The intra- and inter-rater reliability of a standardized assessment of sensory impairment were investigated. Twenty stroke patients were assessed at home by the same physiotherapist on two occasions. There was good consistency overtime on most items. Twenty patients in hospital were assessed by two physiotherapists. The results indicate poor agreement between assessors. Twenty-five patients were assessed by a physiotherapist and a doctor. Results indicate low agreement between these assessors. Results indicate poor inter-rater reliability on a standardized assessment. It is suggested that this may also be a problem for clinical assessments of sensory impairment after stroke.
The EmNSA is a reliable screening tool to evaluate primary somatosensory impairments in neurological and neurosurgical inpatients with intracranial disorders. Further research is necessary to consolidate these results and establish the validity and responsiveness of the Erasmus MC modifications to the NSA.
The study was designed to evaluate the effect of electromyographic (EMG) biofeedback on the recovery of arm function after stroke. Patients who had impaired arm function and were between 2 and 8 weeks after stroke were randomly allocated to receive either treatment incorporating EMG biofeedback or a control treatment in addition to their routine physiotherapy. The two groups of 20 patients were compared before and after 6 weeks of treatment and at follow-up 6 weeks later. There were no significant differences between the groups before treatment or at follow-up, but at the end of treatment those who received EMG biofeedback scored significantly higher on tests of arm function. Patients with severe impairment were shown to benefit most from EMG biofeedback but there was no difference in response to treatment according to patient's age or side of stroke. Men had higher arm function scores than women before and at the end of treatment, but not at follow-up.
The results support the use of the UE and LE sections of the FM motor scale as a stagewise and subsectionwise hierarchical assessment and outcome measure. This allows the use of a shortened method of administration, which can potentially reduce the time required for scale administration, and appropriate scores can be allocated for untested items, such that a legitimate total summed score can be used. A limitation of this study was that the study population consisted predominantly of older people with such severe disability that they were unable to function independently.
Pooled individual data analysis showed sensation of the lower limb is grossly preserved in most stroke survivors but, when present, it affects function. Sensory modalities are highly interrelated; interventions that treat the motor system during functional tasks may be as effective at treating the sensory system as sensory retraining alone.
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