Dimensionality and item-difficulty hierarchy of the Fugl-Meyer assessment of the upper extremity among Japanese patients who have experienced stroke

Tauchi, Yuta; Kyougoku, Makoto; Takahashi, Kayoko; Okita, Yuho; Takebayashi, Takashi

doi:10.1080/10749357.2021.1965797

Cited by 15 publications

(10 citation statements)

References 36 publications

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“…The recovery process of motor paralysis after stroke improved in terms of motor speed and coordination after the emergence of joint movements, weakening of spasticity, and gaining the ability to perform isolated movements. Studies examining the difficulty level of detailed items in FMAUE also support this recovery process [52][53][54]. A method using a motion analyzer that can detect angular and velocity changes in joints is recommended for evaluating functional impairment and determining treatment effects in patients with mild hemiplegia [55].…”

Section: Discussionmentioning

confidence: 93%

Restoring Upper Limb Function by Combined Repetitive Transcranial Magnetic Stimulation and Occupational Therapy in Patients with Chronic Stroke: A Stratified Analysis Factoring the Severity of Motor Paralysis using a Multicenter Cohort Study Database

Sakamoto¹,

Hamaguchi²,

Murata³

et al. 2022

Preprint

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Repetitive transcranial magnetic stimulation (rTMS) with intensive occupational therapy improves upper limb motor paralysis and activities of daily living after stroke; however, amount of improvement according to paralysis severity remains unverified. Target activities for daily living using patients’ upper limb functions can be established by predicting the amount of change after treatment for each severity level of upper limb motor paralysis and further aid practice planning. This study estimated post-treatment score changes for each severity level of motor paralysis (no, poor, limited, notable, and full) stratified according to Action Research Arm Test (ARAT) scores before combined rTMS and intensive occupational therapy. Severity of motor paralysis was the fixed factor for analysis of covariance, delta (post-pre) of the scores was the dependent variable. Ordinal logistic regression analysis was used to compare changes in ARAT subscores in patients, divided according to paralysis severity before treatment. A multicenter retrospective cohort dataset analyzed 907 patients with stroke hemiplegia. Largest treatment-related changes in scores were observed in the Limited recovery group for upper limb motor paralysis and Full recovery group for quality-of-life activities using paralyzed upper limb. These results will help predict treatment effects and determine exercises and goal movements for occupational therapy after rTMS.

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Section: Discussionmentioning

confidence: 93%

Restoring Upper Limb Function by Combined Repetitive Transcranial Magnetic Stimulation and Occupational Therapy in Patients with Chronic Stroke: A Stratified Analysis Factoring the Severity of Motor Paralysis using a Multicenter Cohort Study Database

Sakamoto¹,

Hamaguchi²,

Murata³

et al. 2022

Preprint

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“…Patients with more severe motor paralysis showed greater recovery in the ARAT grip and gross movement scores, whereas those with less severe motor paralysis were more likely to improve the quality of life activities using the paralyzed upper extremity when assessed during a 2-week treatment combining transcranial magnetic stimulation and occupational therapy [45]. Reports examining the degree of difficulty in the sub-items of the FMA-UE have shown that the items in part D are more difficult [46,47]. In patients with mild disease, occupational therapists encouraged the use of the paralyzed upper limb for ADL, which presumably restored the smoothness and speed of the part D movements.…”

Section: Discussionmentioning

confidence: 99%

Upper-Limb Functional Recovery in Chronic Stroke Patients after COVID-19-Interrupted Rehabilitation: An Observational Study

Sakamoto,

Hamaguchi,

Nakayama

et al. 2024

JCM

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Background/Objectives: Upper-limb function of chronic stroke patients declined when outpatient rehabilitation was interrupted and outings restricted, owing to the novel coronavirus infection (COVID-19) pandemic. We investigated whether these patients recovered upper-limb function post-resumption of outpatient rehabilitation. Methods: In this observational study, 43 chronic stroke hemiparesis patients with impaired upper extremity function were scored for limb function via the Fugl-Meyer assessment of the upper extremity (FMA-UE) and the Action Research Arm Test (ARAT) after a structured interview, evaluation, and intervention. Scores at 6 and 3 months pre- and 3 months post-rehabilitation interruption were examined retrospectively; scores immediately and at 3 and 6 months post-resumption of care were examined prospectively. The amount of change for each time period and an analysis of covariance were performed with time as a factor, changes in the FMA-UE and the ARAT scores as dependent variables, and statistical significance at 5%. Results: The time of evaluation significantly impacted the total score, as well as part C and part D of FMA-UE and total, pinch, and gross movement of the ARAT. Post-hoc tests showed that the magnitude of change in limb-function scores from immediately to 3 months post-resumption was significantly higher than the change from 3 months pre- to immediately post-interruption for the total score and part D of the FMA-UE, as well as grip and gross movement of the ARAT (p < 0.05). Conclusions: Upper-limb functional decline in chronic stroke patients, caused by the COVID-19 pandemic-related therapy interruption and outing restrictions, was resolved approximately 3 months post-resumption of rehabilitation therapy. Our data can serve as reference standards for planning and evaluating treatment for chronic stroke patients with inactivity-related impaired upper-limb function.

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“…Among the cutoff values detected, the kinematic feature with the highest Youden’s index was the motor time for both the outward and return reaching motions. Previous studies have reported that patients with stroke have a longer motor time, and the most difficult subitem in the FMA-UE is the motor time measured in Part D [ 55 , 56 ]. In Part D of the FMA-UE, the subject is asked to flex the elbow joint and touch the nose with the index finger five times from the position of shoulder abduction and elbow extension, which is a movement task that requires joint motion coordination which is a movement task that requires, just like reaching to the back of the head, joint motion coordination.…”

Section: Discussionmentioning

confidence: 99%

Feature analysis of joint motion in paralyzed and non-paralyzed upper limbs while reaching the occiput: A cross-sectional study in patients with mild hemiplegia

Sakamoto,

Hamaguchi,

Kanemura

et al. 2024

PLoS ONE

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The reaching motion to the back of the head with the hand is an important movement for daily living. The scores of upper limb function tests used in clinical practice alone are difficult to use as a reference when planning exercises for movement improvements. This cross-sectional study aimed to clarify in patients with mild hemiplegia the kinematic characteristics of paralyzed and non-paralyzed upper limbs reaching the occiput. Ten patients with post-stroke hemiplegia who attended the Department of Rehabilitation Medicine of the Jikei University Hospital and met the eligibility criteria were included. Reaching motion to the back of the head by the participants’ paralyzed and non-paralyzed upper limbs was measured using three-dimensional motion analysis, and the motor time, joint angles, and angular velocities were calculated. Repeated measures multivariate analysis of covariance was performed on these data. After confirming the fit to the binomial logistic regression model, the cutoff values were calculated using receiver operating characteristic curves. Pattern identification using random forest clustering was performed to analyze the pattern of motor time and joint angles. The cutoff values for the movement until the hand reached the back of the head were 1.6 s for the motor time, 55° for the maximum shoulder joint flexion angle, and 145° for the maximum elbow joint flexion angle. The cutoff values for the movement from the back of the head to the hand being returned to its original position were 1.6 s for the motor time, 145° for the maximum elbow joint flexion angle, 53°/s for the maximum angular velocity of shoulder joint abduction, and 62°/s for the maximum angular velocity of elbow joint flexion. The numbers of clusters were three, four, and four for the outward non-paralyzed side, outward and return paralyzed side, and return non-paralyzed side, respectively. The findings obtained by this study can be used for practice planning in patients with mild hemiplegia who aim to improve the reaching motion to the occiput.

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Dimensionality and item-difficulty hierarchy of the Fugl-Meyer assessment of the upper extremity among Japanese patients who have experienced stroke

Cited by 15 publications

References 36 publications

Restoring Upper Limb Function by Combined Repetitive Transcranial Magnetic Stimulation and Occupational Therapy in Patients with Chronic Stroke: A Stratified Analysis Factoring the Severity of Motor Paralysis using a Multicenter Cohort Study Database

Restoring Upper Limb Function by Combined Repetitive Transcranial Magnetic Stimulation and Occupational Therapy in Patients with Chronic Stroke: A Stratified Analysis Factoring the Severity of Motor Paralysis using a Multicenter Cohort Study Database

Upper-Limb Functional Recovery in Chronic Stroke Patients after COVID-19-Interrupted Rehabilitation: An Observational Study

Feature analysis of joint motion in paralyzed and non-paralyzed upper limbs while reaching the occiput: A cross-sectional study in patients with mild hemiplegia

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