Upper Limb Function In Adults Research Articles

Reliability of the Modified Frenchay Scale for the Assessment of Upper Limb Function in Adults With Hemiparesis

ObjectivesTo investigate the reliability of the Modified Frenchay Scale (MFS) in adults with hemiparesis. DesignProspective analysis of videos. SettingStudy conducted in a Neurorehabilitation Unit of a University Hospital. ParticipantsFifty-one patients (17 women [33%], age 46±15, time since injury 5.2±6.7 years) with hemiparesis secondary to stroke (N=47), tumor (N=3), or spinal cord injury (N=1) were enrolled. InterventionThe MFS measures active upper limb function in spastic hemiparesis based on a video recording of 10 daily living tasks, each rated from 0 to 10. Six tasks are bimanual and 4 are unimanual with the paretic hand. MFS videos performed in routine care of patients with hemiparesis between 2015 and 2021 were collected. After a 3-hour group training session, each MFS video was assessed twice, 1 week apart by 4 rehabilitation professionals with various levels of experience in using the scale. Main Outcome MeasuresInternal consistency was determined using Cronbach's alpha. Intra- and inter-rater reliability was measured using intraclass correlation coefficients (ICC, mean [95% CI]), mean differences between ratings and minimal detectable change (MDC). Bland-Altman plots were also performed for inter-rater assessments. ResultsThe mean overall MFS score was 4.95±1.20 with no floor or ceiling effect. Cronbach's α was 0.97. For the overall MFS score, intra- and inter-rater ICCs were 0.99[0.99;1.00] and 0.97[0.95;0.98], respectively; mean intra- and inter-rater differences were 0.10±0.04 and 0.24±0.12, respectively; and MDC were 0.17 and 0.37, respectively. ConclusionsThe MFS is an internally consistent and reliable scale to assess upper limb function in adults with hemiparesis.

Effects of game-based rehabilitation on upper limb function in adults within the first six months following stroke: protocol for a systematic review and meta-analysis.

To evaluate and summarize the level of evidence for the immediate, short-term, and long-term effects of game-based rehabilitation on upper limb function in adults within the first six months following stroke. A game-based intervention is a valuable therapeutic tool for incorporating principles of motor learning and neuroplasticity in the rehabilitation of upper limb function post-stroke. Most of the existing reviews on game-based rehabilitation are focused on the chronic phase of stroke. However, as maximum upper limb motor recovery occurs in the first six months after stroke, further exploration of the effects of game-based rehabilitation in this phase is necessary. We will include randomized clinical trials assessing the immediate, short-term, and long-term effects of game-based rehabilitation on upper limb function in adults within the first six months following stroke. The systematic review will follow the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist and JBI methodology for systematic reviews of effectiveness. A database-specific search strategy will be used in CINAHL, PubMed, Scopus, Web of Science, ProQuest, PEDro, OT Seeker, and Ovid MEDLINE to identify studies in the English language with no date limit. Two reviewers will independently screen, extract data from, and assess risk of bias in the eligible studies. Meta-analysis and publication bias evaluation will be done when adequate data are available. If a meta-analysis is precluded, then a narrative synthesis will be done. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria will be used to assess the certainty of evidence for the outcome measures of interest. PROSPERO CRD42020190100.

Combined transcranial direct current stimulation and robotic upper limb therapy improves upper limb function in adults with cerebral palsy

Combined transcranial direct current stimulation and robotic upper limb therapy improves upper limb function in adults with cerebral palsy

Home-based telerehabilitation shows improved upper limb function in adults with chronic stroke: A pilot study

This pilot study investigates the use of telerehabilitation to improve upper limb performance in chronic stages of stroke recovery. Intervention study with pre/post/one month follow-up tests. Seven adults with chronic stroke participated in the study. Tests consisted of lab-based clinical and kinematic assessments. Participants completed the Upper Limb Training and Assessment (ULTrA) program at home. Training was 5 days/week, 60 min/day for 6 weeks with intermittent supervision of participants. Participants showed improvements in the training program tasks as well as clinical and kinematic assessments. Results also suggest there may be auxiliary benefits in cognitive function. A home-based telerehabilitation program is a viable approach to provide rehabilitation in chronic stages of stroke.

Upper limb function in adults with Duchenne muscular dystrophy

To determine upper limb function and associated factors in adults with Duchenne muscular dystrophy. Cross-sectional study. A sample of 70 men with Duchenne muscular dystrophy (age range 20-43 years). General motor function and, in particular, upper limb distal motor function, were assessed with the Motor Function Measure. Muscle strength and range of motion of the upper limb were evaluated using hand-held dynamo-metry, manual muscle-testing and goniometry. Associations were studied using Spearman's correlation coefficients and multiple linear regression analysis. General motor function was severely impaired. Wide variability was found in distal motor function, muscle strength and range of motion of the upper limb, especially in early adulthood. Muscle strength and range of motion explained 76% of the variance in upper limb distal motor function. This study illustrates a large variability in upper limb function in adult patients with Duchenne muscular dystrophy, and identifies muscle strength and range of motion as factors strongly associated with upper limb function. These results suggest that preserving muscle strength and range of motion in Duchenne patients might be relevant for a better outcome of distal motor function of the upper limb when adult.

Poster 286: Improved Upper-Limb Function in Adults With Cerebral Palsy Using Internet-Based Home Training

Poster 286: Improved Upper-Limb Function in Adults With Cerebral Palsy Using Internet-Based Home Training

Intérêt de la thérapie par contrainte induite chez l’enfant hémiplégique après lésion cérébrale acquise

Constraint-induced movement therapy is a promising technique for improving upper limb function in adults with hemiplegia. It involves restraint of the non-involved limb and intensive movement practice with the paretic limb. Although the technique has been applied successfully to children with cerebral palsy, only two studies have used it in children with acquired brain injury. ObjectiveTo assess the feasibility and efficacy of constraint-induced movement therapy in children with acquired brain injury. MethodsWe used a single-subject experimental design in three children (aged five at the time of the intervention) with hemiplegia in the chronic phase following acquired brain injury. The intervention involved restraint of the unaffected arm with a Mayo Clinic elbow brace for seven hours a day in a hospital setting, together with three hours a day of physical and occupational therapy rehabilitation for five days a week for two weeks. The children were assessed twice at baseline and then once immediately post-treatment and again two months post-treatment. Assessment included a range of timed, quantitative measures of upper limb use, assessment of unilateral spatial neglect and qualitative assessment by therapists and parents in terms of activities of daily living. ResultsThe three children completed the full protocol and improved significantly in all timed, quantitative tests of motor function. These improvements were partially maintained at two months. No improvement in unilateral spatial neglect was found in the paper-and-pencil tasks, although less spatial neglect was observed in activities of daily living such as eating and walking. ConclusionConstraint-induced movement therapy appears to be both feasible and efficient in children with acquired brain injury.

The Effect of Wrist Position on Upper Extremity Function While Wearing a Wrist Immobilizing Splint

In Brief It is typically suggested to angle the wrist in the range of 0° to 30° of extension when customizing a wrist splint. Specifically, 10° to 30° of wrist extension is usually suggested to maximize daily function although there is little empirical evidence to support this recommendation or to guide clinicians in choosing a specific wrist angle to support function. This descriptive study examined the effect of various wrist positions on upper extremity function in adults wearing a wrist immobilizing splint. The Jebsen Taylor Test of Hand Function was administered to 20 adults without upper extremity impairment to determine the effects, if any. The test was administered three consecutive times. Each time the subject wore a commercially available wrist extension splint that positioned the wrist in 0° (neutral), 15°, or 30° of wrist extension. Wrist angles were confirmed via goniometry. The order in which the wrist angles were tested was randomized to control for fatigue and practice effects. The results of this study indicated that there was no significant difference between the tested wrist positions (0°, 15°, 30°) when using the nondominant hand to perform activities while wearing a wrist splint. However, significant differences were found when wearing various angled wrist splints to perform functional activities with the dominant hand albeit only for select tasks (feeding and stacking checkers). During the feeding subtest, participants performed at a significantly faster rate when their dominant wrists were positioned in 15° of extension as compared to performance with a neutral wrist. During the stacking checkers subtest, participants performed at a significantly faster rate when their wrists were positioned in neutral when compared with when they were positioned in 30° of extension. Clinical implications, limitations, and directions for future research are discussed. It is typically suggested to angle the wrist in the range of 0° to 30° of extension when customizing a wrist splint. Specifically, 10-30° of wrist extension is usually suggested to maximize daily function, although there is little empirical evidence to support this recommendation or to guide clinicians in choosing a specific wrist angle to support function. This descriptive study examined the effect of various wrist positions on upper-limb function in adults wearing a wrist-immobilizing splint. Clinical implications, limitations, and directions for future research are discussed.

Poster 61: The Effects of a Pharmacologic Intervention (Botulinum Toxin Type A) and Occupational Therapy on Tone and Upper-Limb Function in Adults With Stroke: A Systematic Review

Poster 61: The Effects of a Pharmacologic Intervention (Botulinum Toxin Type A) and Occupational Therapy on Tone and Upper-Limb Function in Adults With Stroke: A Systematic Review

Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial

Constraint-induced (CI) movement therapy is a promising therapy for improving upper limb function in adults after stroke. It involves restraint of the non-involved limb and extensive movement practice with the involved limb. In this study, a single-blinded, randomized, control study was performed to examine the efficacy of CI therapy, modified to be child friendly, in children with hemiplegic cerebral palsy (CP). Twenty-two children (8 females, 14 males; mean age 6 y 8 mo [SD 1 y 4 mo]; range 4-8 y) were randomized to either an intervention group (n=11) or a delayed treatment control group (n=11). Children wore a sling on their non-involved upper limb for 6 hours per day for 10 out of 12 consecutive days and were engaged in play and functional activities. Children in the treatment group demonstrated improved movement efficiency and dexterity of the involved upper extremity, which were sustained through the 6-month evaluation period, as measured by the Jebsen-Taylor Test of Hand Function and fine motor-subtests of the Bruininks-Oseretsky Test of Motor Proficiency (p<0.05 in both cases). Initial severity of hand impairment and testing compliance were strong predictors of improvement. Caregivers reported significant increases in involved limb frequency of use and quality of movement. However, there was no change in strength, sensibility, or muscle tone (p>0.05 in all cases). Results suggest that for a carefully selected subgroup of children with hemiplegic CP, CI therapy modified to be child-friendly, appears to be efficacious in improving movement efficiency of the involved upper extremity.

Reliability, validity and factor structure of the upper limb subscale of the Motor Assessment Scale (UL-MAS) in adults following stroke

Purpose: The upper limb items of the Motor Assessment Scale (MAS) have been shown to be a sensitive, valid and reliable measure of upper limb function for adults following stroke, however the validity and reliability of summing these items into an independent subscale has not yet been evaluated. The stability, internal consistency and construct validity of the upper limb MAS subscale (UL-MAS) was assessed in this study.Method: Twenty-seven inpatients following stroke (mean age = 67 years, range = 40 – 80) were sampled from an acute, inpatient rehabilitation setting. Patients were evaluated with ‘Upper Arm Function’, ‘Hand Movements’, and ‘Advanced Hand Activities’ items of the MAS by masked physiotherapists who had received standardized training in administration of the MAS.Results: All items were explained by one factor on confirmatory factor analysis and correlated significantly with one another and with the composite (summed total) score. Internal consistency analysis produced a Cronbach's alpha of 0.83 which did not benefit from removal of any items.Conclusions: The acceptable internal consistency score obtained verifies the validity and reliability of using the UL-MAS as an independent scale. This study has also verified the construct validity of the UL-MAS subscale and provides a valuable extension of previous work, which together demonstrates the value of the UL-MAS as a responsive, valid and reliable measure of upper limb function in adults following stroke. The UL-MAS produced a single, composite score that could be interpreted as a total score for upper limb function in this population.

Interrater reliability of the TEMPA for the measurement of upper limb function in adults with traumatic brain injury.

To investigate the interrater reliability of the TEMPA in adults with traumatic brain injury (TBI). Twenty adults with upper limb dysfunction after TBI who were participating in inpatient rehabilitation. The TEMPA assessment was videotaped for each participant and 5 physical therapists independently rated these video recordings. Functional rating and speed of execution for each item of the TEMPA. Intraclass correlation coefficients (ICC) for the speed of execution and functional rating components of the TEMPA ranged from 0.898 to 1.000. The excellent interrater reliability supports the use of the TEMPA in adults with TBI.