Functional Recovery Following Stroke

Simpson, Lisa; Eng, Janice J.

doi:10.1177/1545968312461719

Cited by 48 publications

(22 citation statements)

References 89 publications

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“…In the few cases where measurement error has been reported, its magnitude was again dependent on the assessment metric and platform, with overall mostly similar ranges (e.g., SRD of 13.2% to 95.0%) to the VPIT metrics [ 63 , 76 – 80 ]. Compared to conventional assessments (e.g., FMA-UE measurement error of 7.9%; ARAT of 6.1%) [ 77 , 81 ], the measurement errors of most technology-aided assessment metrics seem consistently elevated, even though comparisons are also challenged by the use of different SRD implementations. Nevertheless, we argue that this results from technology-aided assessments providing a multi-dimensional picture of the behavioral components underlying task performance, which makes them more susceptible to behavioral variability compared to the often ordinal outcome measures of conventional scales.…”

Section: Discussionmentioning

confidence: 99%

Technology-aided assessment of functionally relevant sensorimotor impairments in arm and hand of post-stroke individuals

Kanzler

Schwarz

Held

et al. 2020

J NeuroEngineering Rehabil

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Background Assessing arm and hand sensorimotor impairments that are functionally relevant is essential to optimize the impact of neurorehabilitation interventions. Technology-aided assessments should provide a sensitive and objective characterization of upper limb impairments, but often provide arm weight support and neglect the importance of the hand, thereby questioning their functional relevance. The Virtual Peg Insertion Test (VPIT) addresses these limitations by quantifying arm and hand movements as well as grip forces during a goal-directed manipulation task requiring active lifting of the upper limb against gravity. The aim of this work was to evaluate the ability of the VPIT metrics to characterize arm and hand sensorimotor impairments that are relevant for performing functional tasks. Methods Arm and hand sensorimotor impairments were systematically characterized in 30 chronic stroke patients using conventional clinical scales and the VPIT. For the latter, ten previously established kinematic and kinetic core metrics were extracted. The validity and robustness of these metrics was investigated by analyzing their clinimetric properties (test-retest reliability, measurement error, learning effects, concurrent validity). Results Twenty-three of the participants, the ones with mild to moderate sensorimotor impairments and without strong cognitive deficits, were able to successfully complete the VPIT protocol (duration 16.6 min). The VPIT metrics detected impairments in arm and hand in 90.0% of the participants, and were sensitive to increased muscle tone and pathological joint coupling. Most importantly, significant moderate to high correlations between conventional scales of activity limitations and the VPIT metrics were found, thereby indicating their functional relevance when grasping and transporting objects, and when performing dexterous finger manipulations. Lastly, the robustness of three out of the ten VPIT core metrics in post-stroke individuals was confirmed. Conclusions This work provides evidence that technology-aided assessments requiring goal-directed manipulations without arm weight support can provide an objective, robust, and clinically feasible way to assess functionally relevant sensorimotor impairments in arm and hand in chronic post-stroke individuals with mild to moderate deficits. This allows for a better identification of impairments with high functional relevance and can contribute to optimizing the functional benefits of neurorehabilitation interventions.

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Section: Discussionmentioning

confidence: 99%

Technology-aided assessment of functionally relevant sensorimotor impairments in arm and hand of post-stroke individuals

Kanzler

Schwarz

Held

et al. 2020

J NeuroEngineering Rehabil

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“…Of the n = 21 participants, 14 participants had room for improvement in the ARAT of which 64% (9/14) realized improved scores in the primary outcome measure (ARAT total ) from baseline to completion of intervention, both at immediate completion and/or 1-month post-completion (Table 1 ). 43% (6/14) had changes in the ARAT that are considered to meet significant ARAT specific thresholds [four of these participants had MDC ≥ 3 (MDC 90 = 3.0; Simpson and Eng, 2013 ) and two of these participants had MCID ≥ 5.7 both at immediate completion and/or 1-month post-completion]. The seven participants who had no room for improvement, or had a max score of 57 at ARAT, stayed at the same max level in ARAT both at immediate completion and 1-month post-completion.…”

Section: Resultsmentioning

confidence: 99%

“…Changes in primary outcome scores (ARAT) during treatments suggested that this BCI design may deliver moderate objective positive UE motor changes, as seen in the 64% (9/14) of participant (out of those who had room for improvement) “Responders” who completed the BCI treatments protocol as designed. 43% (6/14) had changes in the ARAT who are considered to meet significant ARAT-specific thresholds [four of these participants had MDC of at least 3 (MDC 90 = 3.0; Simpson and Eng, 2013 ) and two of these participants had MCID of at least 5.7 both at immediate completion and/or 1-month post-completion]. Additionally, the largest positive changes compared to baseline in ARAT were observed 1-month post treatment for a few participants.…”

Section: Discussionmentioning

confidence: 99%

“…For these sub-analyses, and consistent with original study design, a primary objective outcome measure of UE function, the ARAT ( Mathiowetz et al, 1985 ; Beebe and Lang, 2009 ; Malhotra et al, 2016 ), and secondary outcome measures of function (capacity and performance) including the self-report Stroke Impact Scale (SIS) ( Duncan et al, 1999 ; Lin et al, 2010 ), Hand Grip Strength ( An et al, 1980 ; Malhotra et al, 2016 ), and the 9-Hole Peg Test (9HPT) ( Mathiowetz et al, 1985 ) were assessed in the 21 participants who met the aforementioned criteria. The primary outcome measure, with registered minimal detectable change (MDC) and minimal clinically important difference (MCID) values (ARAT MDC 90 ≥ 3 point change, MCID ≥ 5.7 point change) ( Lang et al, 2006 ; Simpson and Eng, 2013 ), was chosen to obtain clinically reliable measures of UE motor function change as a result of BCI intervention. 9HPT was included in this report as an additional objective (time) measure of motor function.…”

Section: Methodsmentioning

confidence: 99%

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Behavioral Outcomes Following Brain–Computer Interface Intervention for Upper Extremity Rehabilitation in Stroke: A Randomized Controlled Trial

et al. 2018

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Stroke is a leading cause of persistent upper extremity (UE) motor disability in adults. Brain–computer interface (BCI) intervention has demonstrated potential as a motor rehabilitation strategy for stroke survivors. This sub-analysis of ongoing clinical trial (NCT02098265) examines rehabilitative efficacy of this BCI design and seeks to identify stroke participant characteristics associated with behavioral improvement. Stroke participants (n = 21) with UE impairment were assessed using Action Research Arm Test (ARAT) and measures of function. Nine participants completed three assessments during the experimental BCI intervention period and at 1-month follow-up. Twelve other participants first completed three assessments over a parallel time-matched control period and then crossed over into the BCI intervention condition 1-month later. Participants who realized positive change (≥1 point) in total ARAT performance of the stroke affected UE between the first and third assessments of the intervention period were dichotomized as “responders” (<1 = “non-responders”) and similarly analyzed. Of the 14 participants with room for ARAT improvement, 64% (9/14) showed some positive change at completion and approximately 43% (6/14) of the participants had changes of minimal detectable change (MDC = 3 pts) or minimally clinical important difference (MCID = 5.7 points). Participants with room for improvement in the primary outcome measure made significant mean gains in ARATtotal score at completion (ΔARATtotal = 2, p = 0.028) and 1-month follow-up (ΔARATtotal = 3.4, p = 0.0010), controlling for severity, gender, chronicity, and concordance. Secondary outcome measures, SISmobility, SISadl, SISstrength, and 9HPTaffected, also showed significant improvement over time during intervention. Participants in intervention through follow-up showed a significantly increased improvement rate in SISstrength compared to controls (p = 0.0117), controlling for severity, chronicity, gender, as well as the individual effects of time and intervention type. Participants who best responded to BCI intervention, as evaluated by ARAT score improvement, showed significantly increased outcome values through completion and follow-up for SISmobility (p = 0.0002, p = 0.002) and SISstrength (p = 0.04995, p = 0.0483). These findings may suggest possible secondary outcome measure patterns indicative of increased improvement resulting from this BCI intervention regimen as well as demonstrating primary efficacy of this BCI design for treatment of UE impairment in stroke survivors.Clinical Trial Registration: ClinicalTrials.gov, NCT02098265.

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“…Согласно прогностическим данным Всемирной организации здравоохранения, количество инсультов в Европе неуклонно увеличивается и к 2025 г. может достигнуть более чем 1 500 000 случаев в год [1]. При этом, по данным некоторых авторов [2,3], успешное восстановление двигательной функции руки происходит лишь в 20% случаев. У пациентов, перенесших нарушение мозгового кровообращения, в первую очередь происходит изменение таких функций паретичной руки, как способность дотянуться до какого-либо объекта и производить манипуляции c ним, а также нарушение взаимодействия обеих рук.…”

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Motor learning of the post-stroke patients presenting with upper limb paresis on the mechanotherapeutic system

Khizhnikova

Klochkov

Kotov-Smolensky

et al. 2018

Vopr. kurortol. fizioter. lech. fiz. kul't.

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Functional Recovery Following Stroke

Cited by 48 publications

References 89 publications

Technology-aided assessment of functionally relevant sensorimotor impairments in arm and hand of post-stroke individuals

Technology-aided assessment of functionally relevant sensorimotor impairments in arm and hand of post-stroke individuals

Behavioral Outcomes Following Brain–Computer Interface Intervention for Upper Extremity Rehabilitation in Stroke: A Randomized Controlled Trial

Motor learning of the post-stroke patients presenting with upper limb paresis on the mechanotherapeutic system

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