Stroke Upper Limb Capacity Scale Research Articles

Italian translation, cultural adaptation, and validation of the Action Research Arm Test (ARAT) and the Stroke Upper Limb Capacity Scale (SULCS) for individuals post-stroke.

This study aims to culturally adapt and validate the Stroke Upper Limb Capacity Scale (SULCS) and Action Research Arm Test (ARAT) for use with post-stroke patients in Italy. The original scales were translated and culturally adapted following the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice" guidelines. We assessed internal consistency and test-retest reliability, while concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Disability Arm Shoulder and Hand (DASH). A total of 56 participants were recruited for the study. The Italian versions of the scales demonstrated excellent stability and reliability both within and between raters. The Cronbach's alpha coefficients were 0.904 for SULCS and 0.998 for ARAT, indicating strong internal consistency among items. The interclass correlation coefficients were 0.998 (95% C.I.: 0.993-0.990) for inter-rater reliability and 0.987 (95% C.I.: 0.984-0.995) for intra-rater reliability for SULCS, and 0.998 (95% C.I.: 0.999-0.996) for inter-rater reliability and 0.992 (95% C.I.: 0.998-0.987) for intra-rater reliability for ARAT. Both scales exhibit robust validity and reliability, making them valuable tools for clinical assessment and functional evaluation of upper limb capacity in post-stroke patients. We recommend the integration of the ARAT and SULCS into initial patient assessments and ongoing monitoring to enhance rehabilitation outcomes.

RETRACTED: Assessment Capacity of the Armeo® Power: Cross-Sectional Study

The use of robotics in rehabilitating motor functions has increased exponentially in recent decades. One of the most used robotic tools is undoubtedly the Armeo® Power, which has proved to have excellent qualities as a rehabilitation tool. However, none of these studies has investigated the ability of Armeo® Power to assess the upper limb by correlating the data resulting from the software with patient-reported outcome measures (PROMs). The present study aims to evaluate the variability between the standardized PROMs, Stroke Upper Limb Capacity Scale (SULCS), Fugl–Meyer upper limb assessment (FMA-UL), and the Armeo® Power measurements. To evaluate the correlation between SULCS and FMA-UL and the strength and joint assessments obtained with the Armeo® Power, Pearson’s correlation coefficient was used. A total of 102 stroke survivors were included in this cross-sectional study, and all participants finished the study. The results showed many statistically significant correlations between PROM items and Armeo® Power data. In conclusion, from this study, it can be stated that Armeo® Power, based on the analysis of the data collected, can be an objective evaluation tool, which can be combined with the operator-employee traditional evaluation techniques, especially when compared to a patient-reported outcome measures (PROMs).

Construct Validity of the Stroke Upper-Limb Capacity Scale as a Measure of Upper Extremity Capacity

<h3>Research Objectives</h3> The Stroke Upper-Limb Capacity Scale (SULCS) is a standardized assessment of 10 upper extremity (UE) functional tasks, but there are little data on construct validity in acute stroke. Using International Classification of Function definitions, we hypothesize: H1 – a stronger relationship between the SULCS and another activity measure (Functional Independence Measure Selfcare (FIM-SC)), as compared to the SULCS and an impairment measure Motricity Index-UE (MI-UE)); H2 – a stronger association between the SULCS and UE items on the FIM (eating, grooming and bathing (FIM-E, FIM-G, FIM-Ba, respectively)) compared to FIM items not dependent on UE function (walking, bowel and expression (FIM-W, FIM-Bo, FIM-Exp, respectively)). <h3>Design</h3> Cross-sectional. <h3>Setting</h3> Academic inpatient rehabilitation unit. <h3>Participants</h3> N=341/488 (70%) admissions with complete data, age=70±15 years, time post stroke=10±9 days, length of stay=14±8 days, female=47.2%, Admission Total FIM=60±20, Admission SULCS=5.5±3.6, Admission MI-UE=65±35. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> SULCS, FIM and MI-UE. <h3>Results</h3> H1: SULCS correlated significantly with FIM-SC and MI-UE (ρ=0.74 and ρ=0.85, respectively; (p< 0.001)). H2: SULCS correlated significantly with upper extremity selfcare items (FIM-E/ρ=0.61, FIM-G/ρ=0.56 and FIM-Ba/ρ=0.60), and significantly but more weakly with non-upper extremity items (FIM-Bo/ρ=0.47, FIM-W/ρ=0.57 and FIM-Exp/ρ=0.37). All p< 0.001. <h3>Conclusions</h3> Contrary to H1, SULCS was similarly and strongly correlated with MI-UE and FIM. The inability to compensate for hemiparesis with the intact extremity on both SULCS and MI-UE may explain this unexpected finding. H2 was generally supported, as SULCS demonstrated stronger correlations with UE selfcare items compared to non-UE items. The correlation between SULCS and FIM-W is likely due to hemiparesis in stroke commonly affecting upper and lower extremities. We conclude that SULCS is likely a valid measure of UE capacity early after stroke. <h3>Author(s) Disclosures</h3> The authors declare that they have no relevant conflicts that relate to the research described in this paper.

Responsiveness and trajectory of changes in the rating of everyday arm-use in the community and home (REACH) scale over the first-year post-stroke

Objective To examine the trajectory of the Rating of Everyday Arm-use in the Community and Home (REACH) scores over the first-year post-stroke, determine if REACH scores are modified by baseline impairment level and explore the responsiveness of the REACH scale through hypothesis testing. Design Consecutive sample longitudinal study. Setting Participants were recruited from an acute stroke unit and followed up at three, six, and 12 months post-stroke. Participants Seventy-three participants with upper limb weakness (Shoulder Abduction and Finger Extension score ≤ 8). Main Measures The REACH scale is a six-level self-report classification scale that captures how the affected upper limb is being used in one's own environment. The Fugl-Meyer Upper Limb Assessment (FMA-UL), Stroke Upper Limb Capacity Scale (SULCS), accelerometer-based activity count ratio and Global Rating of Change Scale (GRCS) were used to capture upper limb impairment, capacity, and use. Results The following proportions of participants improved at least one REACH level: 64% from baseline to three months, 37% from three to six months and 13% from six to 12 months post-stroke. The trajectory of REACH scores over time was associated with baseline impairment. Change in REACH had a moderate correlation to change in SULCS and the GRCS but not FMA-UL or the activity count ratio. Conclusions Results of hypothesis testing provide preliminary evidence of the responsiveness of the REACH scale. On average, individuals with severe impairment continued to show improvement in use over the first year, while those with mild/moderate impairment plateaued and a small proportion decreased in the early chronic phase.

Measurement properties of the Brazilian version of the Stroke Upper Limb Capacity Scale (SULCS-Brazil)

ABSTRACT Background The Stroke Upper Limb Capacity Scale (SULCS) is a clinically useful measure of upper-limb (UL) capacity, which assesses both basic and advanced capacities. Objectives To examine the reliability, construct validity, and interpretability of the SULCS-Brazil with community-dwelling individuals with stroke. Methods The SULCS-Brazil and measures of impairment (handgrip strength and motor function of the paretic UL), capacity (manual and digital dexterities), and performance were applied during the first session, to establish construct validity (80 patients). The SULCS-Brazil was applied again during a second session (a sub-set of 30 patients), to investigate test–retest reliability. Test–retest reliability was evaluated using kappa statistics (k) for the individual items, intraclass correlation coefficient (ICC) for the total scores, standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plot. For the evaluation of construct validity, pre-defined hypotheses were created to estimate the strength of the correlations between the SULCS-Brazil scores and established measures of UL function, using Spearman correlation coefficients. Interpretability was investigated by evaluating both ceiling/ floor effects. Results High level of agreement was found between the SUCLS-Brazil total scores obtained on both applications (ICC = 0.98; 95%CI:0.96–0.99) and 80% of the individual items had almost perfect agreement (k= 0.81–1.0). The SEM (0.46) and the MDC (1.27) showed clinically acceptable values. All pre-defined hypotheses were confirmed, indicating adequate construct validity of the SULCS-Brazil. No significant ceiling/floor effects were observed. Conclusions The SULCS-Brazil showed to be reliable and valid for the evaluation of upper-limb capacity of individuals with stroke.

The German version of the Stroke Upper Limb Capacity Scale: Translation, cross-cultural adaption and evaluation of its psychometric properties

Objective: To investigate the psychometric properties of a newly developed German version of the Stroke Upper Limb Capacity Scale (SULCS). Design: Prospective cohort study. Setting: Neurorehabilitation clinic. Subjects: Patients after stroke (n = 50) with moderate to severe upper limb hemiparesis undergoing inpatient rehabilitation. Intervention: Not applicable. Main measures: The SULCS was administered twice by two different raters on the first day of assessments and another time the day after. Additionally the Fugl-Meyer-Assessment, Action Research Arm Test and the Box and Block Test were conducted. Three and six weeks later, the SULCS, Fugl-Meyer-Assessment and Box and Block Test were repeated. Floor and ceiling effects were analyzed. Results: Reliability was demonstrated to be excellent as displayed by weighted kappa of 0.960 (95%-confidence interval: CIκw = 0.808–1.112) for the intra-rater reliability and 0.936 (CIκw = 0.749–1.123) for the inter-rater reliability. High correlations of the SULCS with the Fugl-Meyer-Assessment (ρ = 0.889), Action Research Arm Test (ρ = 0.872), and Box and Block Test (ρ = 0.845; all P < 0.001) confirmed a high convergent validity. The longitudinal validity was determined by a moderate to high correlation of the SULCS and Box and Block Test changes (ρ ⩾ 0.695, P ⩽ 0.001). Although floor effects were observed for the SULCS (16%), they were more substantial for the Action Research Arm Test and the Box and Block Test (>38%). Conclusion: Due to the good to excellent psychometric properties and the low level of floor effects of the German version of the SULCS, the usage for clinical and scientific purposes can be recommended.

Efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients

Introduction and Aim:Strokeis one of the leading causes of death and disability in India. The incidence of stroke rapidly increases with age, doubling for each decade after 55.In the majority of patients the upper limb is severely impaired than lower limb. The aim of this study was to analyze the efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients.&#x0D; &#x0D; Materials and Methods: This was an experimental study, of pre-post type, that was conducted in the outpatient department of Physiotherapy at ACS Medical College and Hospital,chennai.30 samples were selected from 45 volunteers according to inclusion criteria and the study was conducted for Group A received sensorimotor therapy for one session/day for 6 days a week for 12 weeks. Group B received motor therapy for one session/day for 6 days a week for 12 weeks. Pre and post measurement were done using motor assessment scale, stroke upper limb capacity scale, action research arm test and nine-hole peg test.&#x0D; &#x0D; Results: There was a significant difference in mean values of group A and B on comparison. Group A seems to be more effective than group B.&#x0D; &#x0D; Conclusion: The study concludes that both motor therapy and sensorimotor therapy are beneficial in stroke rehabilitation, but sensorimotor therapy is more effective in improving the gross and fine motor skills of the upper limb of stroke patients.

Arm-Hand Boost Therapy During Inpatient Stroke Rehabilitation: A Pilot Randomized Controlled Trial.

Objective: It was the aim to assess feasibility, safety, and potential efficacy of a new intensive, focused arm-hand BOOST program and to investigate whether there is a difference between early vs. late delivery of the program in the sub-acute phase post stroke.Methods: In this pilot RCT, patients with stroke were randomized to the immediate group (IG): 4 weeks (4 w) BOOST +4 w CONTROL or the delayed group (DG): 4 w CONTROL +4 w BOOST, on top of their usual inpatient care program. The focused arm-hand BOOST program (1 h/day, 5x/week, 4 weeks) consisted of group exercises with focus on scapula-setting, core-stability, manipulation and complex ADL tasks. Additionally, 1 h per week the Armeo®Power (Hocoma AG, Switzerland) was used. The CONTROL intervention comprised a dose-matched program (24 one-hour sessions in 4 w) of lower limb strengthening exercises and general reconditioning. At baseline, after 4 and 8 weeks of training, the Fugl-Meyer assessment upper extremity (FMA-UE), action research arm test (ARAT), and stroke upper limb capacity scale (SULCS) were administered.Results: Eighteen participants (IG: n = 10, DG: n = 8) were included, with a median (IQR) time post stroke of 8.6 weeks (5–12). No adverse events were experienced. After 4 weeks of training, significant between-group differences were found for FMA-UE (p = 0.003) and SULCS (p = 0.033) and a trend for ARAT (p = 0.075) with median (IQR) change scores for the IG of 9 (7–16), 2 (1–3), and 12.5 (1–18), respectively, and for the DG of 0.5 (−3 to 3), 1 (0–1), and 1.5 (−1 to 9), respectively. In the IG, 80% of patients improved beyond the minimal clinical important difference of FMA-UE after 4 weeks, compared to none of the DG patients. Between 4 and 8 weeks of training, patients in the DG tend to show larger improvements when compared to the IG, however, between-group comparisons did not reach significance.Conclusions: Results of this pilot RCT showed that an intensive, specific arm-hand BOOST program, on top of usual care, is feasible and safe in the sub-acute phase post stroke and suggests positive, clinical meaningful effects on upper limb function, especially when delivered in the early sub-acute phase post stroke.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT04584177

Impact of Post-Stroke Recanalization on General and Upper Limb Functioning: A Prospective, Observational Study.

The objective of this study is to assess the impact of recanalization (spontaneous and therapeutic) on upper limb functioning and general patient functioning after stroke. This is a prospective, observational study of patients hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery (n = 98). Patients completed a comprehensive rehabilitation program and were followed-up for 24 weeks. The impact of recanalization on patient functioning was evaluated using the modified Rankin Scale (mRS) and Stroke Upper Limb Capacity Scale (SULCS). General and upper limb functioning improved markedly in the first three weeks after stroke. Age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission were associated with general and upper limb functioning at 12 weeks. Successful recanalization was associated with better functioning. Among patients who underwent therapeutic recanalization, NIHSS scores ≥16.5 indicate lower general functioning at 12 weeks (sensibility = 72.4%; specificity = 78.6%) and NIHSS scores ≥13.5 indicate no hand functioning at 12 weeks (sensibility = 83.8%; specificity = 76.5%). Recanalization, either spontaneous or therapeutic, has a positive impact on patient functioning after acute ischemic stroke. Functional recovery occurs mostly within the first 12 weeks after stroke, with greater functional gains among patients with successful recanalization. Higher NIHSS scores at admission are associated with worse functional recovery.

Adding Contralaterally Controlled Electrical Stimulation of the Triceps to Contralaterally Controlled Functional Electrical Stimulation of the Finger Extensors Reduces Upper Limb Impairment and Improves Reachable Workspace but not Dexterity: A Randomized Controlled Trial.

Different methods of neuromuscular electrical stimulation may be used for poststroke upper limb rehabilitation. This study evaluated the effects of contralaterally controlled functional electrical stimulation of the triceps and finger extensors. This is a randomized controlled trial of 67 participants who were less than 2 yrs poststroke and assigned to the following: (a) arm + hand contralaterally controlled functional electrical stimulation, (b) hand contralaterally controlled functional electrical stimulation, or (c) arm + hand cyclic neuromuscular electrical stimulation. Participants were prescribed 10 sessions/week of assigned electrical stimulation at home plus 24 sessions of functional task practice in the laboratory for 12 wks. The primary outcome measure was the Box and Blocks Test. Secondary measures included reachable workspace, Upper Extremity Fugl-Meyer, Stroke Upper Limb Capacity Scale, Arm Motor Abilities Test, and Motor Activity Log. There were no significant between-group differences on the Box and Blocks Test. At 6 mos after treatment, arm + hand contralaterally controlled functional electrical stimulation improved reachable workspace more than hand contralaterally controlled functional electrical stimulation, between-group difference of 264 (95% confidence interval = 28-500) cm and more than arm + hand cyclic neuromuscular electrical stimulation, between-group difference of 281 (95% confidence interval = 22-540) cm. Arm + hand contralaterally controlled functional electrical stimulation improved Upper Extremity Fugl-Meyer score more than hand contralaterally controlled functional electrical stimulation, between-group difference of 6.7 (95% confidence interval = 0.6-12.7). The between-group differences on the Stroke Upper Limb Capacity Scale and Arm Motor Abilities Test were not significant. Adding contralaterally controlled elbow extension to hand contralaterally controlled functional electrical stimulation does not improve on gains in hand dexterity, but it further reduces upper limb impairment and improves reachable workspace measured in the laboratory. However, these additional benefits may not be large enough to be perceived by stroke survivors when they are performing activities of daily living at home.

Feasibility of an Electromyography-Triggered Hand Robot for People After Chronic Stroke

Effective treatment of the affected hand after stroke is crucial for improved functional independence and recovery. To determine the feasibility and clinical utility of an electromyography-triggered hand robot. Single-group repeated-measures design. Participants completed training 3×/wk for 6 wk. Feasibility data included participant feedback, adverse events, and compliance rates. Upper extremity outcomes were collected at baseline, discharge, and 6-wk follow-up. Outpatient clinic. Twelve stroke survivors at least 6 mo poststroke living in the community. Eighteen sessions of intensive robotic hand therapy over 6 wk. Each 60-min treatment session was personalized to match the participant's ability. Arm Motor Ability Test (AMAT), Stroke Impact Scale Hand subscale (SIS-H), Stroke Upper Limb Capacity Scale (SULCS), Fugl-Meyer Assessment, Box and Block Test, and dynamometer. All participants completed the training phase. Mild skin pinching or rubbing at dorsal proximal interphalangeal joint and proximal arm fatigue were the most common adverse events. Improvements in raw scores were achieved from baseline to discharge for all outcome measures, except the SULCS. Participants significantly improved from baseline to discharge on the AMAT and the SIS-H, and improvements were maintained at 6-wk follow-up. Robotic hand training was feasible, safe, and well tolerated. Participants reported and demonstrated improvements in functional use of the affected arm. Thirty percent of participants achieved clinically significant improvements on the AMAT. We recommend further study of the device in a larger study using the AMAT as a primary outcome measure. It is feasible and safe to implement a robotic hand training protocol for people with moderate to severe arm impairment in an outpatient setting. Robotic training may provide a viable option for this group to actively participate in intensive training of the distal hand.

Assessing upper limb function: Transcultural adaptation and validation of the Portuguese version of the Stroke Upper Limb Capacity Scale

Brachial hemiparesis is one of the most frequent sequelae of stroke, leading to important functional disability given the role of the upper limb in executing activities of daily living (ADL). The Stroke Upper Limb Capacity Scale (SULCS) is a stroke-specific assessment instrument that evaluates functional capacity of the upper limb based on the execution of 10 tasks. The objective of this study is the transcultural adaptation and psychometric validation of the Portuguese version of the SULCS. A Portuguese version of the SULCS was developed, using the process of forward-backward translation, after authorisation from the author of the original scale. Then, a multicentre study was conducted in Portuguese stroke patients ( n = 122) to validate the psychometric properties of the instrument. The relationship between sociodemographic and clinical characteristics was used to test construct validity. The relationship between SULCS scores and other instruments was used to test criterion validity. Semantic and linguistic adaptation of the SULCS was executed without substantial issues and allowed the development of a Portuguese version. The application of this instrument suggested the existence of celling effect (19.7% of participants with maximum score). Reliability was demonstrated through the intraclass correlation coefficient of 0.98. As for construct validity, SULCS was sensible to muscle tonus and aphasia. SULCS classification impacted the scores of the Motor Evaluation Scale for Upper Extremity in Stroke (MESUPES) and the Stroke Impact Scale (SIS). The present version of SULCS shows valid and reliable cultural adaptation, with good reliability and stability.

Assessing functional recovery in the first six months after acute ischemic stroke: a prospective, observational study.

Stroke is a major cause of short-term functional impairment, but the recovery timeframes are not well-established. This study aims to evaluate the progression of functional recovery during the first 24 weeks after acute ischemic stroke, to determine the timeframes for motor, cognitive, and overall recovery. Prospective observational study. Tertiary care center; 12-week inpatient period, followed by 12-week outpatient period. A group of 131 patients with acute stroke in the territory of the middle cerebral artery with age 18-85 years-old. Patients received treatment according to routine clinical practice and underwent a closely-controlled rehabilitation program for 24 weeks. Functionality assessments were conducted at 48 hours, 3 weeks, 12 weeks, and 24 weeks after acute stroke and included the modified Rankin Scale (mRS), the Functional Independence Measure (FIM), and the Stroke Upper Limb Capacity Scale (SULCS). Over the study period, patient functionality improved significantly (P<0.001) as measured by all scales. Assessment scores improved significantly from 48 hours to 3 weeks for all scales; the same occurred from 3 weeks to 12 weeks, except for C-FIM. From 12 weeks to 24 weeks, there were no statistically significant functional improvements for any scale. In comparative terms, cognitive impairment was less severe than motor disability in the acute phase. C-FIM scores at 48 hours were significantly higher than M-FIM and mRS scores. Upper limb functioning measured by SULCS, showed a intermediate degree of disability compared to the C-FIM, M-FIM, and mRS. Functional recovery occurs at least until 24 weeks after acute stroke, but most of the functional gains tend to be achieved during the first 12 weeks. Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks. From 12 to 24 weeks there are observable numerical gains in patient functionality, highlighting the need to maintain an adequate rehabilitation program. This study provides insight into the recovery timeframe for stroke patients, which can support the development of more effective rehabilitation programs.

Assessing upper limb function: transcultural adaptation and validation of the Portuguese version of the Stroke Upper Limb Capacity Scale

BackgroundBrachial hemiparesis is one of the most frequent sequelae of stroke, leading to important functional disability given the role of the upper limb in executing activities of daily living (ADL). The Stroke Upper Limb Capacity Scale (SULCS) is a stroke-specific assessment instrument that evaluates functional capacity of the upper limb based on the execution of 10 tasks. The objective of this study is the transcultural adaptation and psychometric validation of the Portuguese version of the SULCS.MethodsA Portuguese version of the SULCS was developed, using the process of forward-backward translation, after authorisation from the author of the original scale. Then, a multicentre study was conducted in Portuguese stroke patients (n = 122) to validate the psychometric properties of the instrument. The relationship between sociodemographic and clinical characteristics was used to test construct validity. The relationship between SULCS scores and other instruments was used to test criterion validity.ResultsSemantic and linguistic adaptation of the SULCS was executed without substantial issues and allowed the development of a Portuguese version. The application of this instrument suggested the existence of celling effect (19.7% of participants with maximum score). Reliability was demonstrated through the intraclass correlation coefficient of 0.98. As for construct validity, SULCS was sensible to muscle tonus and aphasia. SULCS classification impacted the scores of the Motor Evaluation Scale for Upper Extremity in Stroke (MESUPES) and the Stroke Impact Scale (SIS).ConclusionsThe present version of SULCS shows valid and reliable cultural adaptation, with good reliability and stability.

Stroke Upper Limb Capacity Scale (SULCS): Concurrent Validity and its Relationship With Function

Abstract Date Presented 4/18/2015 The Stroke Upper Limb Capacity Scale (SULCS) is a newer assessment that needs to be further understood and related to other measures commonly used in rehabilitation settings. This research suggests that the SULCS may be preferred over other traditional assessments as a brief measure of upper-extremity capacity.

The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients.

[Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation.

Concurrent Validity of the Stroke Upper Limb Capacity Scale (SULCS)

Concurrent Validity of the Stroke Upper Limb Capacity Scale (SULCS)

The Effect of Arm Support Combined With Rehabilitation Games on Upper-Extremity Function in Subacute Stroke

Background. Use of rehabilitation technology, such as (electro)mechanical devices or robotics, could partly relieve the increasing strain on stroke rehabilitation caused by an increasing prevalence of stroke. Arm support (AS) training showed improvement of unsupported arm function in chronic stroke. Objective. To examine the effect of weight-supported arm training combined with computerized exercises on arm function and capacity, compared with dose-matched conventional reach training in subacute stroke patients. Methods. In a single-blind, multicenter, randomized controlled trial, 70 subacute stroke patients received 6 weeks of training with either an AS device combined with computerized exercises or dose-matched conventional training (CON). Arm function was evaluated pretraining and posttraining by Fugl-Meyer assessment (FM), maximal reach distance, Stroke Upper Limb Capacity Scale (SULCS), and arm pain via Visual Analogue Scale, in addition to perceived motivation by Intrinsic Motivation Inventory posttraining. Results. FM and SULCS scores and reach distance improved significantly within both groups. These improvements and experienced pain did not differ between groups. The AS group reported higher interest/enjoyment during training than the CON group. Conclusions. AS training with computerized exercises is as effective as conventional therapy dedicated to the arm to improve arm function and activity in subacute stroke rehabilitation, when applied at the same dose.

Functional Recovery of the Paretic Upper Limb After Stroke: Who Regains Hand Capacity?

ObjectiveTo describe recovery of upper limb capacity after stroke during inpatient rehabilitation based on the Stroke Upper Limb Capacity Scale (SULCS). DesignProspective observational study. SettingInpatient department of a rehabilitation center. ParticipantsPatients with stroke (N=299) admitted to a specialized stroke rehabilitation center. InterventionNot applicable. Main Outcome MeasuresUpper limb capacity was assessed at the start and end of the rehabilitation phase with the SULCS (range, 0–10). The following demographic and clinical characteristics were registered: age, sex, side of stroke, stroke type, time since stroke, and length of stay in the rehabilitation center. ResultsOn admission, 125 patients had no hand capacity (SULCS score, 0–3), 58 had basic hand capacity (SULCS score, 4–7), and 116 had advanced hand capacity (SULCS score, 8–10). Of the patients without initial hand capacity, 41% regained some hand capacity (SULCS score, ≥4) at discharge. Of these, patients with SULCS scores of 2 and 3 had 29 and 97 times greater chance of regaining some hand capacity compared with patients with an initial SULCS score of 0, respectively. Of the patients with initial basic hand capacity, 78% regained advanced hand capacity at discharge. The SULCS score on admission explained 51% of the SULCS score variance at discharge, while time since stroke was negatively associated with upper limb recovery, explaining an additional 7% of the SULCS score variance at discharge. ConclusionsEven patients with minimal proximal shoulder and elbow control of the upper paretic limb on admission in a rehabilitation center have a fair chance of regaining some hand capacity in the long-term after stroke, whereas patients without such proximal arm control have a much poorer prognosis for regaining hand capacity.

Measuring Upper Limb Capacity in Patients After Stroke: Reliability and Validity of the Stroke Upper Limb Capacity Scale

Houwink A, Roorda LD, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in patients after stroke: reliability and validity of the Stroke Upper Limb Capacity Scale. Objective To investigate the interrater reliability and construct validity of the Stroke Upper Limb Capacity Scale (SULCS). Design Cohort study. Setting Inpatient department of a rehabilitation center. Participants Patients after stroke (N=21; mean age ± SD, 61.7±7.9y; 57% men), undergoing inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures The SULCS was administered by occupational therapists (OTs) within 6 weeks after stroke (t1), 3 months after t1 by the same OT (t2), and within 1 week after t2 by another OT (t3). Interrater reliability, the repeatability between different raters, was assessed by calculating the intraclass correlation coefficient (ICC) based on the scores at t2 and t3. Construct validity, indicating agreement with hypotheses concerning the construct that is being measured, was assessed with Spearman rank correlation coefficient ( ρ). The SULCS scores were cross-sectionally correlated with those of the Action Research Arm Test (ARAT) and the Rivermead Motor Assessment (RMA) at t1, and longitudinally with the respective change scores between t1 and t2. Results The SULCS (range, 0–10) had a high ICC (.94; 95% confidence interval, .86–.97) and strong cross-sectional correlation with both the ARAT and the RMA ( ρ=.91 and ρ=.85, respectively), while the respective change scores showed a strong correlation with the ARAT ( ρ=.71) and a moderate correlation with the RMA ( ρ=.48). Conclusions The SULCS has good interrater reliability and construct validity.