carried out for the period of one year. 100 stroke patients were selected from Neurology ward of Sri Ramakrishna Hospital, Coimbatore who fulfilled the inclusion criteria. Intra rater reliability of S-STREAM was assessed for 1st and 2nd day of consequent 3 weeks. Validity of S-STREAM scale was evaluated by comparing the components of S-STREAM scale’s upper and lower limb voluntary movement with Fugl-meyer motor assessment scale components; Mobility component of S-STREAM was compared with Rivermead mobility index scale on first day of assessment. Data analysis of Intra-rater reliability and validity done with an help of Pearson’s correlation coefficient test. Conclusion: The results of this study shows that the S-STREAM has high Intra rater reliabilit

Development of a Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke: A Simulation and Validation Study

ObjectiveThe authors aimed to develop and validate the Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke (CAT-5F) based on the Barthel Index (BI), Postural Assessment Scale for Stroke patients (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) to improve the efficiency of assessment. The purposes of the CAT-5F assessment are to describe patients’ levels of impairments or disabilities in the 5 functions and to serve as an outcome measure in patients with stroke. DesignThis is a data-mining study based on data from a previous study using simulation analysis to develop and validate the CAT-5F. SettingOne rehabilitation unit in a medical center in Taiwan served as the setting for this study. ParticipantsData were retrieved from totals of 540 (initial assessment) and 309 (discharge assessment) participants with stroke assessed in a previous study. The assessment data (N=540) were from the BI, PASS, and STREAM. InterventionsNot applicable. Main Outcome MeasuresThe outcome measures for this study were from BI, PASS, and STREAM. ResultsThe CAT-5F using the optimal stopping rule (limited reliability increased <0.010) had good Rasch reliability across the 5 functions (0.86-0.96) and needed 12.7 items, on average, for the whole administration. The concurrent validity (Pearson product-moment correlation coefficient, r=0.91-0.96) and responsiveness (standardized response mean=0.33-0.91) of the CAT-5F were sufficient in the patients. ConclusionThe CAT-5F has sufficient administrative efficiency, reliability, concurrent validity, and responsiveness to simultaneously assess basic activities of daily living, postural control, upper extremity/lower extremity motor functions, and mobility in patients with stroke.

Rasch analysis of the upper-limb subscale of the stroke rehabilitation assessment of movement (STREAM) tool in an acute stroke cohort Rasch analysis of the upper-limb subscale of the STREAM tool in an acute stroke population

ABSTRACTBackground: Stroke is a leading cause of disability worldwide. The most common impairment resulting from stroke is upper-limb weakness.Objectives: To determine the usefulness and psychometric validity of the upper-limb subscale of the STREAM in an acute stroke population.Methods: Rasch Analysis, including unidimensionality assumption testing, determining model fit, and analysis of: reliability, residual correlations, and differential item functioning.Results: 125 individuals were assessed using the upper-limb subscale of the Stroke Rehabilitation Assessment of Movement (STREAM) tool. Rasch analysis suggests the STREAM is a unidimensional measure. However, when scored using the originally proposed method (0–2), or using the response pattern (0–5) neither variant fit the Rasch model (p < 0.05). Although, the reliability was good (Person-Separation Index – 0.847 and 0.903, respectively). Correcting for the disordered thresholds, and thereby producing the new scoring pattern, led to substantial improvement in the overall fit (chi-square probability of fit – 22%), however, the reliability was slightly reduced (PSI – 0.806).Conclusions: The study proposes a new scoring method for the upper-limb subscale of the STREAM outcome measure in the acute stroke population.

Prediction of lower extremity motor recovery in persons with severe lower extremity paresis after stroke

ABSTRACTObjective: To investigate the extent of motor recovery and predict the prognosis of lower extremity (LE) recovery in patients with severe LE paresis after strokeMethods: 137 patients with severe LE paresis after stroke were recruited from a local medical centre. Voluntary LE movement was assessed with the LE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-LE). Univariate and stepwise regression analyses were used to investigate 25 clinical variables (including demographic, neuroimaging, and behavioural variables) for finding the predictors of LE recovery.Results: The STREAM-LE at discharge (DCSTREAM-LE) of the participants covered a very wide range (0–19). Specifically, 5.1% of the participants were nearly completely recovered, 11.7% were moderately recovered, 36.5% were slightly recovered, and 46.7% remained severely paralysed. ‘Score of STREAM-LE at admission (ADSTREAM-LE)’ and ‘volume of lesion and oedema’) were significant predictors of LE movement at discharge, explaining 25.1% of the variance of the DCSTREAM-LE (p < 0.001).Conclusions: LE motor recovery varied widely in our participants, indicating that patients’ recovery might not follow simple rules. The low predictive power (about a quarter) indicates that LE motor recovery in patients with severe LE paresis after stroke was hardly predictive.

23 - Romiplostim in Low/INT-1-Risk MDS Results in Reduced Bleeding without Impacting Leukemic Progression: Final Results from a Randomized, Double-Blind, Placebo-Controlled Study

This preliminary study sought to analyze the effects of a training program based on the Proprioceptive Neuromuscular Facilitation (PNF) method on motor recovery of individuals with chronic post-stroke hemiparesis. Eleven individuals with chronic hemiparesis (mean lesion time of 19.64 months) after unilateral and non-recurrent stroke underwent training based on PNF method for twelve sessions, being evaluated for motor function - using the Stroke Rehabilitation Assessment of Movement (STREAM) instrument; functionality, by the Functional Independence Measure (FIM); and gait kinematic (using the Qualisys Motion Capture System), at baseline and post-training. Significant changes in FIM (from median 67 to median 68; P = .043) and STREAM scores (from median 47 to median 55; P = .003) were observed. Data showed significant changes in motor function and functionality after training, suggesting that this program can be useful for rehabilitation of chronic stroke survivors.

Eclectic/mixed model method for upper extremity functional recovery in stroke rehabilitation: A pilot study.

Background:Eclectic treatment method is a flexible approach that uses techniques drawn from various schools of thought involving several treatment methods and allows the therapist to adapt to each client's individual needs. Wider application for eclectic approach is however limited in stroke rehabilitation.Aim:The objective is to find out whether eclectic approach improves upper extremity (UE) functional recovery in acute stroke rehabilitation.Methodology:Twenty-five postacute unilateral supratentorial stroke subjects recruited from tertiary care hospitals recovered with Stage 2–5 in Brunnstorm stage of UE motor recovery (BRS-UE) underwent 45 min of eclectic approach for UE every day involving seven different treatment methods (5 min for each method) for 6 days consecutively. The outcome was UE subscale of the Fugl-Meyer Motor test (UE-FM), UE subscale of the Stroke Rehabilitation Assessment of Movement (UE-STREAM), Wolf Motor Function test (WMFT-FAS), and Stroke Impact Scale-16 (SIS-16) was collected at the end of the sixth session.Results:All the participants showed significant improvement in all the outcome measures. The Stage 2 and 3 subjects showed UE-STREAM (P = 0.007) WMFT-FAS (P < 0.001), SIS (P = 0.023) respectively and for Stage 4 and 5 the subjects have shown UE FM (P < 0.001), WMFT-FAS (P < 0.001), SIS (P = 0.004) with large magnitude of treatment effect for all stages of BRS-UE.Conclusion:Our study findings are in favor of integrating eclectic approach than single intervention/approach in clinical practice to improve the UE functional recovery for motor rehabilitation when the stroke occurs.

Improving the utility of the Brunnstrom recovery stages in patients with stroke

The Brunnstrom recovery stages (the BRS) consists of 2 items assessing the poststroke motor function of the upper extremities and 1 assessing the lower extremities. The 3 items together represent overall motor function. Although the BRS efficiently assesses poststroke motor functions, a lack of rigorous examination of the psychometric properties restricts its utility. We aimed to examine the unidimensionality, Rasch reliability, and responsiveness of the BRS, and transform the raw sum scores of the BRS into Rasch logit scores once the 3 items fitted the assumptions of the Rasch model.We retrieved medical records of the BRS (N = 1180) from a medical center. We used Rasch analysis to examine the unidimensionality and Rasch reliability of both upper-extremity items and the 3 overall motor items of the BRS. In addition, to compare their responsiveness for patients (n = 41) assessed with the BRS and the Stroke Rehabilitation Assessment of Movement (STREAM) on admission and at discharge, we calculated the effect size (ES) and standardized response mean (SRM).The upper-extremity items and overall motor items fitted the assumptions of the Rasch model (infit/outfit mean square = 0.57–1.40). The Rasch reliabilities of the upper-extremity items and overall motor items were high (0.91–0.92). The upper-extremity items and overall motor items had adequate responsiveness (ES = 0.35–0.41, SRM = 0.85–0.99), which was comparable to that of the STREAM (ES = 0.43–0.44, SRM = 1.00–1.13).The results of our study support the unidimensionality, Rasch reliability, and responsiveness of the BRS. Moreover, the BRS can be transformed into an interval-level measure, which would be useful to quantify the extent of poststroke motor function, the changes of motor function, and the differences of motor functions in patients with stroke.