Wolf Motor Function Test Functional Ability Research Articles

Structural connectivity changes in the motor execution network after stroke rehabilitation.

Background:Although quite a very few studies have tested structural connectivity changes following an intervention, it reflects only selected key brain regions in the motor network. Thus, the understanding of structural connectivity changes related to the motor recovery process remains unclear.Objective:This study investigated structural connectivity changes of the motor execution network following a combined intervention of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and intensive occupational therapy (OT) after a stroke using graph theory approach.Methods:Fifty-six stroke patients underwent Fugl-Meyer Assessment (FMA), Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS), diffusion tensor imaging (DTI), and T1 weighted imaging before and after the intervention. We examined graph theory measures related to twenty brain regions using structural connectomes.Results:The ipsilesional and contralesional hemisphere showed structural connectivity changes post-intervention after stroke. We found significantly increased regional centralities and nodal efficiency within the frontal pole and decreased degree centrality and nodal efficiency in the ipsilesional thalamus. Correlations were found between network measures and clinical assessments in the cuneus, postcentral gyrus, precentral gyrus, and putamen of the ipsilesional hemisphere. The contralesional areas such as the caudate, cerebellum, and frontal pole also showed significant correlations.Conclusions:This study was helpful to expand the understanding of structural connectivity changes in both hemispheric networks during the motor recovery process following LF-rTMS and intensive OT after stroke.

Changes in brain morphometry after motor rehabilitation in chronic stroke

Purpose Recent studies have revealed structural changes after motor rehabilitation, but its morphological changes related to upper limb motor behaviours have not been studied exhaustively. Therefore, we aimed to map the grey matter (GM) changes associated with motor rehabilitation after stroke using voxel-based morphometry (VBM), deformation-based morphometry (DBM), and surface-based morphometry (SBM). Methods Forty-one patients with chronic stroke received twelve sessions of low-frequency repetitive transcranial magnetic stimulation plus intensive occupational therapy. MRI data were obtained before and after the intervention. Fugl-Meyer Assessment and Wolf Motor Function Test-Functional Ability Scale were assessed at the two-time points. We performed VBM, DBM, and SBM analyses using T1-weighted images. A correlation analysis was performed between cortical thickness in motor areas and clinical outcomes. Results Clinical outcomes significantly improved after the intervention. VBM showed significant GM volume changes in ipsilesional and contralesional primary motor regions. DBM results demonstrated GM changes contralesionally and ipsilesionally after the intervention. SBM results showed significant cortical thickness changes in posterior visuomotor coordination, precentral, postcentral gyri of the ipsilesional hemisphere and contralesional visuomotor area after the intervention. A combination of threshold p < .05, False Discovery Rate and p < .001 (uncorrected) were considered significant. In addition, cortical thickness changes of the ipsilesional motor areas were significantly correlated with the clinical outcome changes. Conclusions We found GM structural changes in areas involved in motor, visuomotor and somatosensory functions after the intervention. Furthermore, our findings suggest that structural plasticity changes in chronic stroke could occur in the ipsilesional and contralesional hemispheres after motor rehabilitation.

Evaluation of fMRI Activation in Hemiparetic Stroke Patients after Rehabilitation with Low-frequency Repetitive Transcranial Magnetic Stimulation and Intensive Occupational Therapy

Purpose: To evaluate activity changes associated with the intervention of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) after stroke using functional magnetic resonance (fMRI). Methods: Seventy stroke patients were scanned while performing finger tapping tasks twice, before and 12 days after the intervention. Recovery of motor functions assessed using Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS) for upper extremity at each time point. An fMRI analysis was performed, and a region of interest (ROI) analysis was conducted using percentage signal changes (% SC) to determine the magnitude of activation. Results: FMA and WMFT-FAS were significantly increased from pre-intervention to post-intervention. Intervention related activations were seen in the ipsilesional premotor cortex (PMC) and primary motor cortex (M1), thalamo-cortico regions with the paretic hand movements. With the unaffected hand movements, significant clusters in the contralesional primary somatosensory cortex (S1), superior parietal cortex, and bilateral cerebellum were observed. The ROI-based analysis revealed that ipsilesional M1, contralesional PMC, and supplementary motor area (SMA) showed significantly higher results with the paretic hand movements, a trend toward a significant decrease in the contralesional S1 with the unaffected hand movements from the pre-intervention to post-intervention. Conclusions: Our findings suggest that gains in motor functions produced by the intervention of rTMS and intensive OT in hemiparesis stroke patients may be associated with the ipsilesional hemisphere and contralesional hemisphere as well. Identifying rTMS and OT intervention based on cortical patterns may help to implement rTMS in motor rehabilitation after stroke.

Translation and Initial Validation of the Chinese Version of the Action Research Arm Test in People with Stroke

Purpose This study aimed to translate the English version of the Action Research Arm Test (ARAT) into Chinese and to evaluate the initial validation of the Chinese version (C-ARAT) in patients with a first stroke. Methods An expert group translated the original ARAT from English into Chinese using a forward-backward procedure. Forty-four patients (36 men and 8 women) aged 22–80 years with a first stroke were enrolled in this study. The participants were evaluated using 3 stroke-specific outcome measures: C-ARAT, the upper extremity section of the Fugl–Meyer assessment (UE-FMA), and the Wolf Motor Function Test (WMFT). Internal consistency was analysed using Cronbach's α coefficients and item-scale correlations. Concurrent validity was determined using Spearman's rank correlation coefficients. Floor and ceiling effects were considered to be present when more than 20% of patients fell outside the preliminarily set lower or upper boundary, respectively. Results The C-ARAT items yielded excellent internal consistency, with a Cronbach's α of 0.98 (p < 0.001) and item-total correlations ranging from 0.727 to 0.948 (p < 0.001). The C-ARAT exhibited good-to-excellent correlations with the UE-FMA and WMFT functional ability (WMFT-FA) scores, with respective ρ values of 0.824 and 0.852 (p < 0.001), and an excellent negative correlation with the WMFT performance time (WMFT-time), with a ρ value of -0.940 (p < 0.001). The C-ARAT subscales generally exhibited good-to-excellent correlations with stroke-specific assessments, with ρ values ranging from 0.773 to 0.927 (p < 0.001). However, the gross subscale exhibited moderate-to-good correlations with the UE-FMA and WMFT-FA scores, with respective ρ values of 0.665 and 0.720 (p < 0.001). No significant floor effect was observed, and a significant ceiling effect was observed only on the WMFT-time. Conclusions The C-ARAT demonstrated excellent internal consistency and good-to-excellent concurrent validity. This test could be used to evaluate upper extremity function in stroke patients without cognitive impairment.

Recovery in the Severely Impaired Arm Post-Stroke After Mirror Therapy: A Randomized Controlled Study.

This study aimed to examine the effectiveness of mirror therapy on recovery in the severely impaired arm after stroke. Using single-blind randomized controlled design, patients with severely impaired arm within 1-month post-stroke were assigned to receive mirror therapy (n = 20) or control therapy (n = 21), 30 mins twice daily for 4 wks in addition to conventional rehabilitation. During mirror therapy and control therapy, subjects practiced similar structured exercises in both arms, except that mirror reflection of the unaffected arm was the visual feedback for mirror therapy, but mirror was absent for control therapy so that subjects could watch both arms in exercise. Fugl-Meyer Assessment and Wolf Motor Function Test were the outcome measurements. After the intervention, both mirror therapy and control therapy groups had significant arm recovery similarly in Fugl-Meyer Assessment (P = 0.867), Wolf Motor Function Test-Time (P = 0.947) and Wolf Motor Function Test-Functional Ability Scale (P = 0.676). Mirror therapy or control therapy, which involved exercises concurrently for the paretic and unaffected arms during subacute stroke, promoted similar motor recovery in the severely impaired arm.

Comparison of the reaction time of wrist flexion and extension between patients with stroke and age-matched healthy subjects and correlation with clinical measures

Background Brain injury had an effect on reaction time (RT) and brain-injured patients were normally significantly slower than normal controls. The RT of the paretic upper limb (UL) in patients with stroke was slower than in a control group. The present study was designed to compare the RTs of the unaffected and affected sides in stroke survivors and those of normal subjects. This study also explores the relationships among wrist flexion and extension RTs in the affected side and the motor deficits of the UL as measured by clinical Composite Spasticity Index (CSI), Associated Reaction Rating Score (ARRS), and Wolf Motor Function Test (WMFT) scores. Methods Ninety-eight hemiparetic stroke survivors and 20 normal subjects participated in the study. Abnormal muscle tone was measured by CSI. Associated reaction was measured by ARRS. Motor function was measured by WMFT. The subject was asked to flex or extend the affected and non-affected wrists as fast as possible, following an auditory “go” signal. An electrogoniometer attached to the wrist measured wrist flexion and extension angle. RT was defined as the time from the “go” signal to a change in wrist angle denoting movement onset. Clinical assessments and RT were conducted within one day. Differences in the variables between normal subjects and the unaffected sides of the stroke patients were analyzed using analysis of variance. Correlations were assessed by computing Spearman's correlation coefficient. The significance level was set at 5%. Results RTs of wrist flexion and extension in the stroke survivors' affected hands were significantly longer than those in normal subjects and their unaffected hands (P &lt;0.01 for both). The wrist flexion RT moderately correlated with CSI (ρ=0.412, P&lt;0.001) and ARRS (ρ=0.341, P &lt;0.001) and with WMFT functional ability (negatively; ρ=-0.531, P &lt;0.001) and time score (ρ=0.504, P &lt;0.001). Similarly, the wrist extension RT moderately correlated with CSI (ρ=0.429, P&lt;0.001), ARRS (ρ=0.374, P&lt;0.001), and with WMFT functional ability (negatively; ρ=−0.531, P &lt;0.001) and time score (ρ=0.486, P &lt;0.001). Conclusions RTs of wrist flexion and extension on the stroke survivors' affected sides were significantly longer than those on the unaffected sides and those of normal subjects. The wrist flexion and extension RTs moderately correlated with CSI and ARRS and inversely with motor functional performance of the UL in patients with stroke.

A Modified Method for Constraint-induced Movement Therapy: A Supervised Self-training Protocol

Constraint-induced movement therapy (CI therapy) is a rehabilitation treatment that is effective for improving upper extremity function in patients with stroke hemiparesis. In standard protocols, the burdens are great on the patient, therapist, and in terms of health care costs, preventing the wider application of CI therapy. To address this, we developed a protocol based on self-training and examined its effects. Patients with chronic hemiparesis caused by a stroke (intracerebral hemorrhage or cerebral infarct) 180 days after disease onset were included in this study. We performed before and after comparisons after intervention. We assessed motor impairment in the shoulder, elbow, forearm, wrist, and hand with the Fugl-Meyer Assessment (FMA) and determined training tasks, taking into consideration the patient's primary complaint. We established direct supervision by the therapist and self-training to occupy 40% and 60% of the training period, respectively. With this protocol, training was conducted 5 hours per day for 10 consecutive weekdays. We assessed upper extremity function using the FMA, Wolf Motor Function Test (WMFT), and Motricity Index (MI) before and after intervention. There were 40 subjects. Before and after intervention, scores for the FMA upper extremity items, WMFT functional ability scale, WMFT performance times, and MI showed significant improvements, from 49.35 ± 10.1 (mean ± SD) to 52.88 ± 8.0 points, 3.48 ± 0.65 to 3.72 ± 0.67 points, 14.37 ± 13.22 to 10.58 ± 11.97 seconds, and 75.0 ± 12.0 to 77.7 ± 12.0 points, respectively. Our self-training-based CI therapy protocol is likely to be as effective for improving upper extremity function as the standard CI therapy. The method may contribute to the wider use of CI therapy.

Minimal Detectable Change Scores for the Wolf Motor Function Test

Background. The Wolf Motor Function Test (WMFT) is an impairment-based test whose psychometrics have been examined by previous reliability and validity studies. Standards for evaluating whether a given change is meaningful, however, have not yet been addressed. Objectives. To determine the standard error of measurement (SEM) and minimal detectable change (MDC) for the WMFT. Methods. Data were collected from 6 university laboratories that participated in the EXCITE national clinical trial and included 96 individuals with sub-acute stroke (3—9 months). Measurements were made by blinded evaluators who were trained and standardized to administer the WMFT, which was completed on 2 occasions 2 weeks apart. No intervention was given between testing sessions. Results. The WMFT Performance Time score has a SEM of 0.2 seconds and a MDC95 of 0.7 seconds. The individual task timed items MDC 95 ranged from 1.0 second (turn key in lock) to 3.4 seconds (reach and retrieve) with individual task items demonstrating notablly higher variability than the average WMFT Performance Time. The average WMFT Functional Ability Scale SEM and MDC95 is 0.1 points. Conclusions. When assessing the effect of a therapeutic intervention, if an individual experiences an amount of change equal to or greater than the MDC, then one may be 95% confident that this margin of change is truly larger than measurement error and not a chance result. Thus, the determination of SEM and MDC in outcome assessments allows researchers and clinicians to distinguish which results are actual differences versus which results are simply changes resulting from error or chance.

Responsiveness and Validity of Three Outcome Measures of Motor Function After Stroke Rehabilitation

This study investigated and compared the responsiveness and validity of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), and the Wolf Motor Function Test (WMFT) for patients after stroke rehabilitation. A total of 57 patients with stroke received 1 of 3 rehabilitation treatments for 3 weeks. At pretreatment and posttreatment, the 3 outcome measures, as well as the Functional Independence Measure (FIM) as the external criterion, were administered. The standardized response mean (SRM) and the Wilcoxon signed rank test were used to examine the responsiveness. Construct validity and predictive validity were examined by the Spearman correlation coefficient (rho). The responsiveness of the FMA, ARAT, and WMFT functional ability scores was large (SRM=0.95-1.42), whereas the WMFT performance time score was small (SRM=0.38). The responsiveness of the FMA was significantly larger than those of the ARAT and the WMFT-TIME, but not the WMFT functional ability scores. With respect to construct validity, correlations between the FMA and other measures were relatively high (rho=0.42-0.76). The FMA and the WMFT performance time scores at pretreatment had moderate predictive validity with the FIM scores at posttreatment (rho=0.42-0.47). In addition, the ARAT and the WMFT functional ability scores revealed a low predictive validity with the FIM (rho=0.17-0.26). The results support the FMA and the WMFT-FAS are suitable to detect changes over time for patients after stroke rehabilitation. While simultaneously considering the responsiveness and validity attributes, the FMA may be a relatively sound measure of motor function for stroke patients based on our results. Further research based on a larger sample is needed to replicate the findings.