Item Difficulty of Fugl-Meyer Assessment for Upper Extremity in Persons With Chronic Stroke With Moderate-to-Severe Upper Limb Impairment

Abstract

Background and Purpose: Limited research has been conducted with the aim of understanding which upper extremity movements are difficult for persons with severe chronic stroke. The purpose of this study was to test the structure of the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) using Rasch analysis in persons with chronic stroke with moderate to severe deficits and to determine the item difficulty hierarchy. Methods: This was a secondary analysis of data from previous randomized, controlled trials, or clinical trials. The participants were 101 persons with chronic stroke with moderate to severe hemiparesis (time after onset of stroke, 1375.3 ± 1157.9 days; the 33-item FMA-UE, 31.1 ± 12.8). Principal component analysis and infit statistics were used to evaluate dimensionality. Rasch analysis using a rating scale model was performed, and item difficulty was determined. Results: Six misfit items were removed. The results showed that the 27-item FMA-UE was unidimensional. Rasch analysis showed that the movements performed within synergies were among the easiest items. Shoulder and elbow movements were among the easiest items, whereas forearm and wrist movements were among the moderately to most difficult items. Hand items spanned various difficulty levels. Discussion and Conclusions: The FMA-UE is a valid assessment tool of upper extremity motor function in persons with chronic stroke with moderate to severe deficits. The results showed that item difficulty was consistent with the stepwise recovery course proposed by Fugl-Meyer. The movements that are difficult for patients with moderate to severe chronic paresis were determined, which would enable comparison of each movement using a measure of motion difficulty in future studies.

A Bidirectional Fabric-Based Soft Robotic Glove for Hand Function Assistance in Patients with Chronic Stroke

“…We believe this may be due to the ceiling effect when assessing patients with higher hand functions who generally present better motor control and less overall spasticity. This outcome suggests the SR Glove might be more bene cial for patients who suffer from severe to moderate impairment and experience decreased hand strength, an inability to initiate movement, and have spastic hands (29,30). In addition, we also observed that the relatively large standard deviation from the unassisted condition was reduced in the assisted condition, suggesting the SR Glove provided consistent assistance across all participants.…”

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

“…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].…”

Moving toward Appropriate Motor Assessment Tools in People Affected by Severe Acquired Brain Injury: A Scoping Review with Clinical Advices

“…Among the scales for the upper limb, the FMA [ 46 , 47 , 48 ] has a good reliability, validity and responsiveness [ 49 ], although there are some problems with its administration [ 24 ]. Hijikata et al [ 50 ] analyzed the difficulty of performing some items of the FMA-UL in patients with both moderate and severe chronic stroke, showing that all coordination/speed items were at the most difficult levels. Chen and colleagues [ 51 ] attempted to show which version of the FMA was best for brain injury patients, considering the shorter version (FMA-12 items) and the longer version (FMA-37).…”